Repost: The oiling of America Part #2 (Cholestorol)

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Gettingwell , Frank <califpacific> wrote:

 

Part 1

Part 2Enig speaks out

When Mary Enig, a graduate student at the University of Maryland,

read the McGovern committee report, she was puzzled. Enig was

familiar with Kummerow's research and she knew that the consumption

of animal fats in America was not on the increase—quite the contrary,

use of animal fats had been declining steadily since the turn of the

century. A report in the Journal of American Oil Chemists—which the

McGovern Committee did not use—showed that animal fat consumption had

declined from 104 grams per person per day in 1909 to 97 grams per

day in 1972, while vegetable fat intake had increased from a mere 21

grams to almost 60.14 Total per capita fat consumption had increased

over the period, but this increase was mostly due to an increase in

unsaturated fats from vegetable oils—with 50 percent of the increase

coming from liquid vegetable oils and about 41 percent from

margarines made from vegetable oils. She noted a number of studies

that directly contradicted the McGovern Committee's conclusions

that " there is . . . a strong correlation between dietary fat intake

and the incidence of breast cancer and colon cancer, " two of the most

common cancers in America. Greece, for example, had less than one-

fourth the rate of breast cancer compared to Israel but the same

dietary fat intake. Spain had only one-third the breast cancer

mortality of France and Italy but the total dietary fat intake was

slightly greater. Puerto Rico, with a high animal fat intake, had a

very low rate of breast and colon cancer. The Netherlands and Finland

both used approximately 100 grams of animal fat per capita per day

but breast and colon cancer rates were almost twice in the

Netherlands what they are in Finland. The Netherlands consumed 53

grams of vegetable fat per person compared to 13 in Finland. A study

from Cali, Columbia found a fourfold excess risk for colon cancer in

the higher economic classes, which used less animal fat than the

lower economic classes. A study on Seventh-Day Adventist physicians,

who avoid meat, especially red meat, found they had a significantly

higher rate of colon cancer than non-Seventh Day Adventist

physicians. Enig analyzed the USDA data that the McGovern Committee

had used and concluded that it showed a strong positive correlation

with total fat and vegetable fat and an essentially strong negative

correlation or no correlation with animal fat to total cancer deaths,

breast and colon cancer mortality and breast and colon cancer

incidence—in other words, use of vegetable oils seemed to predispose

to cancer and animal fats seemed to protect against cancer. She noted

that the analysts for the committee had manipulated the data in

inappropriate ways in order to obtain mendacious results.

Enig submitted her findings to the Journal of the Federation of

American Societies for Experimental Biology (FASEB), in May, 1978,

and her article was published in the FASEB's Federation Proceedings15

in July of the same year—an unusually quick turnaround. The assistant

editor, responsible for accepting the article, died of a heart attack

shortly thereafter. Enig's paper noted that the correlations pointed

a finger at the trans fatty acids and called for further

investigation. Only two years earlier, the Life Sciences Research

office, which is the arm of FASEB that does scientific

investigations, had published the whitewash that had ushered

partially hydrogenated soybean oil onto the GRAS list and removed any

lingering constraints against the number one ingredient in factory-

produced food. The food giants fight back

Enig's paper sent alarm bells through the industry. In early 1979,

she received a visit from S. F. Reipma of the National Association of

Margarine Manufacturers. Short, bald and pompous, Reipma was visibly

annoyed. He explained that both his association and the Institute for

Shortening and Edible Oils (ISEO) kept careful watch to prevent

articles like Enig's from appearing in the literature. Enig's paper

should never have been published, he said. He thought that ISEO

was " watching out. "

" We left the barn door open, " he said, " and the horse got out. "

Reipma also challenged Enig's use of the USDA data, claiming that it

was in error. He knew it was in error, he said, " because we give it

to them. "

A few weeks later, Reipma paid a second visit, this time in the

company of Thomas Applewhite, an advisor to the ISEO and

representative of Kraft Foods, Ronald Simpson with Central Soya and

an unnamed representative from Lever Brothers. They carried with them—

in fact, waved them in the air in indignation—a two-inch stack of

newspaper articles, including one that appeared in the National

Enquirer, reporting on Enig's Federation Proceedings article.

Applewhite's face flushed red with anger when Enig repeated Reipma's

statement that " they had left the barn door open and a horse got

out, " and his admission that Department of Agriculture food data had

been sabotaged by the margarine lobby.

