processed foods

Why Does Processed Food Make You Fat?

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How Can You Enjoy Eating Without Getting Fat? 

Author: Dr. Stephen Chaney 

You are probably tired of hearing about how bad processed foods are for you. If you have been following the headlines, you probably already know that diets high in processed foods are linked to obesity, type 2 diabetes, heart disease, some forms of cancer, memory loss, liver disease, kidney disease, depression, risk of dying from any cause, and much more.

And this is a serious problem because 60-70% of the American diet comes from processed foods.

In fact, you may have seen these headlines so frequently that your eyes glaze over, and your mind shuts down any time you see the words “processed foods” in the title.

This week I will be sharing the latest studies on why processed foods make us fat. Stick with me on this. This is not just another article on processed foods. While the focus of the article is on processed foods, the studies it covers are valuable because they also identify some unprocessed foods that can make us fat.

Spoiler alert! Today’s “Health Tip” is important because it teaches us that weight control is not as simple as eliminating processed foods from our diet. We also need to know which unprocessed or minimally processed foods to eat less of.

Before I proceed, I should give you a brief review of how processed foods are defined because that definition has changed in recent years.

What Are Processed Foods? 

ScientistEveryone used to have a good understanding of which foods were processed. But several years ago, the scientific community introduced a new food classification system called “The NOVA food classification system” and introduced a new category – ultra-processed foods. I have covered this classification system in previous “Health Tips From the Professor” articles, but I will review it here.

The NOVA system categorizes foods into four groups according to the extent of processing they have undergone:

  1.  Unprocessed foods.
    • This category includes foods like fruit, vegetables, milk, eggs, and meat.

2) Processed culinary ingredients.

    • This category includes foods you might find in restaurants or prepare yourself to which things like salt, sugar, vegetable oils, butter, or cream were added in the preparation.

3) Minimally processed foods.

    • This category includes foods like canned vegetables, freshly made breads, and cheeses.

4) Ultra-processed foods.

    • This category includes foods like soft drinks, chips, packaged snacks, most breakfast cereals, chicken nuggets & fish sticks, fast food burgers, hot dogs, and other processed meats.

The actual list is much longer, but you get the idea. What we call processed foods, scientists now call ultra-processed foods. The article I am discussing used the term “ultra-processed foods” in the title.

But, since the term “ultra-processed foods” has not yet entered the popular vocabulary, I will use the term “processed foods” in this article because it is more understandable to the average reader.

Does Processed Food Make You Fat? 

clinical studyI shared a study in a previous issue of “Health Tips From the Professor” that suggested that the answer was yes, but did not answer the question of why. That’s because of the way the experiment was designed.

The ultra-processed diet and unprocessed diets were matched with respect to:

  • Total calories in the food portions given to the subjects.
  • Caloric density (calories per serving size). That’s because caloric density has been linked to overeating (I’ll discuss that in more detail below.) The authors of the study eliminated that variable.
  • Macronutrients (carbohydrate, fat, & protein). I’m sure you’ve seen blogs suggesting that carbohydrates or fat cause weight gain. And you’ve probably seen blogs suggesting that high protein diets cause weight loss. The authors eliminated these variables.
  • Total sugar, fiber, and sodium. That’s because the sugar, fat, and sodium content of foods increase their tastiness (palatability), which has been linked to overeating (more below). The authors eliminated this variable.

In short, this study compared a tasty, healthy ultra-processed food diet with a tasty, healthy unprocessed food diet. [Note: This does not represent the real world. In the real world the ultra-processed foods eaten by most Americans are higher in caloric density, sugar, fat, and sodium and lower in fiber than unprocessed foods.]

However, in the scientific world, this was an excellent study design. By eliminating variables thought to explain the correlation between ultra-processed food consumption and obesity, the study was able to focus on two questions:

#1: With those variables eliminated, do ultra-processed foods still lead to overeating? Here the answer was a clear, yes.

  • The study participants eating ultra-processed foods ate 500 more calories per day than those eating unprocessed foods. (Both groups were presented with meals and snacks containing the same number of calories and told to eat as much as they wanted.)
  • Participants eating ultra-processed foods gained 2 pounds in just two weeks, while those eating unprocessed foods lost 2 pounds.

#2: If so, what else about ultra-processed foods leads to overeating? One popular theory of why ultra-processed foods lead to overeating is that they cause large blood sugar spikes and crashes, which stimulates appetite. But the authors of the study were disappointed to find no large blood sugar spikes following consumption of ultra-processed food meals.

However, I don’t think their data disproves the blood sugar spike theory. Remember that this was a “healthy ultra-processed food diet”. The amount of sugar and fiber was identical in the ultra-processed and unprocessed food diets. More importantly, when I looked at the sample menus provided by authors as supplementary information, each meal contained a significant percent of whole, low-glycemic foods. This was a “healthy ultra-processed food” diet designed by a dietitian, not what the typical American eats.

So, why did the ultra-processed food group eat more in this study? This study did not provide an answer to that question, but other studies (described below) have provided probable answers to that question.

Why Does Processed Food Make You Fat? 

What do other studies tell us about why processed foods make us overeat and gain weight? Here are the top 7 mechanisms that have been suggested and what they mean for us.

candy bar#1: Caloric Density: Simply put, caloric density is the number of calories in a serving of food. When you consume foods with a high caloric density, you are more likely to consume excess calories without even thinking about it.

When I was still teaching medical students, I used this example to illustrate the effect of caloric density on calories consumed. “There are the same number of calories in a 2-ounce candy bar and a pound of apples. You can eat a 2-ounce candy bar and be ready to eat more. If you eat a pound of apples, you are done for a while”.

Since most processed foods have a higher caloric density than unprocessed foods, the simplest solution to weight control is to limit processed foods in your diet.

However, how you or your favorite restaurant prepares unprocessed foods is important as well. For example, the addition of cheese or cream sauces can significantly increase the caloric density of the food. This is why the NOVA food classification system I described above created a new category of “culinary foods” to describe these kinds of foods.

#2: Hyper-palatability: In prehistoric times foods that were sweet, salty, and fatty were essential for survival, so we are hardwired to desire those foods. Here is why:

  • We need a certain amount of sugar for our brain, red blood cells, and a few other tissues to function. Wild game provides almost no carbohydrate. Fruits were the best source of sugar, but fruits were scarce prior to farming. The craving for sweetness drove us to forage far and wide to find fruits and other plant sources of sugar and carbohydrate.
  • Sodium is essential for survival, but unprocessed plant and animal foods provide very little. That’s why even in Biblical times, salt was worth its weight in gold.
  • In prehistoric times, food was sometimes scarce, especially in winter. It might be a week or more between meals. Fat stores got prehistoric man through these times of scarcity, so it was important to eat fatty meals in times of plenty. [Note: We no longer live in times of scarcity, and those fat stores have gone from being an asset to being a health concern.]

Unfortunately, “Big Food, Inc” has weaponized these hardwired desires for sweet, salty, and fatty foods. Simply put, processed foods taste good because they fulfil our hardwired taste desires. Scientists call it “hyper-palatability”. But whatever you call it, we want to eat more, and that leads to overeating.

And again, the way we prepare the foods we eat also matters. It’s only natural to add extra salt, sugar, and/or fat to the foods we prepare so they taste better. And if we add too much, we make the healthy foods we eat hyper-palatable, and we are tempted to overeat.

On a personal note, I never knew you might want to add sugar and fat to the vegetables you cook before my family moved to the south. On the other hand, I had never eaten collard greens before either.

#3: Food Consistency: When you look at studies on the effect of food consistency on calories consumed, you find that there are several different ways of defining food consistency, but they are all looking at the same thing from a different perspective – like the fable of the 6 blind men trying to describe an elephant.

applesauce
  • Food Structure: The classic study, published in 2009, compared the effect of sliced apples, applesauce, and apple juice eaten shortly before a meal on the number of calories consumed at the meal. In terms of calories consumed during the meal, the results were clear. It was apple juice > applesauce > apple slices.

This drew attention to the effect of food structure on calories consumed. Apples are a whole food with cellular structure intact. Applesauce contains all the nutrients, phytonutrients, and fiber of whole apples, but the cellular structure has been lost. Apple juice contains most of the nutrients and phytonutrients of applesauce, but the fiber has been lost.

Why does the structure of whole foods matter?

    • Cell structure must be destroyed before digestion can occur, the release of sugar and carbohydrates from the food is delayed. This reduces the spikes and valleys of blood sugar that can increase appetite.
    • Transit time of the food through the intestine is also delayed. Thus, the feeling of fulness persists longer, which reduces appetite.

There are two takeaway lessons from this study that may not be so obvious:

    • Neither applesauce nor apple juice meet the NOVA definition of an ultra-processed food. So, simply removing processed foods from your diet may not be enough to reduce your appetite and, therefore, your caloric intake.
    • In addition, adding fiber back to apple juice did not make it equivalent to applesauce in reducing appetite. So, despite what Big Food Inc tells you, adding fiber to processed foods does not turn them into health foods.
  • Soft Versus Hard Foods: Many processed foods are soft, and most unprocessed foods are hard. So, you could think of this as a description that separates processed foods from unprocessed foods.

But, if you consider the apples versus applesauce comparison I described above, it is obvious that soft versus hard description also pertains to minimally processed foods such as applesauce and whole, unprocessed foods such as apples. 

For example, one recent study comparing soft versus hard foods found it didn’t matter whether the soft foods were processed or unprocessed. People in the study ate more calories from all soft foods than from hard, unprocessed foods such as raw fruits and vegetables.

  • Fast Versus Slow Foods: This description separates foods based on the speed at which they are digested and pass through the intestine. Once again, you might think of this as a description that separates processed and unprocessed foods until you think about applesauce versus apples comparison.

And, as you might expect, a recent study comparing “fast” versus “slow” foods found it didn’t matter whether the fast and slow foods were processed or unprocessed. People in the study ate more calories from fast foods than from slow foods.

[Note: This study defined “slow” foods as harder, chunkier, more solid, and more viscous. While the first three adjectives describe what other scientists also refer to as “hard” foods, the final adjective broadens the category to include “soft” foods like oatmeal.]

How Can You Enjoy Eating Without Getting Fat? 

For most Americans, weight is a constant uphill battle. Their weight increases by a few pounds every year, and over time that continuing weight gain adds up. Diets are never enjoyable, which is part of the reason they almost always fail in the long term. You want to control your weight, but you also want to enjoy what you eat. Why is that so hard?

The secret to a healthy weight is to find foods you enjoy that don’t increase your appetite –  foods that fill you up, so you eat less naturally. Here are my 4 tips for eating foods you enjoy without getting fat.

Tip #1: Limit processed foods. Processed foods tend to have a high caloric density; are hyper-palatable, soft, and fast; and lack the intact cellular structure of whole, unprocessed foods. And multiple studies, such as the one I cited above, agree that processed foods cause us to eat more and to gain weight. So, the single most important step you can take to control your weight is to limit your intake of processed foods.

Tip #2: Choose minimally processed foods wisely. The studies I shared above suggest that avoiding processed foods may not be enough. We also need to look at the minimally processed foods we eat (applesauce, for example). These studies suggest we should also favor whole, unprocessed foods over minimally processed foods that are softer and faster (more quickly digested).

By now, you might be saying, “Wait a minute. I thought you said I could enjoy eating without getting fat. How can I enjoy eating if I have to give up my favorite processed and minimally processed foods?”

My short answer would be, “No. But you might want to broaden your horizons”. We all tend to be creatures of habit. We eat a relatively small variety of foods on a regular basis. When my wife and I decided to eat healthier, we kept trying new foods until we found new, healthier foods we loved.

The category of whole unprocessed foods offers many options. There are fruits, vegetables, many varieties of 100% whole grains, beans, nus, seeds, eggs, and meats. And we are blessed to live in a country with abundant choices. When you walk into your local supermarket you will find dozens of foods in each of these categories that you have never tried before. Be daring. Keep trying new foods until you find new favorite foods you love.

