What Are Ultra-Processed Foods?

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Several studies have been published recently that demonstrate the hazard of eating too much processed food: digestive issues, type 2 diabetes, cardiovascular disease, early mortality, and even premature Alzheimer’s disease. Today I’ll focus on some definitions and look at the research on Saturday.

Many of the studies that have examined ultra-processed food have used the NOVA four categories of processed foods developed at the University of Sao Paulo’s School of Public Health in Brazil:

“Ultra-processed foods are industrial formulations made entirely or mostly from substances extracted from foods (oils, fats, sugar, starch, and proteins), derived from food constituents (hydrogenated fats and modified starch), or synthesized in laboratories from food substrates or other organic sources (flavor enhancers, colors, and several food additives used to make the product hyper-palatable). Manufacturing techniques include extrusion, moulding, and preprocessing by frying. Beverages may be ultra-processed.”

Doesn’t that sound appealing? Actually, hot dogs, mac and cheese from a box, and just about every dessert bought in a typical grocery store fits that bill. For the complete list, check out the link in the Reference below.

Now that we know what we’re talking about, I’ll talk about what the research says about ultra-processed foods and assess our risk in the real world. In the meantime, try choosing more foods from the first group for the next few days; that’s healthy eating.

What are you prepared to do today?

        Dr. Chet

Reference:https://educhange.com/wp-content/uploads/2018/09/NOVA-Classification-Reference-Sheet.pdf

Is It Worth It?

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At an obesity conference, the report on the clinical trials for a pre-diabetes and diabetes medication left the crowd on their feet and cheering. There are reports of well-known personalities who’ve used the drug with great results. But the ultimate question about a pharmaceutical approach to obesity has to be this: is it worth the money? Let’s start by looking at the pharmaceutical and then the return on investment.

How It Works

The body makes proteins called incretins which can stimulate the release of insulin. One incretin hormone, GLP-1 (glucagon-like peptide-1), is manufactured in the upper digestive system in response to carbohydrate intake. In subjects with type 2 diabetes, this hormone effect is diminished or no longer present.

The ability to stimulate the production of insulin and prevent the release of glucose by glucagon can be stimulated pharmacologically by semaglutide, a receptor agonist—that means it turns on the glucagon. In subjects with type 2 diabetes, semaglutide stimulates GLP-1 receptors significantly, thereby reducing blood glucose and improving glycemic control. In addition, it has multiple effects on various organ systems; most relevant are a reduction in appetite and food intake, leading to weight loss in the long term. Since GLP-1 secretion from the gut seems to be impaired in obese subjects, it was logical to test it in obese populations. Those were the study results I reported on Tuesday.

All in all, this sounds like it might be a potential solution to our obesity crisis, but there are some unanswered questions. What is the long-term safety of regular use of the drug? How does the microbiome impact the effectiveness of the drug? But more than that, everything comes with a price, which begs the question: is it worth it?

The Price

The price of using semaglutide for obesity is really two-fold. First is the actual cost of the weekly injections which is about $1,400 per month at retail. If your insurance will cover it, I’ve seen prices as low as $25 per month. We know that people lost an average of 18% of their starting weight at 68 weeks—the length of the longest study to date—but the rate of weight loss declined near the end of the study. How long will insurance cover it beyond that, and will a person continue to lose weight? We don’t know.

After using the drug for 20 weeks, the placebo group was switched to a placebo and immediately began to gain weight. By the end of 68 weeks, they had regained all but 5% and were still gaining. Would an investment of close to $17,000 to lose about 20% of your weight be worth it if you began to gain it back? There are many questions around whether people can take this drug for the rest of their lives; every pharmaceutical intervention must have an end strategy. The researchers did not address the issue.

The Bottom Line

The research into this pharmaceutical intervention was well done. However, unless the intervention includes an exit strategy, it could be a waste of money. Perhaps a lower carbohydrate diet may be a partial solution because this drug impacts carbohydrate metabolism. But we don’t know whether the weight loss would be enough to have the body take over and do the same thing on GP-1 by itself.

I think this shows a hopeful approach and it may turn out to be a boost to someone who is absolutely willing to change their lifestyle or someone who needs to lose weight for a specific purpose, such as joint replacement surgery or preparing for IVF. But for most of us, maybe it’s better to save the time and money and do what we know works: Eat less. Eat better. Move more.

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2021;325(14):1414-1425. doi:10.1001/jama.2021.3224
2. JAMA. 2022;327(2):138-150. doi:10.1001/jama.2021.23619

Happy New Year!

