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Are Saltines Healthy? Exploring the Nutritional Value of this Simple Snack

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Did you know that saltine crackers have been a pantry staple in American households for over 150 years?[1] These thin, crispy, square crackers are known for their simple ingredients and salty flavor. But have you ever stopped to wonder – are saltines actually healthy? In this article, we’ll take a closer look at the nutritional value of this popular snack and explore whether saltine crackers deserve a place in a balanced diet.

What Are Saltines?

Saltine crackers, also known as soda crackers, are a type of thin, square cracker made from white flour, shortening, yeast, and baking soda.[2] They get their name from the coarse salt that is sprinkled on top before baking, giving them their signature salty taste.

Saltines have a long history dating back to the 19th century. The first mass-produced saltine cracker was made by F.L. Sommer & Company in 1876 in St. Joseph, Missouri.[1] The company eventually merged with other baking companies to form Nabisco, which still produces the iconic Premium brand of saltine crackers today.

Over the years, saltines have become a versatile pantry staple used in many ways – as a simple snack on their own, crumbled into soups or stews, paired with toppings like cheese or peanut butter, or even used as an ingredient in recipes like pie crusts and casseroles. Their light, neutral flavor and crisp texture make them adaptable to both sweet and savory applications.

But beyond their taste and convenience, how do saltine crackers stack up nutritionally? Let’s take a look at what these simple crackers are really made of.

What Are the Ingredients in Saltines?

The ingredient list for saltine crackers is relatively short and simple compared to many packaged snack foods. According to the Nabisco brand, Premium Saltine Crackers contain:

  • Enriched flour (wheat flour, niacin, reduced iron, thiamine mononitrate, riboflavin, folic acid)
  • Soybean oil
  • Salt
  • High fructose corn syrup
  • Partially hydrogenated cottonseed oil
  • Malted barley flour
  • Baking soda
  • Yeast[3]

As you can see, the primary ingredient in saltines is white flour. White flour is made by removing the bran and germ from wheat grains, leaving only the starchy endosperm. This process strips away much of the fiber, vitamins, and minerals naturally found in whole wheat flour.

To compensate for some of those lost nutrients, the white flour in saltine crackers is “enriched” – meaning that certain vitamins and minerals like iron and B vitamins are added back in. However, other beneficial components like fiber and phytochemicals are not replaced.[4]

Saltines also contain some amount of added sugars, in the form of high fructose corn syrup, as well as hydrogenated oils which contain trans fats. These ingredients provide little nutritional value and may have negative health impacts if consumed in excess.[5]

So based on the ingredient list alone, it’s clear that saltine crackers are a processed food made primarily from refined grains, rather than a nutrient-dense whole food. But what does that mean for their overall nutritional profile? Let’s dig a little deeper.

Are Saltines Healthy?

What Are the Nutritional Benefits of Saltines?

One serving of saltine crackers, which is usually 5 crackers, contains the following nutrients:

  • Calories: 60-70
  • Total fat: 1-2 grams
  • Sodium: 135-150 mg (6-7% DV)
  • Total carbohydrates: 10-12 grams
  • Fiber: 0-1 grams
  • Protein: 1 gram
  • Iron: 4% DV
  • Folate: 4% DV
  • Thiamin: 4% DV
  • Riboflavin: 4% DV
  • Niacin: 4% DV[6]

At first glance, the nutritional profile of saltines doesn’t look too concerning. They are relatively low in calories and fat, and provide small amounts of B vitamins and minerals like iron and folate thanks to the enriched flour.

Some potential nutritional benefits of saltine crackers include:

  • Low calorie: With only 60-70 calories per serving, saltines can be a lighter snack option compared to chips or cookies. Pairing them with nutrient-dense toppings like nut butter, avocado, or tuna salad can make for a more filling and balanced snack.
  • Low fat: Most varieties of saltines contain only 1-2 grams of fat per serving, making them a low-fat food. Some of that fat does come from hydrogenated oils, but the amount is quite small.
  • Fortified with vitamins and minerals: Although the white flour in saltines has been stripped of its natural nutrients, the enrichment process does add back some important vitamins and minerals like ironfolate, and B vitamins. These nutrients play key roles in metabolism, red blood cell production, and fetal development.[7]
  • Easy to digest: The refined flour in saltines makes them a good option for people with digestive issues or nausea, as they are bland, odorless, and easy on the stomach. They are often recommended as a first food to try when recovering from a stomach bug or morning sickness during pregnancy.[8]

However, it’s important to note that while saltine crackers may offer some minor nutritional benefits, they are still a processed food made primarily from refined grains. Let’s look at some of the potential drawbacks of including too many saltines in your diet.