The other thing Reipma told Enig during his unguarded visit was that

he had called in on the FASEB offices in an attempt to coerce them

into publishing letters to refute her paper, without allowing Enig to

submit any counter refutation as was normally customary in scientific

journals. He told Enig that he was " thrown out of the office " —an

admission later confirmed by one of the FASEB editors. Nevertheless,

a series of letters did follow the July 1978 article.16 On behalf of

the ISEO, Applewhite and Walter Meyer of Procter and Gamble

criticized Enig's use of the data; Applewhite accused Enig of

extrapolating from two data points, when in fact she had used seven.

In the same issue, John Bailar, Editor-in-Chief of the Journal of the

National Cancer Institute, pointed out that the correlations between

vegetable oil consumption and cancer were not the same as evidence of

causation and warned against changing current dietary components in

the hopes of preventing cancer in the future—which is of course

exactly what the McGovern Committee did.

In reply, Enig and her colleagues noted that although the NCI had

provided them with faulty cancer data, this had no bearing on the

statistics relating to trans consumption, and did not affect the gist

of their argument—that the correlation between vegetable fat

consumption, especially trans fat consumption, was sufficient to

warrant a more thorough investigation. The problem was that very

little investigation was being done.

University of Maryland researchers recognized the need for more

research in two areas. One concerned the effects of trans fats on

cellular processes once they are built into the cell membrane.

Studies with rats, including one conducted by Fred Mattson in 1960,

indicated that the trans fatty acids were built into the cell

membrane in proportion to their presence in the diet, and that the

turnover of trans in the cells was similar to that of other fatty

acids. These studies, according to J. Edward Hunter of the ISEO, were

proof that " trans fatty acids do not pose any hazard to man in a

normal diet. " Enig and her associates were not so sure. Kummerow's

research indicated that the trans fats contributed to heart disease,

and Kritchevsky—whose early experiments with vegetarian rabbits were

now seen to be totally irrelevant to the human model—had found that

trans fatty acids raise cholesterol in humans.17 Enig's own research,

published in her 1984 doctoral dissertation, indicated that trans

fats interfered with enzyme systems that neutralized carcinogens and

increased enzymes that potentiated carcinogens.18 How much trans fat

is " normal " ?

The other area needing further investigation concerned just how much

trans fat there was in a " normal diet " of the typical American. What

had hampered any thorough research into the correlation of trans

fatty acid consumption and disease was the fact that these altered

fats were not considered as a separate category in any of the data

bases then available to researchers. A 1970 FDA internal memo stated

that a market basket survey was needed to determine trans levels in

commonly used foods. The memo remained buried in the FDA files. The

massive Health and Human Services NHANES II (National Health and

Nutrition Examination Survey) survey, conducted during the years 1976

to 1980, noted the increasing US consumption of margarine, french

fried potatoes, cookies and snack chips—all made with vegetable

shortenings—without listing the proportion of trans.

Enig first looked at the NHANES II data base in 1987 and when she

did, she had a sinking feeling. Not only were trans fats

conspicuously absent from the fatty acid analyses, data on other

lipids made no sense at all. Even foods containing no trans fats were

listed with faulty fatty acid profiles. For example, safflower oil

was listed as containing 14% linoleic acid (a double bond fatty acid

of the omega-6 family) when in fact it contained 80%; a sample of

butter crackers was listed as containing 34% saturated fat when in

fact it contained 78%. In general, the NHANES II data base tended to

minimize the amount of saturated fats in common foods.

Over the years, Joseph Sampagna and Mark Keeney, both highly

qualified lipid biochemists at the University of Maryland, applied to

the National Science Foundation, the National Institutes of Health,

the US Department of Agriculture, the National Dairy Council and the

National Livestock and Meat Board for funds to look into the trans

content of common American foods. Only the National Livestock and

Meat Board came through with a small grant for equipment; the others

turned them down. The pink slip from National Institutes of Health

criticized items that weren't even relevant to the proposal. The

turndown by the National Dairy Council was not a surprise. Enig had

earlier learned that Phil Lofgren, then head of research at the Dairy

Council, had philosophical ties to the lipid hypothesis. Enig tried

to alert Senator Mettzanbaum from Ohio, who was involved in the

dietary recommendations debate, but got nowhere.