Tip #3: Be aware of how foods are prepared. The studies described above also suggest how we prepare the food is important. We can start out with a whole unprocessed food and end up with something no better than processed food if we prepare it incorrectly. If we add lots of cream, cheese, butter, and/or sugar, we increase the caloric density. And this can lead to us consuming more calories without even thinking about it.Throw in some salt and we have also made the food hyper-palatable, which makes us want to eat more.

Now you might be saying, “But I grew up with my food being cooked this way. This is my comfort zone. Do I have to completely change the way I cook my food, and the items I choose at my favorite restaurant?”

Again, my short answer would be, “No, but you might want to try new recipes.” I am not a cooking guru. That would be my wife. But I do know there are lots of books and web sites featuring healthy recipes. Once again, be bold. Try new recipes until you find new favorites. Try new items on your favorite restaurant’s menu or try new restaurants until you find healthier, restaurant foods you love.

Tip #4: Never say never. This is perhaps the most important tip. Whenever we tell ourselves we can never eat a food again, it becomes irresistible. We are setting ourselves up for failure. The goal should be to change unhealthy foods and unhealthy recipes from an everyday occurrence to an occasional pleasure.

The Bottom Line 

Multiple studies show that eating processed foods leads to weight gain. It may be no coincidence that 60-70% of the foods Americans eat is highly processed and 60-70% of us are overweight or obese.

In the article above, I summarize recent studies asking why processed foods make us fat. If you think these studies are only of interest to scientists, you would be wrong. These studies also help us to identify unprocessed and minimally processed foods in our diet that can make us fat.

For more information on these studies, and 4 tips on how you can enjoy eating without getting fat, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

 _____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

 

Do Processed Foods Cause Cancer?

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How Can You Reduce Your Cancer Risk?

Author: Dr. Stephen Chaney 

We are facing a food crisis in this country. Big Food Inc is taking over our diet. Currently, 73% of our food supply is processed. And because these are manufactured foods, not real foods, they are 52% cheaper than the whole unprocessed foods we should be eating.

And Big Food Inc has seduced us. They know our weaknesses. The foods they make are convenient and easy to prepare. They also know our bodies were created with an ingrained craving for sweet, salty, and fatty foods. These cravings served us well in prehistoric times, but in today’s world Big Food Inc has weaponized them. Their foods are designed to satisfy every craving. They have done their best to make their processed foods irresistible!

The result is no surprise. In 2018 (LG Baraldi et al, BMJ Open, 2018, 8(3) e020574 60% of the calories the Average American consumes came from processed foods, and the percentage has only increased since then.

This is alarming because higher consumption of processed foods has been linked to increased risk of obesity, diabetes, and all-cause mortality.

Some studies have suggested that higher consumption of processed foods may also be linked to increased risk of cancer. The authors of the current study (K Chang, eClinicalMedicine 2023;56: 101840) set out to test this hypothesis.

How Are Processed Foods Defined In This Study?

Before I proceed with describing the findings of this study, I should probably contrast the common definition of processed foods with the current scientific definition of processed foods. The scientific community has recently developed something called “The NOVA food classification system” to describe the various levels of food processing.

The NOVA system categorizes foods into four groups according to the extent of processing they have undergone:

  1. Unprocessed or minimally processed foods.
    • This category includes foods like fruit, vegetables, milk, and meat.

2) Processed culinary ingredients.

    • This category includes foods you might find in restaurants or prepare yourself to which things like sugar, vegetable oils, butter, or cream were added in the preparation.

3) Processed foods.

    • This category includes foods like canned vegetables, freshly made breads, and cheeses.

4) Ultra-processed foods.

    • This category includes foods like soft drinks, chips, packaged snacks, most breakfast cereals, chicken nuggets & fish sticks, fast food burgers, hot dogs, and other processed meats.

The actual list is much longer, but you get the idea. What we call processed foods, scientists call ultra-processed foods. Since the term “ultra-processed foods” has not yet entered the popular vocabulary, I will use the term “processed foods” in describing the results of this study because it is more understandable to the average reader.

How Was This Study Done?

clinical studyThe authors of this study started by using data from the UK Biobank study. The UK Biobank study is a long-term study in the United Kingdom that is investigating the contributions of genetics and environment to the contribution of disease.

The authors focused on 197,426 (54.6% women) participants in the study who completed up to five 24-hour dietary recalls between 2009 and 2012. The participants were age 58 (range 40 to 69) when they entered the study and were followed for an average of 9.8 years. None of the participants had been diagnosed with cancer at the time of their enrollment in the study.

The purpose of this study was to examine the correlation between percent of “processed food” in the participant’s diets and both the frequency of newly diagnosed cancer and the frequency of cancer deaths during the 9.8 years of follow-up.

More importantly, the size of this study allowed the authors to examine associations between processed food consumption and both the risk of cancer and cancer mortality for 34 site-specific cancers – something most previous studies were unable to do.

  • The percentage “processed food” in their diets was calculated from the 24-hour dietary recalls using the NOVA scoring system.
  • The frequency of newly diagnosed cancers and cancer deaths was obtained by linking the data in this study with the national cancer and mortality registries, provided by the National Health Service.

Do Processed Foods Cause Cancer?

CancerThe authors started by dividing participants into four equal quartiles based on their consumption of processed foods:

  • For quartile 1 processed foods made up between 0 and 13.4% of calories (average = 9.2%).
  • For quartile 2 processed foods made up between 13.5 and 20% of calories (average = 16.7%).
  • For quartile 3 processed foods made up between 20.1 and 29.4% of calories (average = 24.3%).
  • For quartile 4 processed foods made up between 29.5 and 100% of calories (average = 41.4%).

They started by looking at the risk of developing cancer during the 9.8-year follow-up period. A total of 15,921 participants developed cancer during that time. When the authors compared the group consuming the most processed foods with the group consuming the least processed foods:

  • The risk of overall cancer of any type increased by 7%.
  • The risk of lung cancer increased by 25%.
  • The risk of ovarian cancer increased by 45%.
  • The risk of diffuse large B-cell lymphoma increased by 63%.
  • The risk of brain cancer increased by 52%.

Furthermore, every 10% increase in processed food consumption was associated with:

  • A 2% increase in overall cancer incidence…and…
  • A 19% increase in ovarian cancer incidence.

A total of 4,009 participants died from cancer during that time. When the authors compared the group consuming the most processed foods with the group consuming the least processed foods:

  • Overall cancer mortality increased by 17%.
  • Lung cancer mortality increased by 38%.
  • Ovarian cancer mortality increased by 91%.

Furthermore, every 10% increase in processed food consumption was associated with:

  • A 6% increase in overall cancer mortality.
  • A 16% increase in breast cancer mortality.
  • A 30% increase in ovarian cancer mortality.

The authors concluded, “Our UK-based study suggests that higher [processed food] consumption may be linked to an increased [frequency] and mortality for overall and certain site-specific cancers especially ovarian cancer in women…These findings suggest that limiting [processed food] consumption may be beneficial to prevent and reduce the modifiable burdens of cancer.”

How Can You Reduce Your Cancer Risk?

American Cancer SocietyLet’s start with the American Cancer Society recommendations to limit cancer risk:

1) Avoid tobacco use. 

2) Get to and stay at a healthy weight.

If you are already at a healthy weight, stay there. If you are carrying extra pounds, try to lose some. Losing even a small amount of weight can reduce your risk of cancer and have other health benefits. It is a good place to start.

3) Be physically active and avoid time spent sitting.

Current recommendations are to get at least 150-300 minutes of moderate intensity or 75-150 minutes of vigorous intensity activity each week. Getting to or exceeding 300 minutes is ideal.

In addition, you should limit sedentary behavior such as sitting, lying down, watching TV, and other forms of screen-based entertainment. This is especially important if you spend most of your working day sitting.

4) Follow a healthy eating plan.

A healthy eating pattern includes a variety of vegetables, fiber-rich legumes (beans and peas), fruits in a variety of colors, and whole grains. It is best to avoid or limit red and processed meats, sugar-sweetened beverages, highly processed foods, and refined grain products. This will provide you with key nutrients in amounts that help you get to and stay at a healthy weight.

5) It is best not to drink alcohol.

It is best not to drink alcohol. People who choose to drink alcohol should limit their intake to no more than 2 drinks per day for men and 1 drink a day for women.

This study adds an exclamation point to the American Cancer Society’s recommendation to avoid or limit “processed meats, sugar-sweetened beverages, highly processed foods, and refined grain products”.

You may be asking, “What is so harmful about processed foods?” The most obvious harm is that they are replacing healthier foods that reduce cancer risk, such as “a variety of vegetables, fiber-rich legumes (beans and peas), fruits in a variety of colors, and whole grains” that the American Cancer Society recommends for reducing cancer risk.

But there are other reasons as well. In the words of the authors:

  • “Evidence has been accumulating on the strong obesity and type-2 diabetes-promoting potential of [processed foods], both of which are risk factors for many cancers including those of the digestive tract and some hormone-related cancers in women.
  • Emerging research has suggested other common properties of [processed foods] that may contribute to adverse cancer outcomes, including the use of controversial food additives, contaminants such as acrylamide that form during [food processing], and toxic contaminants such as phthalates and bisphenol-F that migrate from food packaging [into the food].”

The Bottom Line 

You probably know that processed foods are bad for you. But do processed foods cause cancer? A very large study (197,426 people followed for 9.8 years) suggests the answer to that question appears to be yes.

When the authors of the study compared the group consuming the most processed foods with the group consuming the least processed foods:

  • The risk of overall cancer of any type increased by 7%.
  • The risk of lung cancer increased by 25%.
  • The risk of ovarian cancer increased by 45%.
  • The risk of diffuse large B-cell lymphoma increased by 63%.
  • The risk of brain cancer increased by 52%.

And when they looked at cancer deaths and did the same comparison:

  • Overall cancer mortality increased by 17%.
  • Lung cancer mortality increased by 38%.
  • Ovarian cancer mortality increased by 91%.

The authors concluded, “Our study suggests that higher [processed food] consumption may be linked to an increased [frequency] and mortality for overall and certain site-specific cancers especially ovarian cancer in women…These findings suggest that limiting [processed food] consumption may be beneficial to prevent and reduce the modifiable burdens of cancer.”

These results are alarming because the most recent study shows that 60% of calories in the American diet comes from processed foods, and the percentage is increasing each year. We need to reverse this trend!

For more information on this study, why processed foods increase your risk of cancer, and what the American Cancer Society recommends to reduce your risk of cancer, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

 

 

Is Erythritol Bad For Your Heart?

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Who Should Be Concerned About Erythritol Intake?

Author: Dr. Stephen Chaney 

Everyone is searching for the perfect sweetener. And if you were in the marketing department of Big Food Inc, the perfect sweetener would be defined as:

  • Natural, meaning that it is found in fruits, vegetables, or other plant foods.
  • Low in calories. Of course, a perfect sweetener would have zero calories because it is not metabolized in our bodies.
  • Low glycemic, meaning that it would have a minimal effect on blood sugar levels. Once again, a perfect sweetener would have zero effect on blood sugar levels.
  • Safe, meaning that it has no adverse effects on our health.

Sugar alcohols appear to meet all these criteria, so they have become the sweetener of choice for lots of highly processed foods. This is especially true for the sugar alcohol, erythritol, since it is currently the least expensive of the sugar alcohols.

So, a recent study (M Witowski et al, Nature Medicine, 2023) suggesting that erythritol might increase the risk of heart disease was quite surprising.

This is the first study to suggest a link between erythritol and heart disease, and it was a flawed study (I will discuss the flaws below).