What Are the Potential Health Risks of Saltines?

While enjoying a few saltine crackers now and then is unlikely to harm your health, there are some good reasons to limit your intake of this snack food. Some of the potential health risks and drawbacks of saltines include:

  • High in sodium: The word “saltine” is right there in the name, so it should come as no surprise that these crackers pack a decent amount of sodium. With 135-150 mg of sodium per serving (about 6-7% of the daily value), the sodium in saltines can add up quickly, especially if you eat more than one serving at a time. Consistently high sodium intake is linked to high blood pressure, heart disease, and stroke.[9] If you are watching your sodium intake, you may want to opt for unsalted or low-sodium varieties of crackers.
  • Low in fiber: Saltine crackers contain very little fiber, with most brands providing 0-1 grams per serving. Dietary fiber is important for digestive health, blood sugar control, and maintaining a feeling of fullness.[10] Relying on saltines as a regular snack without balancing them with other high-fiber foods could lead to digestive issues and hunger between meals. Opting for whole grain crackers or pairing saltines with high-fiber toppings can help boost the fiber content.
  • Made from refined grains: As mentioned earlier, saltine crackers are typically made with refined white flour rather than whole wheat flour. Refined grains have been stripped of beneficial nutrients like fiber, vitamins, and minerals. Diets high in refined grains have been linked to an increased risk of type 2 diabetes, heart disease, and weight gain.[11] The 2020-2025 USDA Dietary Guidelines for Americans recommend making at least half of your grain intake whole grains for optimal health.[12]
  • May contain added sugars and unhealthy fats: Some brands of saltine crackers contain high fructose corn syrup and partially hydrogenated oils, which are sources of added sugars and unhealthy trans fats. While the amounts in saltines are relatively small, regularly choosing snack foods with these ingredients can make it harder to stay within recommended limits for added sugars and trans fats, which have both been linked to negative health outcomes like obesity, diabetes, and heart disease.[13][14]
  • Easy to overeat: Let’s face it – it’s really easy to mindlessly munch through a sleeve of saltine crackers, especially given their light, crispy texture. Eating too many crackers in one sitting can lead to excess calorie intake. While the calories in saltines aren’t extremely high, they can still contribute to weight gain if portion sizes aren’t kept in check.[15]
Read More:  The Truth About Skinny Pop: Is It Actually Healthy?

So while saltine crackers aren’t the worst snack choice out there, they do have some nutritional drawbacks to consider. But how do they compare to other popular types of crackers? Let’s take a look.

How Do Saltines Compare to Other Crackers?

When browsing the cracker aisle at the grocery store, you’ll likely see a wide variety of options beyond just saltines. Some popular alternatives include whole wheat crackers, multigrain crackers, and seed-based crackers. Let’s see how saltines stack up against these other cracker choices.

What Are the Differences Between Saltines and Whole Wheat Crackers?

As the name implies, whole wheat crackers are made with whole wheat flour rather than refined white flour. Whole wheat flour is less processed and retains more of the natural nutrients found in the wheat grain, including fiber, vitamins, and minerals.

Here’s a quick comparison of the nutrition facts for one serving (about 15 grams) of whole wheat crackers vs saltines:

Whole Wheat Crackers Saltines
Calories 55 60-70
Total Fat 1.5g 1-2g
Sodium 7% DV 6-7% DV
Total Carbs 9.6g 10-12g
Fiber 1.4g 0-1g
Protein 1g 1g
Iron 2% DV 4% DV
Folate 3% DV 4% DV

As you can see, whole wheat crackers contain slightly fewer calories and carbohydrates compared to saltines, but provide a bit more fiber. The other nutrient values are fairly comparable between the two types of crackers.