A USDA official confided to the Maryland research group that

they " would never get money as long as they pursued the trans work. "

Nevertheless they did pursue it. Sampagna, Keeney and a few graduate

students, funded jointly by the USDA and the university, spend

thousands of hours in the laboratory analyzing the trans fat content

of hundreds of commercially available foods. Enig worked as a

graduate student, at times with a small stipend, at times without

pay, to help direct the process of tedious analysis. The long arm of

the food industry did its best to put a stop to the group's work by

pressuring the USDA to pull its financial support of the graduates

students doing the lipid analyses, which the University of Maryland

received due to its status as a land grant college.

In December of 1982, Food Processing carried a brief preview of the

University of Maryland research19 and five months later the same

journal printed a blistering letter from Edward Hunter on behalf of

the Institute of Shortening and Edible Oils.20 The University of

Maryland studies on trans fat content in common foods had obviously

struck a nerve. Hunter stated that the Bailar, Applewhite and Meyer

letters that had appeared in Federation Proceedings five years

earlier, " severely criticized and discredited " the conclusions

reached by Enig and her colleagues. Hunter was concerned that Enig's

group would exaggerate the amount of trans found in common foods. He

cited ISEO data indicating that most margarines and shortenings

contain no more than 35% and 25% trans respectively, and that most

contain considerably less.

What Enig and her colleagues actually found was that many margarines

indeed contained about 31% trans fat—later surveys by others revealed

that Parkay margarine contained up to 45% trans—while many

shortenings found ubiquitously in cookies, chips and baked goods

contained more than 35%. She also discovered that many baked goods

and processed foods contained considerably more fat from partially

hydrogenated vegetable oils than was listed on the label. The finding

of higher levels of fat in products made with partially hydrogenated

oils was confirmed by Canadian government researchers many years

later, in 1993.21

Final results of Enig's ground-breaking compilation were published in

the October 1983 edition of the Journal of the American Oil Chemists

Society.22 Her analyses of more than 220 food items, coupled with

food disappearance data, allowed University of Maryland researchers

to confirm earlier estimates that the average American consumed at

least 12 grams of trans fat per day, directly contradicting ISEO

assertions that most Americans consumed no more that six to eight

grams of trans fat per day. Those who consciously avoided animal fats

typically consumed far more than 12 grams of trans fat per day. Cat

and mouse games in the journals

The ensuing debate between Enig and her colleagues at the University

of Maryland, and Hunter and Applewhite of the ISEO, took the form of

a cat and mouse game running through several scientific journals.

Food Processing declined to publish Enig's reply to Hunter's attack.

Science Magazine published another critical letter by Hunter in

1984,23 in which he misquoted Enig, but refused to print her

rebuttal. Hunter continued to object to assertions that average

consumption of trans fat in partially hydrogenated margarines and

shortenings could exceed six to eight grams per day, a concern that

Enig found puzzling when coupled with the official ISEO position that

trans fatty acids were innocuous and posed no threat to public

health.

The ISEO did not want the American public to hear about the debate on

hydrogenated vegetable oils—for Enig this translated into the sound

of doors closing. A poster presentation she organized for a campus

health fair caught the eye of the dietetics department chairman who

suggested she submit an abstract to the Society for Nutrition

Education, many of whose members are registered dietitians. Her

abstract concluded that " . . . meal plans and recipes developed for

nutritionists and dieticians to use when designing diets to meet the

Dietary Guidelines, the dietary recommendation of the American Heart

Association or the Prudent Diet have been examined for trans fatty

acid content. Some diet plans are found to contain approximately 7%

or more of calories as trans fatty acids. " The Abstract Review

Committee rejected the submission, calling it " of limited interest. "