Reputable scientists don’t put much credence in a weak first study like this one. We generally consider the conclusions of a first study like this one to be an unproven hypothesis at this point.

But we are cautious. There will be many follow-up, better designed studies, to test this hypothesis. Once these studies have been published, the scientific community will look at all the evidence and either issue a warning or conclude that there is no reason for concern.

But that doesn’t stop the Dr. Strangeloves of the world from warning you of the “dangers” of erythritol and telling you to avoid it at all costs.

For that reason, I felt it was appropriate to address this issue. I will:

  • Describe the study and its flaws.
  • Put the study into the broader perspective of what we know about sweeteners.
  • Identify the two population groups who should be most concerned about erythritol.

How Was The Study Done And What Did It Show?

This study can be divided into three parts.

heart disease#1: An Association Between Erythritol Blood Levels And Heart Disease.

There were three separate experiments included in this section of the study. In each experiment patients were recruited after visiting cardiac clinics for diagnostic procedures. The average age of these patients was 67 and 45% of them already had experienced a non-fatal heart attack prior to the study. In other words, these were all older patients with pre-existing heart disease who were at high risk of heart attack or stroke in the near future.

The first study was a metabolomic study. In simple terms this means that high-tech equipment and computing were used to measure hundreds of metabolites in the blood of the patients and, in this case, correlate each of them with the occurrence of heart attacks and strokes over the next three years.

  • This study identified 16 sugar alcohols and related metabolites in the blood of these patients that were associated with an increased risk of heart attack and stroke. (I will discuss the significance of this observation in more detail later.)

Because erythritol was among the top 6 compounds in terms of association with increased heart attack and stroke risk, and erythritol is the most commonly used sugar alcohol in processed foods, the next two studies focused on the association between blood levels of erythritol and heart attack/stroke risk. Their results were predictable.

  • High blood levels of erythritol were associated with an increased risk of heart attack and stroke over the next three years.

Flaws In This Portion Of The Study:thumbs down symbol

  • As the authors of the study pointed out, these studies were done with older patients with pre-existing heart disease who were at high risk of heart attack or stroke. They acknowledged that it is not known whether these associations exist with younger, healthier patients.
  • As the authors also pointed out, these are associations. They do not prove cause and effect. In particular, the studies did not measure the diet, exercise habits, and other lifestyle factors of these patients that may have contributed to their increased risk of heart attack and stroke.
  • When you look closely at the data, it is clear that the association is only seen at the highest blood levels of erythritol. Specifically, the blood levels of erythritol in these patients were divided into quartiles. The risk of heart attack and stroke in the first three quartiles (low to moderate blood levels of erythritol) were identical to the control. However, the fourth quartile (highest blood levels of erythritol) was associated with a dramatically increased risk of heart attack and stroke. That raises three important questions:
    • “How much erythritol were patients in the fourth quartile consuming?”
      • The authors did not look at dietary intake of erythritol but did note a previous study estimated that Americans consume up to 30 grams of erythritol a day.
    • 30 grams of erythritol a day is a huge amount of erythritol. Where does that erythritol come from?
      • Much of it comes from erythritol-containing highly processed foods like zero calorie sugar substitutes (either erythritol alone or erythritol mixed with artificial sweeteners to improve the taste); reduced- and low calorie carbonated and non-carbonated beverages; hard candy and cough drops, cookies, cakes, pastries, and bars; puddings and pie fillings; soft candies; syrups and toppings; ready to eat cereals; fruit novelty snacks; and frozen desserts.
      • But it is also found in foods you might not suspect, such as plant-based “milk” substitutes; chocolate and flavored milks; barbecue and tomato sauce, fruit-based smoothies, the syrup used in canned fruits, yoghurt; low calorie salad dressings; and salty snacks.
      • In other words, the only way anyone can consume 30 grams of erythritol in a day is to consume large quantities of erythritol-containing highly processed foods (I will discuss the significance of this observation later).
    • “What else was different about patients in the fourth quartile?”
      • When you look carefully at the data, the patients in the fourth quartile were significantly older, with a higher incidence of diabetes, pre-existing coronary artery disease, previous non-fatal heart attacks, congestive heart failure, and greater triglycerides – all of which significantly increase their risk of heart attack and stroke.

#2: Mechanistic Studies:

Next the authors did in vitro and animal studies looking at the effect of high levels of erythritol on blood clotting.

  • These studies showed that high levels of erythritol promoted blood clotting both in vitro and in mice. The authors concluded that these studies provided a plausible mechanism for a link between high erythritol blood levels and increased risk of heart attack and stroke.

Flaws In This Portion Of The Study:thumbs down symbol

  • Other critics have pointed out that the assays used were not accurate models of blood clotting in humans. This particular critique is beyond my expertise, so I won’t comment further. However:
    • As someone who was involved in cancer drug development for over 30 years, I know that in vitro and animal models are poor indicators of how things work in humans.
    • And as a biochemist, I have two concerns:
      • The authors provided no mechanistic rationale for why erythritol would enhance blood clotting.
      • The authors made no effort to show that the effect of erythritol was unique. Would high levels of other sugar alcohols or other naturally occurring sugars have the same effect on blood clotting in their assays? We don’t know.

#3: Blood Levels Of Erythritol After Oral Intake.

Finally, the authors gave subjects 30 grams of erythritol and measured blood levels over the next several days.

  • This experiment showed that very high blood levels of erythritol were attained and maintained for at least two days before gradually decreasing to baseline. The authors concluded this experiment showed that it was feasible to attain and maintain high blood levels of erythritol for several days following a single ingestion of 30 grams of erythritol.

Flaws In This Portion Of The Study:thumbs down symbol

  • I have already pointed out that 30 grams per day is a huge amount of erythritol. However, erythritol in the diet will come from a variety of foods, some of which will contain components (fiber etc.) that slow the absorption of erythritol.
  • In contrast, the subjects in this experiment were given 300 ml of liquid containing 30 grams of erythritol and told to drink it in two minutes!
  • In other words, these subjects were consuming 30 grams of erythritol in 2 minutes rather than 24 hours, and they were consuming it in the most easily absorbable form. For a study like this, that makes the effective dose orders of magnitude greater than the amount of erythritol that anyone consumes from their diet over a 24-hour period. The study design was completely unrealistic.

Is Erythritol Bad For Your Heart?

Question MarkAs described above, this is the first study to suggest an association between erythritol and heart disease, and it was a highly flawed study.

It is also important to know that erythritol is not an artificial sweetener. It is found naturally in foods like grapes, peaches, pears, watermelons, and mushrooms. It is also found in some fermented foods like cheese, soy sauce, beer, sake, and wine.

It is also a byproduct of normal human metabolism, so we always have some of it circulating in our bloodstream. Our body knows how to handle low to moderate intakes of erythritol.

However, to help you really understand what this study means, I need to put it into the context of other studies. I will do this in story form (You will find more details about these studies in my book “Slaying The Food Myths”).

First, let’s look at highly processed food consumption:

  • Multiple recent studies have shown that high consumption of highly processed food is associated with increased risk of obesity, diabetes, heart disease, and premature death. We don’t know what it is about highly processed food consumption that is responsible for the increased risk, but it is unlikely to be just one thing.
  • As I pointed out above, the only way to achieve the high blood levels of erythritol associated with increased heart disease risk is to consume large quantities of erythritol-containing highly processed foods.

Next, let’s follow the history of sweeteners in highly processed foods.

  • When I was a young man, sucrose (table sugar) was added to most highly processed foods. Sucrose is foundsugar cubes naturally in many fruits and vegetables. Small to moderate intake of sucrose in unprocessed and minimally processed foods posed no problem. However, large intakes of sugar in highly processed foods were found to increase the risk of obesity, diabetes, heart disease, and premature death.
  • At that point, sucrose became a “sugar villain”, and Big Food, Inc substituted fructose and high fructose corn syrup (a mixture of fructose and glucose) for sugar in their highly processed foods. As with sucrose, fructose is found naturally in many foods, and small to moderate intakes of fructose and high fructose corn syrup posed no health risks. However, large intakes of fructose and high fructose corn syrup in highly processed foods were found to increase the risk of obesity, diabetes, heart disease, and premature death.
  • Fructose and high fructose corn syrup then became the sugar villains. And because high fructose corn syrup is chemically and biologically indistinguishable from natural sugars like honey, date sugar, coconut sugar, it is likely that high intakes of these sugars in highly processed foods would cause the same problem.
  • So Big Food, Inc started relying on artificial sweeteners in their highly processed foods. But guess what? Artificial SweetenersRecent studies have suggested that artificial sweeteners in highly processed foods are associated with obesity, diabetes, and heart disease.
  • That has caused Big Food, Inc to rely more on sugar alcohols in their highly processed foods, particularly erythritol because it is the least expensive of the sugar alcohols. Now the current study comes along and suggests that high intake of erythritol in highly processed foods may increase the risk of heart disease.
  • If this hypothesis is confirmed by better designed studies, it is not clear what Big Food, Inc will do next. The metabolomic study described above showed that high blood levels of several other sugar alcohols are associated with an increased risk of heart disease.

Hopefully, you are starting to see a pattern here. It’s time to ask the question, “Is it the sweetener, or is it the food?”

Clearly, it doesn’t matter what sweetener we are talking about. Large intake of any natural sweetener in the context of a diet rich in highly processed foods appears to have an adverse effect on our health. And we don’t know whether these adverse health effects are caused by the sweetener or some other component of the highly processed foods.

If you want to improve your health, the best solution is to decrease your intake of highly processed foods. That will automatically reduce your intake of sweeteners and other unhealthy components of highly processed foods and increase your intake of healthy components from the whole foods you will be eating instead.

Who Should Be Concerned About Erythritol Intake?

The authors of this study identified two groups who should be most concerned about erythritol consumption – diabetics and adherents of the keto diet.

  • Diabetics are at high risk because they are told to consume non-caloric sweeteners instead of sugars, and they are not told to avoid highly processed foods. Consequently, they consume much higher amounts of non-caloric sweeteners than the average American.
  • I must admit that I didn’t foresee keto adherents as a high-risk group. However, it appears that keto enthusiasts love their sweets as much as the rest of us, and the sweetener of choice for keto-friendly sweets is erythritol. The authors said that a single serving of keto ice cream contains 30 grams of erythritol. I can hardly imagine how much erythritol they must be getting in their diet.

And, once again, the best advice for both groups is to simply decrease the amount of highly processed food in their diet.

The Bottom Line 

Erythritol is not an artificial sweetener. It is found naturally in foods like grapes, peaches, pears, watermelons, and mushrooms. It is also found in some fermented foods like cheese, soy sauce, beer, sake, and wine.

It is also a byproduct of normal human metabolism, so we always have some of it circulating in our bloodstream. Our body knows how to handle erythritol.

That is why it was a surprise when a recent study claimed that high intake of erythritol is associated with an increased risk of heart attack and stroke. The Dr. Strangeloves of the world are already starting to tell you that erythritol is deadly and you should avoid it at all costs. But reputable scientists are saying, “Not so fast”.

This is the first study to suggest an association between erythritol and heart disease, and it was a highly flawed study.

In fact, the study showed that low to moderate intakes of erythritol had no effect on heart disease risk. It was only the highest intake of erythritol that was associated with increased risk of heart disease. And given the distribution of erythritol in the American diet, the only way someone could take in that much erythritol is to consume large amounts of erythritol-sweetened highly processed foods.

A brief review of the literature on sweeteners reveals that this is a common pattern for every natural sweetener tested. Low to moderate intake of these sweeteners has no adverse health effects. However, high intake of every sweetener tested in the context of a highly processed food diet is associated with an increased risk of obesity, diabetes, heart disease, and premature death.

That raises the question, “Is it the sweetener, or is it the food?”