The main nutritional advantage of choosing whole wheat crackers over saltines is the fiber content. Dietary fiber is important for digestive health, promoting regular bowel movements and feeding the beneficial bacteria in your gut.[16] Fiber also helps you feel full and satisfied after eating, which can help with appetite control and weight management.[17]

Whole grains like whole wheat have also been linked to a lower risk of heart disease, stroke, type 2 diabetes, and certain cancers.[18] Choosing whole grain crackers more often can be an easy way to boost your intake of whole grains and reap some of these health benefits.

That said, it’s still important to check the ingredient list and nutrition label when choosing whole wheat crackers, as some brands may still contain added sugars, unhealthy fats, or excess sodium. Look for brands made with 100% whole wheat flour and minimal added ingredients.

What Are the Differences Between Saltines and Multigrain Crackers?

Multigrain crackers are made with a blend of different whole grains, such as wheat, oats, rye, barley, or corn. Some brands may also include seeds like sesame, flax, or chia. The exact mix of grains and seeds varies by brand.

Like whole wheat crackers, multigrain crackers tend to be higher in fiber and nutrients compared to saltines due to the use of whole grains. However, it’s important to note that just because a cracker is labeled “multigrain” doesn’t necessarily mean it’s made entirely from whole grains.

Some multigrain crackers may still contain refined flour as the first ingredient, with smaller amounts of whole grains and seeds added in. Be sure to check the ingredient list and look for brands that list a whole grain as the first ingredient, such as whole wheat flour, oats, or brown rice flour.

Here’s a comparison of one popular brand of multigrain crackers vs saltines:

Multigrain Crackers Saltines
Calories 120 60-70
Total Fat 3g 1-2g
Sodium 6% DV 6-7% DV
Total Carbs 20g 10-12g
Fiber 3g 0-1g
Protein 3g 1g
Iron 8% DV 4% DV
Folate 4% DV 4% DV

As you can see, this particular brand of multigrain crackers is higher in calories, fat, carbohydrates, fiber, and protein compared to saltines. The higher calorie and carbohydrate content is likely due to the larger serving size (28 grams vs 15 grams for saltines).

The fiber and protein content of multigrain crackers will vary depending on the specific mix of grains and seeds used, but they will generally be a higher-fiber option compared to saltines. The combination of protein, fat, and fiber may also make multigrain crackers more filling and satisfying as a snack.

Read More:  Is Cream of Wheat Healthy for You? Exploring the Nutritional Benefits and Drawbacks

Multigrain crackers can be a nutritious choice, but as with any packaged snack food, it’s still important to pay attention to portion sizes and choose brands with simple, whole food ingredients and minimal added sugars and unhealthy fats. Pairing multigrain crackers with protein-rich toppings like cheese, hummus, or nut butter can make for a well-rounded snack.

What Are Some Ways to Make Saltines Healthier?

While saltine crackers aren’t the most nutrient-dense snack choice, there are some ways you can incorporate them into a healthy diet in moderation. Here are a few tips for making your saltine snacking a bit healthier:

How Can You Pair Saltines with Nutritious Toppings?

One of the simplest ways to boost the nutritional value of saltine crackers is to pair them with nutrient-rich toppings. This can help balance out the refined carbs in the crackers and add some extra fiberprotein, healthy fats, and vitamins to your snack.

Some nutritious topping ideas for saltines include:

  • Nut butter: Spread a thin layer of peanut butter, almond butter, or cashew butter on your saltines for a dose of healthy fats, protein, and minerals like magnesium and zinc.[19]
  • Cheese: Top saltines with a slice of cheese like cheddar, Swiss, or mozzarella for a boost of protein and calcium. Opt for low-fat varieties to keep saturated fat and calories in check.
  • Avocado: Mash a ripe avocado and spread it on saltine crackers for a creamy, satisfying snack rich in heart-healthy monounsaturated fats and fiber. Add a squeeze of lemon juice and a sprinkle of black pepper for extra flavor.
  • Hummus: Dip your saltines in hummus for a boost of proteinfiber, and healthy fats from chickpeas and olive oil. Choose brands with minimal added ingredients and sodium.
  • Tuna or chicken salad: Top saltines with a small scoop of tuna or chicken salad made with Greek yogurt or mashed avocado instead of mayo for a protein-rich, lower-fat option. Add diced celery or chopped nuts for crunch.
  • Sliced vegetables: Add some color and nutrients to your saltine stack with sliced cucumbers, tomatoes, radishes, or bell peppers. The water and fiber in veggies can help balance out the refined carbs in the crackers.