Early in 1985 the Federation of American Societies for Experimental

Biology (FASEB) heard more testimony on the trans fat issue. Enig

alone represented the alarmist point of view, while Hunter and

Applewhite of the ISEO, and Ronald Simpson, then with the National

Association of Margarine Manufacturers, assured the panel that trans

fats in the food supply posed no danger. Enig reported on University

of Maryland research that delineated the differences in small amounts

of naturally occurring trans fats in butter, which do not inhibit

enzyme function at the cellular level, and man-made trans fats in

margarines and vegetable shortenings which do. She also noted a 1981

feeding trial in which swine fed trans fatty acid developed higher

parameters for heart disease than those fed saturated fats,

especially when trans fatty acids were combined with added

polyunsaturates.24 Her testimony was omitted from the final report,

although her name in the bibliography created the impression that her

research supported the FASEB whitewash.25

In the following year, 1986, Hunter and Applewhite published an

article exonerating trans fats as a cause of atherosclerosis in the

prestigious American Journal of Clinical Nutrition26, whose sponsors,

by the way, include companies like Procter and Gamble, General Foods,

General Mills, Nabisco and Quaker Oats. The authors once again

stressed that the average per capita consumption of trans fatty acids

did not exceed six to eight grams. Many subsequent government and

quasi government reports minimizing the dangers of trans fats used

the 1986 Hunter and Applewhite article as a reference.

Enig testified again in 1988 before the Expert Panel on the National

Nutrition Monitoring System (NNMS). In fact she was the only witness

before a panel, which began its meeting by confirming that the cause

of America's health problems was the overconsumption of " fat,

saturated fatty acids, cholesterol and sodium. " Her testimony pointed

out that the 1985 FASEB report exonerating trans fatty acids as safe

was based on flawed data.

Behind the scenes, in a private letter to Dr. Kenneth Fischer, of the Life Sciences Research Office (LSRO), Hunter and

Applewhite charged that " the University of Maryland group continues

to raise unwarranted and unsubstantiated concerns about the intake of

and imagined physiological effects of trans fatty acids and . . .

they continue to overestimate greatly the intake of trans acids by

typical Americans. " " No one other than Enig, " they said, " has raised

questions about the validity of the food fatty acid composition data

used in NHANES II and. . . she has not presented sufficiently

compelling arguments to justify a major reevaluating. "

The letter contained numerous innuendos that Enig had

mischaracterized the work of other researchers and had been less than

scientific in her research. It was widely circulated among National

Nutrition Monitoring System agencies. John Weihrauch, a USDA

scientist, not an industry representative, slipped it surreptitiously

to Dr. Enig. She and her colleagues replied by asking, " If the trade

association truly believes `that trans fatty acids do not pose any

harm to humans and animals'. . . why are they so concerned about any

levels of consumption and why do they so vehemently and so frequently

attack researchers whose finding suggest that the consumption of

trans fatty acids is greater than the values the industry reports? "

Maryland researchers argued that trans fats should be included in

food nutrition labels; the Hunter and Applewhite letter asserted

that " there is no documented justification for including trans

acids . . . as part of nutrition labeling. "

During her testimony Enig also brought up her concerns about other

national food databases, citing their lack of information on trans.

The Food Consumption Survey contained glaring errors—reporting, for

example, consumption of butter in amounts nearly twice as great as

what exists in the US food supply, and of margarine in quantities

nearly half those known to exist in the food supply. " The fact that

the data base is in error should compel the Congress to require

correction of the data base and reevaluation of policy flowing from

erroneous data, " she argued, " especially since the congressional

charter for NHANES was to compare dietary intake and health status

and since this data base is widely used to do just that. " Rather

than " correction of the data base, " [The] National Nutritional

Monitoring System officials responded to Enig's criticism by dropping

the whole section pertaining to butter and margarine from the 1980

tables.

Enig's testimony was not totally left out of the National Nutritional

Monitoring System final report, as it had been from the FASEB report

three years earlier. A summary of the proceedings and listing of

panelists released in July of 1989 by Director Kenneth Fischer

announced that a transcript of Enig's testimony could be obtained

from Ace Federal Reporter in Washington DC.27 Unfortunately, his

report wrongly listed the date of her testimony as January 20, 1988,

rather than January 21, making her comments more difficult to

retrieve.

The Enig-ISEO debate was covered by the prestigious Food Chemical

News and Nutrition Week 28—both widely read by Congress and the food

industry, but virtually unknown to the general public. National media

coverage of dietary fat issues focused on the proceedings of the

National Heart, Lung and Blood Institute as this enormous bureaucracy

plowed relentlessly forward with the lipid hypothesis. In June of

1984, for example, the press diligently reported on the proceedings

of the NHLBI's Lipid Research Clinics Conference, which was organized

to wrap up almost 40 years of research on lipids, cholesterol and

heart disease.