Clearly, it doesn’t matter what sweetener we are talking about. Large intake of any natural sweetener in the context of a diet rich in highly processed foods is likely to have an adverse effect on our health. And we don’t know whether these adverse health effects are caused by the sweetener or some other component of a highly processed food diet.

If you want to improve your health, the best solution is to decrease your intake of highly processed foods. That will automatically reduce your intake of sweeteners and other unhealthy components of highly processed foods and increase your intake of healthy components from the whole foods you will be eating instead.

For more details on the study and information about which foods are likely to contain erythritol and the population groups who should be most concerned about erythritol consumption, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease

Can Unhealthy Eating Give You Colon Cancer?

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What Are Ultra-Processed Foods, And Why Might They Cause Colon Cancer? 

Author: Dr. Stephen Chaney 

The new year is almost here. If you are like millions of Americans, you may already be making a list of potential New Year’s resolutions and “checking it twice”. If weight loss and a healthier diet are important to you, you may want to put cutting back on ultra-processed foods at the top of your list.

And that’s not easy to do. We love our junk foods and our convenience foods.

  • It’s so easy to just stop by the nearest drive-through to pick up a quick meal. And we are hardwired to desire sweet, salty, and fatty foods. That’s why we love the taste of junk foods.
  • We lead busy lives. It’s easier and quicker to pop prepackaged foods into the microwave or oven than prepare a meal from scratch.
  • Even when we go on a diet to lose weight or improve our health, we want quick and easy. And “Big Food Inc” is only too happy to grant us our wish. They offer ultra-processed meals for every weight loss plan and diet program.
  • Many of us are second or third generation junk and convenience food lovers. Junk and convenience foods have become normal. Ultra-processed foods now make up 57% of the daily calories consumed by most Americans.
    • For example, my mother believed in a balanced diet as long as the foods came from a can or a box. That was normal for me growing up. If my wife had not been brought up very differently, I would not be nearly as healthy as I am today.

Unfortunately, it is becoming increasingly clear that ultra-processed foods are bad for us. In recent issues of “Health Tips From the Professor” I have shared studies suggesting that ultra-processed foods make us fat, increase our risk of diabetes, and increase our risk of cancer. And if that weren’t bad enough, ultra-processed foods give us gas.

The cancer study referenced above showed that ultra-processed foods increased the risk of overall cancer and breast cancer but did not break it down into other kinds of cancer.

Colon cancer ranks third in overall cancers and second in cancer deaths for both men and women. And foods like processed meats are thought to increase the risk of colon cancer. This inspired the authors of a recent study to ask whether ultra-processed foods increased the risk of colon cancer.

What Are Ultra-processed Foods, And Why Might They Cause Colon Cancer?

Fast Food ExamplesUltra-processed foods:

  • Usually go through several physical and chemical processes, such as extruding, molding, prefrying, and hydrogenation that can lead to the formation of toxic carcinogens that may increase the risk of colon cancer.
    • One example you may have heard about recently would be acrylamide in French fries. Another example would be nitrosamines in processed meats.
  • Are usually high in added sugar, fat, and refined starch which contribute to increased weight gain and obesity, an established risk factor for colon cancer.
  • Are usually low in phytonutrients, fiber, calcium, and vitamin D, which are known to reduce the risk of colon cancer
  • Typically contain ingredients of little or no nutritive value, such as refined sugar, hydrogenated oils, emulsifiers, artificial sweeteners, thickening agents, and artificial colors. Some of these ingredients, such as emulsifiers and artificial sweeteners, have been suggested to cause inflammation in the intestine, which is known to increase the risk of colon cancer.
  • Have long shelf-lives because of added preservatives. This allows migration of carcinogens such as bisphenol A from the packaging materials into the food.

Examples of ultra-processed foods include:

  • Sodas
  • Chips
  • Candy and packages of cookies or crackers
  • Most breakfast cereals
  • Boxed cake, cookie, and pancake mix
  • Chicken nuggets and fish sticks
  • Fast food burgers
  • Hot dogs and other processed meat
  • Infant formula
  • Instant noodles
  • Most store-bought ice cream
  • Flavored yogurt

How Was This Study Done?

clinical studyThis study used data collected from:

  • The Nurses’ Health Study (NHS) which enrolled 121,700 female nurses aged 30-55 in 1976 and followed them for 28 years.
  • The Nurses’ Health Study II (NHS II) which enrolled 116,429 female nurses aged 25-42 in 1989 and followed them for 24 years.
  • The Health Professions’ Follow-up Study (HPFS) which enrolled 51,529 male health professionals aged 40-75 in 1986 and followed them for 28 years.

After excluding participants who had incomplete data or a previous cancer diagnosis, the investigators running the study ended up with 67,425 women from NHS, 92,482 women from NHS II, and 46,341 men from HPFS for analysis.

Ultra-processed food consumption was scored as follows:

  • The dietary intake of each participant in the studies was assessed with a food frequency questionnaire every four years.
  • Each questionnaire was scored for the percentage of ultra-processed foods.
  • Then each participant in the study was ranked in terms of the percent ultra-processed foods in their diet averaged over the entire time they were enrolled in the study.
  • The participants were then divided into 5 groups based on the number of servings of ultra-processed foods/day they consumed, ranging from a high of 9 servings/day to a low of 3 servings/day.

Every two years the participants were asked to report any cancer diagnosis in the previous two years. Study physicians reviewed the medical records and pathology reports to confirm a diagnosis of colon cancer. If the patient had died, death certificates and medical records were used to confirm a diagnosis of colon cancer.

The investigators then compared the incidence of colon cancer in the group consuming the most ultra-processed foods to the group consuming the least ultra-processed foods.

  • These comparisons were adjusted for compounding factors like race, family history of cancer, history of endoscopy, physical activity, smoking status, alcohol use, aspirin use, menopausal status, and post-menopausal hormone use.
  • The comparisons were also adjusted for obesity and a healthy diet score called AHEI. I will explain the significance of these adjustments below.
  • Finally, the investigators looked at how various categories of ultra-processed food influenced the results.

Can Unhealthy Eating Give You Colon Cancer?

colon cancerHere is what the study found:

  • Men in the highest fifth of ultra-processed food consumption had a 29% higher risk of developing colon cancer than those in the lowest fifth.
  • No association between ultra-processed food consumption and risk of developing colon cancer was seen for women.

When they looked at subgroups of ultra-processed foods again comparing the top fifth in consumption with the lowest fifth:

  • Consumption of ultra-processed ready to eat products containing meat, poultry, or seafood increased the risk of colon cancer by 44% in men and 14% in women.
  • Consumption of sugar-sweetened beverages increased the risk of colon cancer by 21% in men but did not significantly affect risk of colon cancer in women.
  • Consumption of ultra-processed ready to eat mixed dishes increased the risk of colon cancer by 17% in women but did not significantly affect risk of colon cancer in men.
  • Consumption of ultra-processed dairy products decreased the risk of colon cancer by 17% in women but did not significantly affect risk of colon cancer in men.

The reason for the differing effect of poor diet on the risk of colon cancer in men and women is not clear, but it has been observed in previous studies.

The investigators concluded, “…high consumption of total ultra-processed foods in men and certain subgroups of ultra-processed foods in men and women was associated with an increased risk of colorectal cancer. Further studies are needed to better understand the potential attributes of ultra-processed foods that contribute to colorectal carcinogenesis.”

What Does This Study Mean For You?

There are several take-home lessons from this study:

1: The 29% increase in colon cancer risk reported for men probably underestimates the true risk. I say that because:

  • Ultra-processed food consumption increases the likelihood that you will gain weight, and obesity is a known risk factor for colon cancer. However, the 29% number was obtained after adjusting the data for obesity. Without that adjustment the increased risk would have been greater
  • Ultra-processed foods are low in the protective phytonutrients and fiber provided by fruits, vegetables, and whole grains. However, the 29% number was obtained after adjusting the data for a healthy eating index (which includes the amounts of fruits, vegetables, and whole grains in the diet). Without that adjustment the increased risk would have been greater.

2: While we don’t know the mechanism(s) for the increased risk of colon cancer reported in this study, we can make some informed guesses. I say that because:

  • Once you have removed obesity and fruits, vegetables, and whole grains from consideration, you are left with:
    • The effect of ultra-processed foods on your gut bacteria.
    • The additives, preservatives, and other potentially carcinogenic chemicals in ultra-processed foods.

3: Finally, don’t think you are off the hook if you are a woman.

  • As I mentioned in the introduction, ultra-processed foods also increase your risk of obesity, diabetes, and breast cancer.

And that brings us back to what I said at the beginning of this article, “If you are like millions of Americans, you may already be making a list of New Year’s resolutions and “checking it twice”. If weight loss and a healthier diet are important to you, you may want to put cutting back on ultra-processed foods at the top of your list.”

The Bottom Line 

A recent study showed that ultra-processed food consumption increased the risk of colon cancer in men, but not in women. The reason for the differing effect of ultra-processed foods on the risk of colon cancer in men and women is not clear, but it has been observed in previous studies on the effect of poor diet on colon cancer risk.

However, don’t think you are off the hook if you are a woman. Previous studies have shown that ultra-processed food consumption increased the risk of obesity, diabetes, and total cancers in both men and women and the risk of breast cancer in women.

The investigators concluded, “…high consumption of total ultra-processed foods in men and certain subgroups of ultra-processed foods in men and women was associated with an increased risk of colorectal cancer.”

That brings me to my recommendation. “If you are like millions of Americans, you may already be making a list of potential New Year’s resolutions and “checking it twice”. If weight loss and a healthier diet are important to you, you may want to put cutting back on ultra-processed foods at the top of your list.”

For more details on this study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

 

 

 

Can Diet Protect Your Mind?

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Which Diet Is Best?

Author: Dr. Stephen Chaney 

can diet prevent alzheimer'sAlzheimer’s is a scary disease. There is so much to look forward to in our golden years. We want to enjoy the fruits of our years of hard work. We want to enjoy our grandkids and perhaps even our great grandkids. More importantly, we want to be able to pass on our accumulated experiences and wisdom to future generations.

Alzheimer’s and other forms of dementia have the potential to rob us of everything that makes life worth living. What is the use of having a healthy body, family, and fortune if we can’t even recognize the people around us?

Alzheimer’s and other forms of dementia don’t happen overnight. The first symptoms of cognitive decline are things like forgetting names, where you left things, what you did last week. For most people it just keeps getting worse.

Can diet protect your mind? Recent studies have given us a ray of hope. For example, several meta-analyses have shown that adherence to the Mediterranean diet was associated with a 25-48% lower risk of cognitive decline and dementia.

However, there were several limitations to the studies included in these meta-analyses. For example:

  • For most of the studies the diet was assessed only at the beginning of the study. We have no idea whether the participants followed the same diet throughout the study. This means, we cannot answer questions like:
    • What is the effect of long-term adherence to a healthy diet?
    • Can you reduce your risk of cognitive decline if you switch from an unhealthy diet to a healthy diet?
  • These studies focused primarily on the Mediterranean diet. This leaves the question:
    • What about other healthy diets? Is there something unique about the Mediterranean diet, or do other healthy diets also reduce the risk of cognitive decline?

This study (C Yuan et al, American Journal of Clinical Nutrition, 115: 232-243, 2022) was designed to answer those questions.

How Was The Study Done?

clinical studyThe investigators utilized data from The Nurse’s Health Study. They followed 49,493 female nurses for 30 years from 1984 to 2014. The average age of the nurses in 1984 was 48 years, and none of them had symptoms of cognitive decline at the beginning of the study.

The nurse’s diets were analyzed in 1984, 1986, and every 4 years afterwards until 2006. Diets were not analyzed during the last 8 years of the study to eliminate something called “reverse causation”. Simply put, the investigators were trying to eliminate the possibility that participants in the study might change their diet because they were starting to notice symptoms of cognitive decline.