By pairing saltines with nutritious toppings, you can turn a simple cracker into a more balanced and satisfying snack. Just be mindful of portion sizes and choose toppings with minimal added sugars, unhealthy fats, and excess sodium.

Can You Substitute Saltines for Other Healthy Snacks?

While it’s perfectly fine to enjoy saltine crackers in moderation, if you find yourself relying on them as your go-to snack day after day, it may be worth exploring some more nutrient-dense options. Here are a few crunchy, satisfying snack ideas that can provide more nutritional bang for your buck compared to saltines:

  • Whole grain crackers: As mentioned earlier, switching to whole grain crackers like Triscuits, Wheat Thins, or Wasa crispbreads can give you more fiber and nutrients compared to saltines. Look for brands with minimal added ingredients and pair them with nutritious toppings.
  • Rice cakes: Plain rice cakes are low in calories and fat, and some brands are made with whole grain brown rice for added fiber. Top them with nut butter, hummus, sliced fruit, or cucumber rounds for a light, crunchy snack.
  • Popcorn: Air-popped or lightly oil-popped popcorn is a whole grain snack that’s high in fiber and low in calories. Skip the movie theater butter and season it with herbs, spices, or a light sprinkle of parmesan cheese instead.
  • Roasted chickpeas: Drain and rinse a can of chickpeas, pat them dry, toss with a little olive oil and your favorite seasonings, and roast at 400°F for 20-30 minutes for a crunchy, protein-packed snack. Store leftovers in an airtight container.
  • Veggie sticks with dip: Cut raw carrots, celery, bell peppers, and cucumbers into sticks and pair them with hummus, guacamole, or Greek yogurt dip for a fiber-rich, low-calorie snack that satisfies your crunch craving.
  • Nuts and seeds: A small handful of nuts or seeds like almonds, walnuts, pumpkin seeds, or sunflower seeds provides healthy fats, proteinfiber, and minerals. Look for raw or dry-roasted varieties without added oils or sugars.
  • Fresh fruit: While not as crunchy as crackers, fresh fruits like apples, pears, and berries are sweet, refreshing, and packed with vitamins, minerals, and fiber. Pair them with a small piece of cheese or a tablespoon of nut butter for a balanced snack.

Remember, variety is key when it comes to snacking. Rotating between different nutrient-dense snack options can help you get a wider range of vitamins, minerals, and beneficial plant compounds while keeping things interesting for your taste buds.

Are There Any Benefits of Eating Saltines When You Are Sick?

While saltine crackers may not be the most nutrient-dense food choice for everyday snacking, they do have some unique properties that can make them helpful to eat when you’re feeling under the weather. Here’s a closer look at some of the potential benefits of reaching for the saltines when sickness strikes.

Do Saltines Help with Nausea or Upset Stomach?

One of the most common reasons people turn to saltine crackers when they’re sick is to help settle an upset stomach or quell nausea. There are a few reasons why saltines may be particularly well-suited for this purpose:

  1. Bland and easy to digest: Saltine crackers are made with simple ingredients and are baked until very dry and crisp. This makes them easy to chew and digest, which can be helpful when your stomach is feeling sensitive or you’re struggling to keep food down.[20]
  2. Low in fat and fiber: While fat and fiber are important nutrients for overall health, they can be harder to digest and may worsen symptoms like nausea or diarrhea in some people. The low fat and fiber content of saltines may make them easier to tolerate when your digestive system is out of whack.[21]
  3. Salty flavor may help with electrolyte balance: When you’re vomiting or have diarrhea, you can lose a lot of fluids and electrolytes like sodium. The salt on saltine crackers may help replenish some of that lost sodium, which is important for maintaining proper fluid balance in your body.[22] However, it’s still important to also drink plenty of clear fluids like water, broth, or electrolyte beverages to stay hydrated.
  4. Dry texture may absorb excess stomach acid: Some people find that the dry, absorbent texture of saltines helps soak up excess stomach acid and settle indigestion or heartburn. However, there’s limited scientific evidence to support this claim, and it may not work for everyone.
Read More:  The Truth Behind Chomps: Are They Really Healthy?