The problem with the 40 years of NHLBI-sponsored research on lipids,

cholesterol and heart disease was that it had not produced many

answers—at least not many answers that the NHLBI was pleased with.

The ongoing Framingham Study found that there was virtually no

difference in coronary heart disease " events " for individuals with

cholesterol levels between 205 mg/dL and 294 mg/dL—the vast majority

of the US population. Even for those with extremely high cholesterol

levels—up to almost 1200 mg/dL, the difference in CHD events compared

to those in the normal range was trivial.29 This did not prevent Dr.

William Kannel, then Framingham Study Director, from making claims

about the Framingham results. " Total plasma cholesterol " he said, " is

a powerful predictor of death related to CHD. " It wasn't until more

than a decade later that the real findings at Framingham were

published—without fanfare—in the Archives of Internal Medicine, an

obscure journal. " In Framingham, Massachusetts, " admitted Dr. William

Castelli, Kannel's successor " the more saturated fat one ate, the

more cholesterol one ate, the more calories one ate, the lower

people's serum cholesterol. . . we found that the people who ate the

most cholesterol, ate the most saturated fat, ate the most calories

weighed the least and were the most physically active. " 30

NHLBI's Multiple Risk Factor Intervention Trial (MRFIT) studied the

relationship between heart disease and serum cholesterol levels in

362,000 men and found that annual deaths from CHD varied from

slightly less than one per thousand at serum cholesterol levels below

140 mg/dL, to about two per thousand for serum cholesterol levels

above 300 mg/dL, once again a trivial difference. Dr. John LaRosa of

the American Heart Association claimed that the curve for CHD deaths

began to " inflect " after 200 mg/dL, when in fact the " curve " was a

very gradually sloping straight line that could not be used to

predict whether serum cholesterol above certain levels posed a

significantly greater risk for heart disease. One unexpected MRFIT

finding the media did not report was that deaths from all causes—

cancer, heart disease, accidents, infectious disease, kidney failure,

etc.—were substantially greater for those men with cholesterol levels

below 160 mg/dL.31 Lipid Research Clinics Trial

What was needed to resolve the validity of the lipid hypothesis once

and for all was a well-designed, long-term diet study that compared

coronary heart disease events in those on traditional foods with

those whose diets contained high levels of vegetable oils—but the

proposed Diet-Heart study designed to test just that had been

cancelled without fanfare years earlier. In view of the fact that

orthodox medical agencies were united in their promotion of margarine

and vegetable oils over animal foods containing cholesterol and

animal fats, it is surprising that the official literature can cite

only a handful of experiments indicating that dietary cholesterol

has " a major role in determining blood cholesterol levels. " One of

these was a study involving 70 male prisoners directed by Fred

Mattson32—the same Fred Mattson who had pressured the American Heart

Association into removing any reference to hydrogenated fats from

their diet-heart statement a decade earlier. Funded in part by

Procter and Gamble, the research contained a number of serious flaws:

selection of subjects for the four groups studied was not randomized;

the experiment inexcusably eliminated " an equal number of subjects

with the highest and lowest cholesterol values; " twelve additional

subjects dropped out, leaving some of the groups too small to provide

valid conclusions; and statistical manipulation of the results was

shoddy. But the biggest flaw was that the subjects receiving

cholesterol did so in the form of reconstituted powder—a totally

artificial diet. Mattson's discussion did not even address the

possibility that the liquid formula diet he used might affect blood

cholesterol differently than would a whole foods diet when, in fact,

many other studies indicated that this is the case. The culprit, in

fact, in liquid protein diets appears to be oxidized cholesterol,

formed during the high-temperature drying process, which seems to

initiate the buildup of plaque in the arteries.33 Powdered milk

containing oxidized cholesterol is added to reduced fat milk—to give

it body—which the American public has accepted as a healthier choice

than whole milk. It was purified, oxidized cholesterol that

Kritchevsky and others used in their experiments on vegetarian

rabbits.

The NHLBI argued that a diet study using whole foods and involving

the whole population would be too difficult to design and too

expensive to carry out. But the NHLBI did have funds available to

sponsor the massive Lipid Research Clinics Coronary Primary

Prevention Trial in which all subjects were placed on a diet low in

cholesterol and saturated fat. Subjects were divided into two groups,

one of which took a cholesterol-lowering drug and the other a

placebo. Working behind the scenes, but playing a key role in both

the design and implementation of the trials, was Dr. Fred Mattson,

formerly of Procter and Gamble.