The data from the dietary analyses were used to calculate adherence to 3 different healthy diets:

  • The Mediterranean diet.
  • The DASH diet. The DASH diet was designed to reduce the risk of high blood pressure. But you can think of it as an Americanized version of the Mediterranean diet.
  • The diet recommended by the USDA. Adherence to this diet is evaluated by something called the Alternative Healthy Eating Index or AHEI.

Adherence to each diet was calculated by giving a positive score to foods that were recommended for the diet and a negative score for foods that were not recommended for the diet. For more details, read the article.

In 2012 and 2014 the nurses were asked to fill out questionnaires self-assessing the early stages of cognitive decline. They were asked if they had more trouble than usual:

  • Remembering recent events or remembering a short list of items like a grocery list (measuring memory).
  • Understanding things, following spoken instructions, following a group conversation, or following a plot in a TV program (measuring executive function).
  • Remembering things from one second to the next (measuring attention).
  • Finding ways around familiar streets (measuring visuospatial skills).

The extent of cognitive decline was calculated based on the number of yes answers to these questions.

Can Diet Protect Your Mind?

Vegan FoodsHere is what the investigators found when they analyzed the data:

At the beginning of the study in 1984 there were 49,493 female nurses with an average age of 48. None of them had symptoms of cognitive decline.

  • By 2012-2014 (average age = 76-78) 46.9% of them had cognitive decline and 12.3% of them had severe cognitive decline.

Using the data on dietary intake and the rating systems specific to each of the diets studied, the investigators divided the participants into thirds based on their adherence to each diet. The investigators then used these data to answer two important questions that no previous study had answered:

#1: What is the effect of long-term adherence to a healthy diet? To answer this question the investigators averaged the dietary data obtained every 4 years between 1984 and 2006 to obtain cumulative average scores for adherence to each diet. When the investigators compared participants with the highest adherence to various healthy diets for 30 years to participants with the lowest adherence to those diets, the risk of developing severe cognitive decline was decreased by:

  • 40% for the Mediterranean diet.
  • 32% for the DASH diet.
  • 20% for the USDA-recommended healthy diet (as measured by the AHEI score).

#2: Can you reduce your risk of cognitive decline if you switch from an unhealthy diet to a healthy diet? To answer this question, the investigators looked at participants who started with the lowest adherence to each diet and improved to the highest adherence by the end of the study. This study showed that improving from an unhealthy diet to a healthy diet over 30 years decreased the risk of developing severe cognitive decline by:

  • 20% for the Mediterranean diet.
  • 25% for the DASH diet.

There were a few other significant observations from this study.

  • The inverse association between healthy diets and risk of cognitive decline was greater for nurses who had high blood pressure.
    • This is an important finding because high blood pressure increases the risk of cognitive decline.
  • The inverse association between healthy diets and risk of cognitive decline was also greater for nurses who did not have the APOE-ɛ4 gene.
    • This illustrates the interaction of diet and genetics. The APOE-ɛ4 gene increases the risk of cognitive decline. Healthy diets reduced the risk of cognitive decline in nurse with the APOE-ɛ4 gene but not to the same extent as for nurses without the gene.

This study did not investigate the mechanism by which healthy diets reduced the risk of cognitive decline, but the investigators speculated it might be because these diets:

  • Were anti-inflammatory.
  • Supported the growth of healthy gut bacteria.

The investigators concluded, “Our findings support the beneficial roles of long-term adherence to the [Mediterranean, DASH, and USDA] dietary patterns for maintaining cognition in women…Further, among those with initially relatively low-quality diets, improvement in diet quality was associated with a lower likelihood of developing severe cognitive decline. These findings indicate that improvements in diet quality in midlife and later may have a role in maintenance of cognitive function among women.”

Which Diet Is Best?

Mediterranean Diet FoodsIn a sense this is a trick question. That’s because this study did not put the participants on different diets. It simply analyzed the diets the women were eating in different ways. And while the algorithms they were using were diet-specific, there was tremendous overlap between them. For more specifics on the algorithms used to estimate adherence to each diet, read the article.

That is why the investigators concluded that all three diets they analyzed reduced the risk of cognitive decline rather than highlighting a specific diet. However, based on this and numerous previous studies the evidence is strongest for the Mediterranean and DASH diets.

And I would be remiss if I didn’t also mention the MIND diet. While it was not included in this study, the MIND diet:

  • Was specifically designed to reduce cognitive decline.
  • Can be thought of as a combination of the Mediterranean and DASH diets.
  • Includes data from studies on the mind-benefits of individual foods. For example, it recommends berries rather than all fruits.

The MIND diet has not been as extensively studied as the Mediterranean and DASH diets, but there is some evidence that it may be more effective at reducing cognitive decline than either the Mediterranean or DASH diets alone.

Which Foods Are Best?

AwardThe authors of this study felt it was more important to focus on foods rather than diets. This is a better approach because we eat foods rather than diets. With that in mind they analyzed their data to identify the foods that prevented cognitive decline and the foods increased cognitive decline. This is what they found:

  • Fruits, fruit juices, vegetables, fish, nuts, legumes, low-fat dairy, and omega-3 fatty acids (fish oil) reduced the risk of cognitive decline.
  • Red and processed meats, omega-6 fatty acids (most vegetable oils), and trans fats increased the risk of cognitive decline.

While this study did not specifically look at the effect of processed foods on cognitive decline, diets high in the mind-healthy foods listed above are generally low in sodas, sweets, and highly processed foods.

What Does This Study Mean For You?

Question MarkThe question, “Can diet protect your mind”, is not a new one. Several previous studies have suggested that healthy diets reduce the risk of cognitive decline, but this study breaks new ground. It shows for the first time that:

  • Long-term adherence to a healthy diet can reduce your risk of cognitive decline by up to 40%.
    • This was a 30-year study, so we aren’t talking about “diet” in the traditional sense. We aren’t talking about short-term diets to drop a few pounds. We are talking about a life-long change in the foods we eat.
  • If you currently have a lousy diet, it’s not too late to change. You can reduce your risk of cognitive decline by switching to a healthier diet.
    • This is perhaps the best news to come out of this study.

Based on current evidence, the best diets for protecting against cognitive decline appear to be the Mediterranean, DASH, and MIND diets.

And if you don’t like restrictive diets, my advice is to:

  • Eat more fruits, fruit juices, vegetables, fish, nuts, legumes, low-fat dairy, and omega-3 fatty acids (fish oil).
  • Eat less red and processed meats, omega-6 fatty acids (most vegetable oils), and trans fats.
  • Eat more plant foods and less animal foods.
  • Eat more whole foods and less sodas, sweets, and processed foods.

And, of course, a holistic approach is always best. Other lifestyle factors that help reduce your risk of cognitive decline include:

  • Regular exercise.
  • Weight control.
  • Socialization.
  • Memory training (mental exercises).

The Bottom Line 

Alzheimer’s is a scary disease. What is the use of having a healthy body, family, and fortune if we can’t even recognize the people around us?

A recent study looked at the effect of diet on cognitive decline in women. The study started with middle-aged women (average age = 48) and followed them for 30 years. The investigators then used these data to answer two important questions that no previous study had answered:

#1: What is the effect of long-term adherence to a healthy diet? When the investigators compared participants with the highest adherence to various healthy diets for 30 years to participants with the lowest adherence to those diets, the risk of developing severe cognitive decline was decreased by:

  • 40% for the Mediterranean diet.
  • 32% for the DASH diet.
  • 20% for the USDA recommendations for a healthy diet.

#2: Can you reduce your risk of cognitive decline if you switch from an unhealthy diet to a healthy diet? This study showed that improving from an unhealthy diet to a healthy diet over 30 years decreased the risk of developing severe cognitive decline by:

  • 20% for the Mediterranean diet.
  • 25% for the DASH diet.

The investigators concluded, “Our findings support the beneficial roles of long-term adherence to the [Mediterranean, DASH, and USDA] dietary patterns for maintaining cognition in women…Further, among those with initially relatively low-quality diets, improvement in diet quality was associated with a lower likelihood of developing severe cognitive decline. These findings indicate that improvements in diet quality in midlife and later may have a role in maintenance of cognitive function among women.”

For more details on the study, which diets, and which foods are best for protecting your mind, and what this study means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Does Processed Food Give You Gas?

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Why Does Processed Food Give You Gas?

Author: Dr. Stephen Chaney 

Does it feel like a war is going on in your belly every time you eat? It could be IBD (inflammatory bowel disease). IBD can take several forms, but the two most common are Crohn’s disease and ulcerative colitis.

What do we know about IBD?

  • The symptoms of IBD can make you miserable. They include:
    • Abdominal pain and cramping.
    • Diarrhea with occasional bouts of constipation.
    • Gas and bloating.
    • Loss of appetite and/or unexpected weight loss.
  • There are about 1.6 million Americans with IBD and 70,000 new cases/year.
    • The prevalence of IBD in the United States has increased by 34% between 2006 and 2016.
  • As you might suspect from its name, IBD is a chronic inflammation of the gastrointestinal tract.
    • It is thought to be caused by “dysbiosis of the gastrointestinal track” (In layman’s terms that means damage to your intestine caused by too many bad bacteria and not enough good bacteria).
    • There is also a genetic component to the disease. Some people are much more susceptible to IBD than others.

If you watch TV, you know that there are drugs for treating IBD. The ads make them sound like miracle drugs. But if you listen carefully, you also know that these drugs have a long list of side effects. And some of the side effects are pretty scary.

Are There Natural Approaches For Controlling IBD?

BacteriaSo, if your belly is a bit rumbly, you might be wondering if there is a more natural approach you could take. We know that diet affects the balance between bad and good bacteria in our intestine. Could something as simple as changing your diet, quell the fire in your belly?

While the answer seems obvious, it has been hard to prove. The results of previous studies have been inconclusive. That is because previous studies:

  • Included too few people. 1.6 million people in the US with IBD may sound like a lot, but that represents only 0.4% of the population. Unless you have a really big study, there won’t be enough people who develop IBD to give you statistically significant results.
  • Were too short. IBD doesn’t develop overnight.
  • Did not include a diverse enough population. Previous studies were confined to individual countries or specific regions within a country.

This study (N Narula et al, British Medical Journal, 2021;374:n1554) was designed to overcome the limitations of previous studies. It also looked at the effect of diet on IBD from a different perspective than most previous studies.

  • It did not focus on the effect of individual foods on IBD. Since consumption of processed foods is known to affect the population of intestinal bacteria, the authors of this study asked whether processed food consumption might influence the likelihood of developing IBD.

How Was The Study Done?

Clinical StudyThe authors of this study used data collected from the PURE (Prospective Urban Rural Epidemiology) study between January 1, 2003, and December 31, 2016. The PURE study collected data from a very diverse population. Specifically, it collected data from 21 low-, middle-, and high-income countries across 7 geographical regions (Europe, North America, South America, Africa, Middle East, South Asia, Southeast Asia, and China).

  • This study followed 116,087 adults aged 35-70 years (average age 50, percent women = 60%) in the PURE study for an average of 9.7 years. During that time, 467 participants (0.4%) developed IBD.
  • All participants filled out a baseline food-frequency questionnaire that had been designed and validated for foods specific to their country.
  • Participants were asked if they had a diagnosis of Crohn’s disease or ulcerative colitis as part of an annual follow-up questionnaire. To assure the accuracy of these answers they were validated with medical records whenever possible.

Does Processed Food Give You Gas?