While saltine crackers can be a comforting and easy-to-tolerate food when you’re feeling nauseous, it’s important to listen to your body and not force yourself to eat if you don’t feel up to it. Stick to small, frequent sips of clear liquids until your nausea subsides, and gradually add in bland, easy-to-digest foods like saltines, bananas, rice, and applesauce as you start feeling better.

Can Saltines Help with Diarrhea or Constipation?

In addition to helping with nausea and upset stomach, some people also turn to saltine crackers when dealing with diarrhea or constipation. However, the evidence for their effectiveness in these situations is mixed.

For diarrhea, the dry, absorbent texture of saltines may help firm up loose stools by absorbing excess water in the digestive tract. The salt content may also help replace some of the sodium lost through watery stools. However, it’s still important to also drink plenty of fluids and electrolytes to prevent dehydration, which can be a serious complication of diarrhea.[23]

Some doctors recommend the “BRAT” diet for diarrhea, which stands for Bananas, Rice, Applesauce, and Toast.[24] Saltine crackers could be used in place of toast as a bland, starchy food to help bind loose stools. However, the BRAT diet is no longer routinely recommended for children, as it may not provide enough nutrients to support a child’s growth and development.[25] For adults, it’s okay to eat these bland foods for a day or two, but be sure to also incorporate other nutrient-rich foods as soon as you’re able to tolerate them.

On the flip side, some people claim that the dry, rough texture of saltines can help “scrape out” the digestive tract and relieve constipation. However, there’s no scientific evidence to support this idea. In fact, the low fiber content of saltine crackers could potentially worsen constipation by adding more bulk to stool without providing the indigestible roughage needed to stimulate regular bowel movements.

If you’re struggling with constipation, focus on increasing your intake of high-fiber foods like fruits, vegetables, whole grains, and legumes, as well as drinking plenty of water to help keep things moving smoothly.[26] Regular physical activity can also help promote healthy digestion and prevent constipation.[27]

While saltine crackers may provide some temporary relief from digestive symptoms like nausea or diarrhea, they shouldn’t be relied on as a long-term solution for gut health. Focus on eating a balanced, nutrient-rich diet, staying hydrated, and managing any underlying health conditions with the guidance of your healthcare provider.

FAQs

Are saltine crackers a healthy snack?

Saltine crackers can be enjoyed as an occasional snack, but they’re not the most nutrient-dense option. They’re made primarily from refined white flour and provide little fiberprotein, or healthy fats. Pairing saltines with nutritious toppings like nut butter, cheese, hummus, or sliced veggies can make them a more balanced snack choice.

Are saltine crackers healthier than bread?

It depends on the type of bread. Saltine crackers are usually lower in calories and carbohydrates compared to a slice of white bread, but whole grain breads will typically be higher in fiberprotein, and nutrients. When choosing between crackers and bread, opt for whole grain varieties with minimal added ingredients.

What are the healthiest crackers to eat?

The healthiest crackers are those made with whole grains, seeds, and other nutrient-dense ingredients. Look for brands that list a whole grain (like whole wheat, brown rice, or oats) as the first ingredient and have minimal added sugars, unhealthy fats, and sodium. Some nutritious cracker options include Triscuits, Wasa crispbreads, Ryvita rye crackers, and Mary’s Gone Crackers.

Are saltine crackers good for your stomach?

Saltine crackers can be easy to digest and may help settle an upset stomach or relieve nausea due to their bland flavor, dry texture, and low fat content. However, they shouldn’t be relied on as a sole treatment for digestive issues. Be sure to also stay hydrated with clear fluids and gradually incorporate other gentle, nutrient-rich foods as tolerated.

Are saltine crackers junk food?