An interesting feature of the study was the fact that a good part of

the trial's one-hundred-and-fifty-million-dollar budget was devoted

to group sessions in which trained dieticians taught both groups of

study participants how to choose " heart-friendly " foods—margarine,

egg replacements, processed cheese, baked goods made with vegetable

shortenings, in short the vast array of manufactured foods awaiting

consumer acceptance. As both groups received dietary indoctrination,

study results could support no claims about the relation of diet to

heart disease. Nevertheless, when the results were released, both the

popular press and medical journals portrayed the Lipid Research

Clinics trials as the long-sought proof that animal fats were the

cause of heart disease. Rarely mentioned in the press was the ominous

fact that the group taking the cholesterol-lowering drugs had an

increase in deaths from cancer, stroke, violence and suicide.34

LRC researchers claimed that the group taking the cholesterol-

lowering drug had a 17% reduction in the rate of CHD, with an average

cholesterol reduction of 8.5%. This allowed LRC trials Director Basil

Rifkind to claim that " for each 1% reduction in cholesterol, we can

expect a 2% reduction in CHD events. " The statement was widely

circulated even though it represented a completely invalid

representation of the data, especially in light of the fact that when

the lipid group at the University of Maryland analyzed the LRC data,

they found no difference in CHD events between the group taking the

drug and those on the placebo.

A number of clinicians and statisticians participating in a 1984

Lipid Research Clinics Conference workshop, including Michael Oliver

and Richard Krommel, were highly critical of the manner in which the

LRC results had been tabulated and manipulated. The conference, in

fact, went very badly for the NHLBI, with critics of the lipid

hypothesis almost outnumbering supporters. One participant, Dr.

Beverly Teter of the University of Maryland's lipid group, was

delighted with the state of affairs. " It's wonderful' " she remarked

to Basil Rifkind, study coordinator, " to finally hear both sides of

the debate. We need more meetings like this " His reply was terse and

sour: " No we don't. " National Cholesterol Consensus Conference

Dissenters were again invited to speak briefly at the NHLBI-sponsored

National Cholesterol Consensus Conference held later that year, but

their views were not included in the panel's report, for the simple

reason that the report was generated by NHLBI staff before the

conference convened. Dr. Teter discovered this when she picked up

some papers by mistake just before the conference began, and found

they contained the consensus report, already written, with just a few

numbers left blank. Kritchevsky represented the lipid hypothesis camp

with a humorous five-minute presentation, full of ditties. Edward

Ahrens, a respected researcher, raised strenuous objections about

the " consensus, " only to be told that he had misinterpreted his own

data, and that if he wanted a conference to come up with different

conclusions, he should pay for it himself.

The 1984 Cholesterol Consensus Conference final report was a

whitewash, containing no mention of the large body of evidence that

conflicted with the lipid hypothesis. One of the blanks was filled

with the number 200. The document defined all those with cholesterol

levels above 200 mg/dL as " at risk " and called for mass cholesterol

screening, even though the most ardent supporters of the lipid

hypothesis had surmised in print that 240 should be the magic cutoff

point. Such screening would, in fact, need to be carried out on a

massive scale as the federal medical bureaucracy, by picking the

number 200, had defined the vast majority of the American adult

population as " at risk. " The report resurrected the ghost of Norman

Jolliffe and his Prudent Diet by suggesting the avoidance of

saturated fat and cholesterol for all Americans now defined as " at

risk, " and specifically advised the replacement of butter with

margarine.

The Consensus Conference also provided a launching pad for the

nationwide National Cholesterol Education Program, which had the

stated goal of " changing physicians' attitudes. " NHLBI-funded studies

had determined that while the general population had bought into the

lipid hypotheses, and was dutifully using margarine and buying low-

cholesterol foods, the medical profession remained skeptical. A

large " Physicians Kit " was sent to all doctors in America, compiled

in part by the American Pharmaceutical Association, whose

representatives served on the NCEP coordinating committee. Doctors

were taught the importance of cholesterol screening, the advantages

of cholesterol-lowering drugs and the unique benefits of the Prudent

Diet. NCEP materials told every doctor in America to recommend the

use of margarine rather than butter.

Part 3

Part 4

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