Does processed food give you gas? Does it give you abdominal pain, diarrhea, and bloating? In short, does it give you IBD? That is the question this study was designed to answer. Here are the results of the study:

  • When comparing those eating the most processed food (≥5 servings/day) to those consuming the least (≤1 serving/day), processed food consumption increased the risk of developing IBD by 1.82-fold. This finding was equally true for:
    • Both Crohn’s disease and ulcerative colitis.
    • Adults <50 and adults >50.
    • Every region of the world included in the PURE study.
  • When the investigators looked at different categories of processed foods:
    • Processed meat intake increased the risk of IBD by 2.07-fold.
    • Soft drink intake increased the risk of IBD by 1.94-fold.
    • Refined sweetened food intake increased the risk of IBD by 2.58-fold.
    • Salty food and snack intake increased the risk of IBD by 2.06-fold.
  • When the investigators looked at different categories of unprocessed foods:
    • White meat, red meat, dairy, starchy foods, fruits, vegetables, and legumes had no effect on the risk of developing IBD.
    • Sodium intake (as measured by urinary excretion of sodium) also had no effect on the risk of developing IBD.

Why Does Processed Food Give You Gas?

Question MarkYou may be wondering why does processed food give you gas – and other symptoms of IBD.

The simplest explanation is that whole grains, unprocessed fruits & vegetables, and legumes provide the fiber that supports the growth of friendly gut bacteria. Processed foods displace these foods from our diet.

But these investigators think something else about processed foods may be contributing to the increased risk of IBD. That is because in their study:

  • Processed meat increased the risk of IBD, but unprocessed white and red meat had no effect on IBD.
  • Processed sweetened foods increased the risk of IBD, but unprocessed starchy foods and naturally sweet fruits had no effect on IBD.
  • Processed salty foods and snacks increased the risk of IBD, but sodium intake had no effect on IBD.

The investigators also noted that in mouse studies:

  • Some food additives found in processed foods cause bacteria to stick to the epithelial lining of the intestine and/or cause leaky gut syndrome, both of which can lead to chronic inflammation of the intestine.

The investigators concluded, “In this study, higher ultra-processed food intake was associated with a higher risk of IBD.”

They went on to say, “As white meat, unprocessed red meat, dairy, starchy foods, fruits, vegetables, and legumes were not found to be associated with development of IBD, this study suggests that it may not be the food itself that confers this risk but rather the way the food is processed or ultra-processed…Further studies are needed to identify specific potential contributing factors among processed foods that might be responsible for the observed associations in our study.”

[Note: This is a fancy way of saying that the detrimental effects of processed foods may be due to more than the fact that they displace healthier foods from the diet. It may also be due to the effect of food additives on the risk of developing IBD.]

What Does This Study Mean For You?

Questioning WomanIBD is a rare disease (0.4% of the population). If you don’t have digestive issues, it would be easy to ignore this study and continue with a diet of highly processed foods.

However, I would remind you that in recent issues of “Health Tips From the Professor”, I have shared recent studies showing that highly processed foods increase your risk of:

And these studies are just the tip of the iceberg. We know that diets rich in whole grains and unprocessed fruits and vegetables decrease the risk of heart attack, stroke, and Alzheimer’s disease. And a diet rich in whole grains, fruits, and vegetables is the antithesis of a processed food diet.

The evidence is overwhelming. Highly processed foods may be convenient and tasty. But if you value your health, they are not your friends.

The Bottom Line 

A recent study looked at the effect of consuming processed foods on the risk of developing inflammatory bowel disease (IBD). The study found:

  • When comparing those eating the most processed food (≥5 servings/day) to those consuming the least (≤1 serving/day), processed food consumption increased the risk of developing IBD by 1.82-fold. This finding was equally true for:
    • Both Crohn’s disease and ulcerative colitis.
    • Adults <50 and adults >50.
    • Every region of the world included in the study.

The investigators concluded, “In this study, higher ultra-processed food intake was associated with a higher risk of IBD.”

They went on to say, “…This study suggests that it may not be the food itself that confers this risk but rather the way the food is processed or ultra-processed…Further studies are needed to identify specific potential contributing factors among processed foods that might be responsible for the observed associations in our study.”

[Note: This is a fancy way of saying that the detrimental effect of processed foods may be due to more than the fact that they displace healthier foods from the diet. It may also be due to the effect of food additives commonly found in processed foods on the risk of developing IBD.]

For more details on the study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Is Diabetes Increasing In Our Children?

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Why Is Diabetes Increasing In Our Children? 

Author: Dr. Stephen Chaney

Last week I shared a study documenting the alarming increase in ultraprocessed food consumption by our children and the effect it was having on their health (https://chaneyhealth.com/healthtips/are-we-killing-our-children-with-kindness/). For example, childhood obesity is closely linked to ultraprocessed food consumption.

In case you don’t understand why that is, here is what I said last week: “Because ultraprocessed foods are made in a factory, not grown on a farm:

  • They are high in fat, sugar, and refined carbohydrates. That means they have a high caloric density. Each bite has 2-3 times the calories found in a bite of fresh fruits and vegetables.
  • Even worse, the food industry has weaponized our natural cravings for sweet, salty, and fatty foods. They feed their prototypes to a series of consumer tasting panels until they find the perfect blend of sugar, salt, and fat to create maximum craving.
  • And if that weren’t enough, they add additives to create the perfect flavor and “mouth appeal”.
    • It is no wonder that clinical studies have found a strong correlation between high intake of ultraprocessed food and obesity in both children and adults.
    • It is also no wonder that the rate of childhood obesity has almost quadrupled in the last 40 years.”

Unfortunately, whenever you see an increase in obesity, type 2 diabetes is not far behind. Several studies have reported a dramatic increase in type 2 diabetes in our children over the last 20 years.

Because diabetics can manage their blood sugar levels with insulin and/or a variety of drugs, many people consider it as just an inconvenience. Nothing could be further from the truth. Diabetes is a deadly disease, and it is even deadlier when it appears early in life.

You probably already know that long-term complications of diabetes include heart disease and irreversible damage to nerves, kidneys, eyes, and feet. But you may not have known that childhood diabetes is more dangerous than diabetes in adults because:

  • It is more challenging to manage in children.
  • The complications of diabetes start to show up much earlier in life and affect quality of life at a much earlier age. For example:
    • Cardiovascular events occur 15 years earlier in someone with diabetes.
    • On average, a 50-year-old with diabetes will die 6 years earlier than someone without diabetes.
    • On average, a 10-year-old with diabetes will die 19 years earlier than a child without diabetes.

The study (JM Lawrence et al, JAMA, 326: 717-727, 2021) I will discuss today is the largest and most comprehensive study of childhood diabetes to date.

How Was This Study Done?

Clinical StudyThe data for this study were obtained from the SEARCH For Diabetes In Youth Study. This study collected data on physician-diagnosed cases of diabetes in 3.47 million children ages 19 or younger from 6 geographical areas in the US in 2001, 2009, and 2017.

The 6 geographical areas were:

  • Southern California (7 counties, including Los Angeles).
  • Colorado (14 counties, including Denver).
  • Ohio (8 counties, including Cincinnati)
  • South Carolina (4 counties, including Columbia).
  • Washington State (5 counties, including Seattle).
  • Indian Health Service users in select areas of Arizona and New Mexico.

The data on diabetes diagnoses were obtained by creating active surveillance networks composed of pediatric and adult endocrinologists, other clinicians, hospitals, and health plans in the study areas.

Is Diabetes Increasing In Our Children?

IncreaseTo answer this question let’s start with a historical perspective:

  • In 1950 obesity in US children was rare and type 2 diabetes in children was practically unknown.
    • Since then, obesity rates have skyrocketed, and type 2 diabetes has followed along behind it.
  • Between 1925 and 1950 the prevalence of type 1 diabetes in US children remained constant, but it has been steadily increasing since 1950.
    • Type 1 diabetes remains more prevalent than type 2 diabetes in our children, but the prevalence of type 2 diabetes has been increasing faster than type 1 diabetes.

Now let’s look at the results from the SEARCH For Diabetes In Youth Study:

Prevalence of Type 2 Diabetes:

  • The prevalence of type 2 diabetes in US children aged 10-19 increased from 0.34/1000 youths in 2001, to 0.46/1000 youths in 2009, to 0.67/1000 youths in 2017.
    • This is a 94% increase between 2001 and 2017. Put another way, the prevalence of type 2 diabetes in our children has almost doubled in just 16 years!
    • The greatest increase was seen among Black (0.85/1000 youths), Hispanic (0.57/1000 youths), and American Indian (0.42/1000 youths) population groups.
  • These data are consistent with 3 previous studies reporting a doubling of type 2 diabetes in children over similar time periods.

Note: Since data collection ended in 2017, this study does not take into account the increase in type 2 diabetes caused by increased body weight and reduced activity in children during the pandemic. There are no firm data on the increase in type 2 diabetes in children during the pandemic, but some hospitals have reported increases of 50% to 300% in new diagnoses of type 2 diabetes in 2020.

Prevalence of Type 1 Diabetes:

  • The prevalence of type 1 diabetes in US children aged 19 and younger increased from 1.48/1000 youths in 2001, to 1.93/1000 youths in 2009, to 2.15/1000 youths in 2017.
  • This is a 45% increase between 2001 and 2017.
    • The greatest increase was seen among White (0.93/1000 youths), Black (0.89/1000 youths), and Hispanic (0.59/1000 youths) population groups.
    • These data are consistent with a similar study of type 1 diabetes in children in Holland.

In summary:

  • This study documents a dramatic increase in the prevalence of both type 1 and type 2 diabetes in US children between 2001 and 2017.
  • Type 2 diabetes is still less prevalent than type 1 diabetes in US children, but it is increasing twice as fast.

Why Is Diabetes Increasing In Our Children?

Question MarkWhen it comes to type 2 diabetes, the experts agree:

  • The increase in type 2 diabetes in children is directly related to the obesity epidemic, which is now impacting our children. The obesity epidemic is, in turn, caused by:
    • Decreased exercise. Video games and social media have replaced actual games played outside.

However, when it comes the increase in type 1 diabetes, the experts are perplexed. There is no easy explanation. Let’s start with the basics:

  • Type 1 diabetes is an autoimmune disease. With type 1 diabetics, their immune system starts attacking the insulin-producing beta cells in their pancreas. Consequently, they lose the ability to produce insulin.
  • The autoimmune response seen in type 1 diabetes is caused by a combination of genes and environment. Specifically:
    • Certain genes predispose to type 1 diabetes. However:
      • Only some people with those genes develop type 1 diabetes.
      • Our genetics doesn’t change with time, so genetics cannot explain the increases in type 1 diabetes we are seeing.
  • That leaves the environment. There are many hypotheses about how our children’s environment influences their risk of developing type 1 diabetes. However:
    • Some of these hypotheses involve things that have not changed over the last 15-20 years. They cannot explain the increase in type1 diabetes we are seeing in children.
    • Some of these hypotheses are not supported by good data. They are speculative.

With that in mind, I will list the top 5 current hypotheses and evaluate each of them.

#1: The viral infection hypothesis: Basically, this hypothesis states that type 1 diabetes can be triggered by child with flucommon viral infections such as the flu.

  • This is a plausible hypothesis. Whenever our immune system is stimulated by invaders it sometimes goes rogue and triggers autoimmune responses.
  • It is also supported by good data. The onset of type 1 diabetes is often associated with a viral infection in genetically susceptible children.
  • However, prior to the pandemic viral infections have been constant. They haven’t changed over time. Therefore, they cannot explain an increase in type 1 diabetes between 2001 and 2017.

#2: The hygiene hypothesis: Basically, this hypothesis states that when we raise our children in a sterile environment, their immune system doesn’t develop normally. Essentially the hypothesis is saying that it’s not a bad thing if your toddler eats some dirt and moldy fruits. However:

  • The data linking hygiene to food allergies is better than the data linking hygiene to autoimmune responses.
  • There is no evidence that hygiene practices have changed significantly between 2001 and 2017.

#3: The vitamin D hypothesis: Basically, this hypothesis states that vitamin D deficiency is associated with the autoimmune response that causes type 1 diabetes.