While saltine crackers are processed and lack fiber and nutrients compared to whole grain options, they’re not necessarily “junk food” in the same category as chips, cookies, or candy. However, they’re not a nutrient-dense choice and should be enjoyed in moderation as part of a balanced diet.

Why are saltines so addictive?

The combination of a crispy texture and salty flavor can make saltine crackers easy to overeat, especially when mindlessly snacking. Some people may also crave the salt on saltines due to an underlying mineral deficiency or imbalance. If you find yourself constantly reaching for saltines, try exploring other crunchy, satisfying snack options like veggies with hummus, air-popped popcorn, or roasted chickpeas.

Takeaways

  • Saltine crackers are made from refined white flour, which has been stripped of its bran and germ, leaving only the starchy endosperm. This means they are low in fiber and nutrients compared to whole grain options.
  • One serving of saltines (5 crackers) contains around 60-70 calories, 1-2g fat, 135-150mg sodium (6-7% DV), and small amounts of B vitamins and minerals from enriched flour. They provide little protein or fiber.
  • Potential benefits of saltines include being low calorie, low fat, fortified with some vitamins and minerals, easy to digest, and helpful for settling an upset stomach or nausea.
  • Drawbacks of saltines include being high in sodium, low in fiber, made from refined grains, potentially containing added sugars and unhealthy fats, and easy to overeat.
  • Whole grain crackers like Triscuits or Wasa crispbreads are higher in fiber and nutrients compared to saltines. Multigrain crackers with seeds are also a more nutritious option.
  • Pairing saltines with healthy toppings like nut butter, cheese, hummus, avocado, or sliced veggies can make them a more balanced snack. Other nutritious crunchy snack options include popcorn, roasted chickpeas, rice cakes, and fresh veggies with dip.
  • Saltines may help relieve nausea or settle an upset stomach due to their bland flavor, dry texture, and low fat content. However, they’re not a cure-all for digestive issues and should be eaten alongside other gentle, nutrient-rich foods and plenty of fluids.

In conclusion, saltine crackers can certainly be enjoyed as part of a balanced diet, but they’re not the most nutritious snack option. If you’re looking for a crunchy cracker fix, opt for whole grain or seed-based varieties more often and pair them with nutrient-dense toppings. And if you’re feeling under the weather, saltines may provide some relief, but be sure to also prioritize hydration and gentle, nourishing foods to support your recovery.

References

  1. https://www.mashed.com/230934/the-untold-truth-of-saltine-crackers/
  2. https://www.leaf.tv/articles/what-are-the-ingredients-in-saltine-crackers/
  3. https://smartlabel.nabisco.com/00044000024970-0011#ingredients
  4. https://wholegrainscouncil.org/whole-grains-101/whats-whole-grain-refined-grain
  5. https://www.hsph.harvard.edu/nutritionsource/salt-and-sodium/
  6. https://www.nutritionix.com/i/nabisco/premium-saltine-crackers/51d2f50e3938c6d21900017f
  7. https://ods.od.nih.gov/factsheets/Folate-Consumer/
  8. https://www.livestrong.com/article/263024-are-saltine-crackers-good-for-a-bad-stomach/
  9. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/effects-of-excess-sodium-infographic
  10. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/fiber/art-20043983
  11. https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/whole-grains/
  12. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf
  13. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/added-sugars
  14. https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/fats-and-cholesterol/types-of-fat/transfats/
  15. https://www.healthline.com/nutrition/why-snacking-is-bad#TOC_TITLE_HDR_2
  16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124841/
  17. https://www.hsph.harvard.edu/nutritionsource/carbohydrates/fiber/
  18. https://www.bmj.com/content/353/bmj.i2716
  19. https://www.healthline.com/nutrition/9-healthy-nuts#TOC_TITLE_HDR_11
  20. https://www.mountsinai.org/health-library/selfcare-instructions/nausea-and-vomiting-self-care
  21. https://my.clevelandclinic.org/health/articles/9678-bland-diet
  22. https://medlineplus.gov/fluidandelectrolytebalance.html
  23. https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea/treatment
  24. https://www.seattlechildrens.org/conditions/a-z/brat-diet/
  25. https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/Treating-Vomiting.aspx
  26. https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/treatment
  27. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291444/
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