  • One of the functions of vitamin D is to regulate the immune system.
  • As I have reported previously, suboptimal vitamin D levels are associated with increased risk of developing type 1 diabetes.
  • While we know that up to 61% of children in the US have suboptimal vitamin D levels, we don’t know whether that percentage has changed significantly in recent years.

happy gut bacteria#4: The gut bacteria hypothesis: Basically, this hypothesis suggests that certain populations of gut bacteria increase the risk of developing type 1 diabetes. This is what we know.

  • Children who develop type 1 diabetes have a unique population of gut bacteria.
  • This population of gut bacteria also triggers inflammation, and chronic inflammation can lead to autoimmune responses.
  • A diet rich in highly processed foods supports growth of the same gut bacteria found in children with type 1 diabetes.
  • Consumption of highly processed foods has increased significantly in the last twenty years.

#5: The obesity hypothesis: Basically, this hypothesis suggests that obesity increases the risk of developing type 1 diabetes.

  • While the mechanism is not clear, childhood obesity is associated with both inflammatory and autoimmune diseases like type 1 diabetes.
  • Childhood obesity has increased dramatically in the past few years.

As you may have noticed, there are weaknesses to each of these hypotheses. This is why there is no current agreement among experts as to why type 1 diabetes is increasing in our children.

My guess is that none of these hypotheses can fully explain the increase in type 1 diabetes in our children, but that several of them may contribute to it.

What Can We Do?

Family Riding BicyclesWhatever the mechanism, the increase in both type 1 and type 2 diabetes in our children is troubling. Unless this trend is reversed, we may be dooming our children to short, unhealthy lives. So, what can we, as concerned parents and grandparents, do?

For type 2 diabetes, the answer is clear.

1) Reverse the dominance of ultraprocessed foods in children’s diets. Encourage the consumption of whole, unprocessed or minimally processed foods, and include lots of fresh fruits and vegetables. Set a good example as well.

2) Encourage more activity. Get them outside and moving. Create family activities that involve exercise.

3) Reverse the obesity epidemic. If we succeed in reversing the dominance of ultraprocessed foods in their diet and encouraging more activity, we can reverse the obesity epidemic without putting our children on crazy diets.

For type 1 diabetes, the answer is less clear because the cause for the increase in type 1 diabetes is uncertain. However, I will point out that:

1) Increased consumption of fresh fruits and vegetables, whole grains, and legumes supports the growth of friendly gut bacteria that reduce inflammation and the risk of autoimmune diseases. For more detail on an anti-inflammatory diet, click here.

2) Reversing the obesity epidemic also reduces inflammation and the risk of autoimmune diseases.

3) Adequate vitamin D levels reduce the risk of autoimmune diseases, including type 1 diabetes. My recommendation is to get your 25-hydroxyvitamin D levels tested and supplement with vitamin D3 as needed, especially during the winter months.

The Bottom Line

Last week I shared a study documenting the alarming increase in ultraprocessed food consumption by our children and the effect it was having on their health. For example, childhood obesity is closely linked to ultraprocessed food consumption, and the rate of childhood obesity has almost quadrupled in the last 40 years.

Unfortunately, whenever you see an increase in obesity, type 2 diabetes is not far behind. This week’s study looked at the prevalence of childhood diabetes in 3.47 million children from 6 geographical areas of the United States between 2001 and 2017. This study found:

  • The prevalence of type 2 diabetes in US children increased 94% between 2001 and 2017. It almost doubled.
  • The prevalence of type 1 diabetes in US children increased 45% between 2001 and 2017.

These statistics are tragic because diabetes is a deadly disease.

You probably already know that long-term complications of diabetes include heart disease and irreversible damage to nerves, kidneys, eyes, and feet. But you may not have known that childhood diabetes is more dangerous than diabetes in adults because:

  • It is more challenging to manage in children.
  • The complications of diabetes start to show up much earlier in life and affect quality of life at a much earlier age. For example:
    • Cardiovascular events occur 15 years earlier in someone with diabetes.
    • On average, a 50-year-old with diabetes will die 6 years earlier than someone without diabetes.
    • On average, a 10-year-old with diabetes will die 19 years earlier than a child without diabetes.

For more details about this study, why the prevalence of diabetes in US children is increasing, and what we can do about it, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease

Are We Killing Our Children With Kindness?

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The Danger Of Ultraprocessed Foods 

Author: Dr. Stephen Chaney

fast foodIt breaks my heart when I see a mom and her children in the checkout line of a supermarket with a cart filled with sodas, sweets, and convenience foods and devoid of fresh fruits and vegetables – or when I see fast food restaurants packed with parents and their children.

I get it. Our kids love these foods. It seems like an act of kindness to give them the foods they crave. But are we killing our children with kindness?

Let me explain. The human brain is hardwired to crave sweets, salt, and fat. In prehistoric times each of these cravings had a survival benefit. For example:

  • Mother’s milk is naturally sweet. It only makes sense that babies should crave the nutrition source that is essential for their early growth and development.
  • Fruits provide a cornucopia of vitamins, minerals, and phytonutrients. But fruits were scarce and seasonal in prehistoric times. Their sweetness provided an incentive for early man to seek them out.
  • Some salt is essential for life. Yet in early history it was scare. It was worth its weight in gold.
  • In prehistoric times it was feast or famine. The human body has an unlimited capacity to store fat in times of plenty, and those fat stores carried early man through times of famine.

Today most Americans live in a time of food abundance. There are fast food restaurants on almost every street corner and in every shopping mall. We think of famine as the days we skipped lunch because we were busy.

Yet these cravings remain, and the food industry has weaponized them. They are churning out an endless supply highly processed foods and beverages. These foods are not being designed to improve their nutritional value. They are designed to satisfy our cravings and lure us and our children into consuming more of them every year.

Scientists have developed a classification system that assigns foods in the American diet to different groups based on the degree of processing of that food. As you might expect, the best classification is unprocessed foods. The worst classification is called “ultraprocessed foods”. [I will describe this classification system in more detail in the next section.]

It is time we asked how much ultraprocessed foods our children are eating and what it is doing to their health. That is the topic of the study (L Wang et al, JAMA, 326: 519-530, 2021) I will discuss today.

How Was This Study Done?

Clinical StudyThe data for this study were obtained from NHANES (National Health and Nutrition Examination Survey) dietary data collected from 33,795 American children (ages 2-19, average age = 10) between 1999 and 2018.

NHANES is a program conducted by the CDC to survey the health and nutritional status of adults and children in the United States. The survey has been conducted on a continuous, yearly basis since 1999.

The dietary data are collected via 24-hour dietary recalls conducted by trained interviewers, with a second recall administered over the phone 3-10 days later to improve the accuracy of the data.

  • Children aged 12-19 completed the dietary survey on their own.
  • For children aged 6-11, a parent or guardian assisted them in filling out the survey.
  • For children aged 2-5, a parent or guardian filled out the survey for them.

The foods and beverages consumed by the children were divided into 4 major groups based on the extent of processing using a well-established classification system called NOVA. The 4 groups are:

1) Unprocessed Or Minimally Processed Foods.

  • This includes whole foods and foods that are minimally processed without the addition of oils, fats, sugar, salt, or other ingredients to the food.
  • Examples of minimally processed foods include things like oatmeal, nut butters, dried fruit, frozen fruits or vegetables, and dried beans.

2) Processed Culinary Ingredients.

  • This includes recipes from restaurants or in-home cooking that add small amounts of oils, fats, sugar, salt, and seasonings to whole foods.

3) Processed Foods

  • This includes foods made in factories by the addition of salt, sugar, oil, or other substances added to whole or minimally processed foods.
  • Examples include tomato paste, canned fruits packed in sugar syrup, cheese, smoked or cured meat.

4) Ultraprocessed Foods

  • These are industrial formulations created in factories mostly or entirely from substances extracted from foods (oils, fats, sugar, starch, and proteins), derived from food constituents (hydrogenated fats and modified starch), or synthesized in laboratories (flavor enhancers, colors, and food additives).
  • Examples include sugar sweetened beverages; sweet or savory packaged snacks; chocolates and candies; burgers, hot dogs, and sausages; poultry and fish nuggets, pastries, cakes, and cake mixes.

Are We Killing Our Children With Kindness?

Obese ChildAs I said above, the important question is, “Are we killing our children with kindness when we give them the sugary drinks, sweets, convenience foods, and fast foods they crave?” After all, the foods we give them when they are young are the ones they are most likely to select when they get older.

Let’s start by looking at how pervasive these foods have become. That was the purpose of the study I am discussing today, and the results of this study are alarming. When they looked at the changes in food consumption by our children between 1999 and 2018:

  • The percentage of calories from ultraprocessed foods increased from 61.4% to 67%. That means:
    • Today, more than 2/3 of the calories our children consume daily come from ultraprocessed foods!
  • The percentage of calories from unprocessed and minimally processed foods decreased from 28.8% to 23.5%. That means:
    • In the span of just 19 years the diets of our children have gone from bad to worse!
  • Ultraprocessed foods were more likely to be consumed away from home and at fast food restaurants.

When the investigators looked at individual categories of ultraprocessed foods:

  • The percentage of calories coming from ready to heat and eat dishes like frozen pizzas and other frozen meals or snacks increased from 2.2% to 11.2%.
  • The percentage of calories coming from sweet snacks and desserts increased from 10.7% to 12.9%.
  • The percentage of calories coming from sugar sweetened beverages decreased from 10.8% to 5.3%.
    • This is potentially the only good news from this study.

The authors concluded. “Based on NHANES data from 1999 to 2018, the estimated energy intake from consumption of ultraprocessed foods has increased among youths in the US and has consistently comprised the majority of their total energy intake.”

“These results suggest that food processing may need to be considered as a food dimension in addition to nutrients and food groups in future dietary recommendations and food policies.”

The Danger Of Ultraprocessed Foods

Fast Food DangersThis study clearly shows that ultraprocessed foods have become the mainstay of our children’s diets. Forget a balanced diet! Forget “Eat your fruits and vegetables”! Our children’s diets have been fundamentally transformed by “Big Food, Inc”.

You might be saying to yourself, “So, they are eating their favorite processed foods. What’s the big deal? How bad can it be?” My answer is, “Pretty Bad”. I chose the title, “Are we killing our children with kindness”, for a reason.

When you look at what happens to children who eat a diet that is mostly ultraprocessed foods:

#1: Their nutrition suffers. When the investigators divided the children into 5 groups based on the percentage of calories coming from ultraprocessed foods, the children consuming the most ultraprocessed food had:

  • Significantly higher intakes of carbohydrates (mostly refined carbohydrates); total fats; polyunsaturated fats (mostly highly processed omega-6-rich vegetable oils); and added sugars.
  • Significantly lower intakes of fiber; protein; omega-3 polyunsaturated fatty acids; calcium; magnesium; potassium; zinc; vitamins A, C, D, and folate.
    • The low intake of fiber means our children will be less likely to have health-promoting friendly bacteria and more likely to have disease-promoting bad bacteria in their guts.
    • The low intake of calcium, magnesium, and vitamin D means they will be less likely to achieve maximum bone density as young adults and will be more likely to suffer from osteoporosis as they age.

#2: They are more likely to become obese. Remember, these are foods that are made in a factory, not grown on a farm.

  • They are high in fat, sugar, and refined carbohydrates. That means they have a high caloric density. Each bite has 2-3 times the calories found in a bite of fresh fruits and vegetables.
  • As I said earlier, the food industry has weaponized our natural cravings for sweet, salty, and fatty foods. They feed their prototypes to a series of consumer tasting panels until they find the perfect blend of sugar, salt, and fat to create maximum craving.
  • And if that weren’t enough, they add additives to create the perfect flavor and “mouth appeal”.
    • It is no wonder that clinical studies have found a strong correlation between high intake of ultraprocessed food and obesity in both children and adults.
    • It is also no wonder that the rate of childhood obesity has almost quadrupled (5% to 18.5%) in the last 40 years.

#3: They are more likely to become sick as adults and die prematurely.

  • Obesity; high intake of fat, sugar, and refined carbohydrates; and low intake of fiber, omega-3s, and essential nutrients all contribute to an increased risk of diabetes, heart disease, and some cancers.
    • It is no wonder that clinical studies have found a strong correlation between high intake of ultraprocessed food and increased risk of diabetes, heart disease, some cancers, and premature death in adults.
    • It is also no wonder a recent study found that type 2 diabetes in children has almost doubled between 2001 and 2017.

The data are clear. When we allow our children to subsist on a diet mostly made up of the ultraprocessed foods they crave, we may be giving them, not love, but a lifetime of obesity and declining health instead. And yes, we may be killing them with kindness.

Instead, my recommendations are:

  • expose your children to a variety of fresh fruits, vegetables, and minimally processed foods at an early age.
  • They will reject some of them, and that’s OK. Introduce others until you find whole, minimally processed foods they like. Reintroduce them to some of the foods they initially rejected as they get older.
  • Don’t keep tempting ultraprocessed foods in your house.
  • You may just succeed in putting your children on the path to a healthier diet and a healthier, longer life.

The Bottom Line

It breaks my heart when I see a mom and her children in the checkout line of a supermarket with a cart filled with sodas, sweets, and convenience foods and devoid of fresh fruits and vegetables – or when I see fast food restaurants packed with parents and their children.

I get it. Our kids love these foods. It seems like an act of kindness to give them the foods they crave. But are we killing our children with kindness?

It is time we asked how much ultraprocessed foods our children are eating and what it is doing to their health. A recent study did just that. When they looked at the changes in food consumption by our children between 1999 and 2018:

  • The percentage of calories from ultraprocessed foods increased from 61.4% to 67%. That means:
    • Today, more than 2/3 of the calories our children consume daily come from ultraprocessed foods!
  • The percentage of calories from unprocessed and minimally processed foods decreased from 28.8% to 23.5%. That means:
    • In the span of just 19 years the diets of our children have gone from bad to worse!

This study clearly shows that ultraprocessed foods have become the mainstay of our children’s diets. Forget a balanced diet! Forget “Eat your fruits and vegetables”! Our children’s diets have been fundamentally transformed by “Big Food, Inc”.

You might be saying to yourself, “So, they are eating their favorite processed foods. What’s the big deal? How bad can it be?” My answer is, “Pretty Bad”. I chose the title, “Are we killing our children with kindness”, for a reason.

When you look at what happens to children who eat a diet that is mostly ultraprocessed foods:

  • Their nutrition suffers.
  • They are more likely to become obese.
  • They are more likely to become sick as adults and die prematurely.

For more details about this study, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Do Processed Foods Increase Your Risk Of Diabetes?

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Why Do We Keep Eating Processed Foods?

Fast Food DangersUnless you are Rip Van Winkle and have been asleep for the past 20 years you probably know that the highly processed foods in the typical American diet are bad for your health. But perhaps you didn’t realize just how bad they were.

But first, let’s start with a bit of perspective. Scientists like to be precise. Even healthy foods go through some processing.

  • The oatmeal you ate this morning was either steel-cut or ground. That is processing.
  • The almond butter you put on your whole grain toast this morning was made by roasting and grinding. That is processing.

So, scientists have developed the term “ultra-processed food” to describe the worst of the worse. In short, ultra-processed foods:

  • Usually go through several physical and chemical processes, such as extruding, molding, prefrying, and hydrogenation that can lead to the formation of toxic contaminants. One example you may have heard about recently would be acrylamide in French fries.
  • Typically contain ingredients of no or little nutritive value, such as refined sugar, hydrogenated oils, emulsifiers, artificial sweeteners, thickening agents, and artificial colors. Some of these ingredients have been linked to cancer, heart disease, and premature death.
  • Have long shelf-lives because of added preservatives. This allows migration of chemicals such as bisphenol A from the packaging materials into the food.

Examples of ultra-processed foods include:

  • Sodas
  • Chips
  • Candy and packages of cookies or crackers
  • Most breakfast cereals
  • Boxed cake, cookie, and pancake mix
  • Chicken nuggets and fish sticks
  • Fast food burgers
  • Hot dogs and other processed meats
  • Infant formula
  • Instant noodles
  • Most store-bought ice cream
  • Flavored yogurt

In short, ultra-processed foods include sodas and the junk and convenience foods Americans hold so dear. Even things like infant formula and flavored yogurt make the list.

Evidence of the ill effects of ultra-processed foods on our health is becoming overwhelming. In previous issues of “Health Tips From the Professor” I have shared recent studies that have shown that heavy consumption of ultra-processed foods is linked to increased risk of obesity and cancer. Other studies have linked ultra-processed food consumption with increased risk of depression, heart disease, and premature death.

In this issue of “Health Tips From the Professor” I:

  • Ask the important question, “If we know these foods are so bad for us, why do we still keep eating them?”

How Was The Study Done?

Clinical StudyThe data from this study were taken from an ongoing study in France (the NutriNet-Sante study) looking at associations between nutrition and health. This study began enrolling French adults 18 and older in 2009.

This is a web-based study. Participants are prompted to go to a dedicated website and fill out questionnaires related to things like sex, age, height, weight, smoking status, physical activity, health status, and diet.

With respect to diet, participants filled out a series of 3 nonconsecutive 24-hour dietary records at the time of enrollment and every 6 months. This is a particularly strong feature of this study. Many studies of this type only analyze participant’s diets at the beginning of the study. Those studies have no way of knowing how the participant’s diets may have changed during the study.

Diagnosis of type 2 diabetes for study participants was obtained from the French centralized health records.

The study enrolled 104,708 participants, 20% men and 80% women, and followed them for an average of 6 years. The average age of the participants was 43 years.

Do Processed Foods Increase Your Risk Of Diabetes?

High Blood SugarIn this study the range of ultra-processed foods in the French diet ranged from 7% to 27% (average = 17%). High intake of ultra-processed foods was associated with:

  • Younger participants. Simply put, young people were more likely to drink sodas and eat junk food than older adults.
  • Increased caloric intake. Ultra-processed foods have a higher caloric density than whole, unprocessed foods.
  • No surprise here. Previous studies have shown that ultra-processed food consumption increases the risk of obesity.
  • Poorer diet quality. Again, no surprise. Junk foods tend to crowd healthier foods out of the dirt. Specifically, ultra-processed food consumption was associated with:
    • Higher intake of sugar and salt.
    • Lower intake of fiber.
    • Higher intake of sugary drinks, red and processed meats.
    • Lower intake of whole grains, yogurt, nuts, fruits, and vegetables.

However, even after statistically correcting for all these factors, there was a significant association between ultra-processed food consumption and the onset of type 2 diabetes in the 6-year follow-up period.

  • There was a linear relation between ultra-processed food consumption and the development of type 2 diabetes. Simply put, the more ultra-processed food the participants consumed the more likely they were to be diagnosed with type 2 diabetes.
  • There was a 15% increased risk of developing type 2 diabetes for every 10% increase in ultra-processed food consumption.

The authors concluded:

“In this large observational prospective study, a higher proportion of ultra-processed food in the diet was associated with a higher risk of type 2 diabetes. Even though these results need to be confirmed in other populations and settings, they provide evidence to support efforts by public health authorities to recommend limiting ultra-processed food consumption.”

What Does This Study Mean For You?

Questioning WomanYou might be tempted to say that a 15% increase in the risk of developing diabetes is a small price to pay for continuing to eat the foods you enjoy. However, you should be alarmed by this study. Here is why.

The French diet is much healthier than the American. Remember that ultra-processed foods only comprised 17% of the French Diet. In contrast, a recent survey found that:

  • Ultra-processed foods make up 58% of the average American’s diet.
  • Ultra-processed foods account for 90% of the added sugar in our diet.

It is no wonder that obesity and diabetes are reaching epidemic proportions in our country.

You might also be tempted to think that you can just take some medications and live with type 2 diabetes. However, you should think of type 2 diabetes as a gateway disease. It increases your risk of heart disease, high blood pressure, Alzheimer’s disease, kidney damage, and neuropathy, just to name a few. These are diseases that make your life miserable and ultimately kill you.

More importantly, type 2 diabetes is completely reversible if you catch it early enough. Just lose some weight, exercise more, give up the ultra-processed foods, and eat a healthy diet. I recommend a whole food, primarily plant-based diet.

Why Do We Keep Eating Processed Foods?

Fast FoodsWe all know that ultra-processed foods are bad for us. Study after study show that they make us sick. They kill us prematurely. And, unlike most topics in the field of nutrition, this is not controversial.

For example, there have been lots of bizarre diets that have come and gone over the years. There have been books written on “The Steak Lover’s Diet” and “The Drinking Man’s Diet”. But nobody has written a book on “The Junk Food Lover’s Diet”. It simply would not be believable.

So why do we Americans keep eating such unhealthy foods. Part of the answer is physiological. A preference for sweet, salty, and fatty foods is hardwired into our brain. That’s because they had great survival value in prehistoric times.

If we think back to the time when we were hunters and gatherers:

  • Fruits are healthy foods. They are a great source of antioxidants, phytonutrients, and fiber, but there were no orchards or grocery stores back then. We had to search for fruits in the wild. Our desire for sweet tasting foods provided the motivation to seek them out.
  • Game was seasonal and sometimes scarce. We had to be prepared to go for days or weeks without eating except for the leaves and roots we could gather. Our bodies are designed to store fat as the primary energy source to get us through the lean times. Our preference for fatty foods encouraged us to store as much fat as possible in times of plenty so we would be prepared for times of scarcity.
  • If we fast forward to our early recorded history, salt was scarce. It was worth its weight in gold. Yet some salt is essential for life. Our preference for salty foods encouraged us to search out supplies of salt.

Unfortunately, the food industry has weaponized these food preferences to create the ultra-processed foods we know today. Their ads entice us by associating these foods with youth and good times. And ultra-processed foods have become ubiquitous. There are fast food restaurants on almost every street corner and shopping mall in the country.

Fortunately, we do not have to let the food industry destroy our health. We can retrain our taste buds to appreciate the sweetness of fresh fruits and vegetables. We can substitute healthy fats for the kinds of fat found in most ultra-processed foods. We can also retrain our taste buds to appreciate herbs and spices with just a pinch of salt.

The Bottom Line

Ultra-processed foods, such as sodas, junk foods, and convenience foods have become the biggest food group in the American diet. A recent study found:

  • Ultra-processed foods make up 58% of the average American’s diet.
  • Ultra-processed foods account for 90% of the added sugar in our diet.

That is scary because ultra-processed foods are deadly. Previous studies have shown that consumption of ultra-processed foods is linked to obesity, heart disease, cancer, and Alzheimer’s disease.

The study discussed this week looked at the association between ultra-processed food consumption and type 2 diabetes. It showed:

  • There was a linear relation between ultra-processed food consumption and the development of type 2 diabetes. Simply put, the more ultra-processed food the participants consumed the more likely they were to be diagnosed with type 2 diabetes.
  • There was a 15% increased risk of developing type 2 diabetes for every 10% increase in ultra-processed food consumption.

You might be tempted to think that you can just take some medications and live with type 2 diabetes. However, you should think of type 2 diabetes as a gateway disease. It increases your risk of heart disease, high blood pressure, Alzheimer’s disease, kidney damage, and neuropathy, just to name a few. This are diseases that make your life miserable and ultimately kill you.

More importantly, type 2 diabetes is completely reversible if you catch it early enough. Just lose some weight, exercise more, give up the ultra-processed foods, and eat a healthy diet. I recommend a whole food, primarily plant-based diet.

For more details and a discussion of why Americans continue to eat ultra-processed food even though we know it is bad for us, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Health Tips From The Professor