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It’s good to be back talking to all of you again. The New Year is a time of optimism, everything seems possible, and there’s an enthusiasm for achieving health goals. One thing many people want to do is to lose some weight. It seems appropriate to cover a couple of drugs that were recently approved by the FDA to treat obesity. They’re a pharmaceutical approach to weight loss, and they’ve gotten so much press I have to cover them.

You’ve probably seen the commercials for a pre-diabetes and diabetes medication called Ozempic. It also has a sister drug called Wegovy that was approved for use in teens. In at least two clinical trials, subjects who had weekly injections of the drug lost at least 15% or more of their body weight in 68 weeks. Those who were switched to placebo injections started to gain back the weight they lost. All subjects were supported with monthly consultations with dieticians to induce a 500-calorie reduction in food intake and to increase exercise levels. Markers for type 2 diabetes improved such as HbA1c and blood glucose.

Is this the be-all and end-all to the obesity epidemic? And exactly how does this drug work? I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2021;325(14):1414-1425. doi:10.1001/jama.2021.3224
2. JAMA. 2022;327(2):138-150. doi:10.1001/jama.2021.23619

Aging Stressor: Excess Body Weight

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The last major stressor that comes with age is excess body weight. The first book that I ever bought in grad school was about obesity. In it, there was a chart of almost 100 health issues that were linked by research to carrying extra body fat and one that was not. In the 40 years since then, the list of negative effects of obesity has grown.

If you remember my answer to the question from last week’s Memo about what one thing would I do differently in my life, that’s the reason I chose getting to a healthier weight and staying there. Pick a body system, any system, and you’ll find the deleterious impact of excess fat on that system. Immune system? Yes. Joints? Yes. Liver? That too. Pancreas? Yes—and on and on and on. That’s why it’s important to get to a healthy weight as young as you can and stay there.

But what about now? It’s been a 50-year fight for me, and I still have not succeeded to the extent I would like. Getting to a healthy weight is not about a specific diet or foods or anything other than one thing: the quantity of food we eat.

I’m going to give you the simplest approach to losing excess body fat I can with two ways to do it.

  • Use a smaller plate when you eat meals and fill it only once. Moving from a dinner plate to a salad plate will cut off about 20 to 25% of the calories you eat. You can use the same logic with smoothies or cereal or soups. Smaller portions yield fewer calories.
  • As an alternative, reduce your caloric intake by 250 to 500 calories per day if you already track your food intake. That’s it.

Can you work on the quality of food? Sure. How about fewer carbs or less fat? If you want. What I’m saying is that to attack the excess body weight you carry, you have to attack your number of calories and eat fewer of them. Start with the sledgehammer to break down the wall. You can get to the chisel later on to fine-tune your lifestyle.

That one benefit of being overweight? It reduces the risk of osteoporosis. I don’t think that’s worth the hundreds of other risks it increases.

Aging with a Vengeance

The first Aging with a Vengeance webinar will be on Super Bowl Sunday; the topic will be increasing muscle mass. I’ll be covering a specific strength training program together with nutrition approaches including diet and supplements. The approach is based on the practical application of the most recent research. The first Memo of 2023 will give details on how to sign up for the webinar and the materials you’ll get.

Have a Very Merry Christmas from all of us at DrChet.com! Talk to you again on January 1, 2023.

What are you prepared to do today?

        Dr. Chet

Aging Stressor: The Muscular System

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Sarcopenia is the number one issue that impacts muscles—that’s the loss of skeletal muscle mass and strength that comes with age. It can begin as early as the 20s in some and accelerates once we pass 60; it’s thought to be primarily due to the genetics of aging. There’s also little question that a sedentary lifestyle contributes to muscle loss. Losing muscle mass impacts not just strength, but also stamina, posture, balance, and the ability to move your body.

There are several types of muscle fibers, but they all appear to become slow-twitch fibers as we age. And they get smaller. However, and this is important, they don’t ever seem to go away completely. Strength training has been shown to be effective even for people who are 100 years old; they get stronger, which helps deal with all those issues I mentioned before. The research hasn’t demonstrated that muscles will get larger, but most studies end at three to six months, which is too soon to really judge results; it’s probably going to take more than six months to gain back what we lost over many decades.

The key to dealing with sarcopenia is strength training—the earlier in life the better, but it’s never too late. Strength training can encompass many approaches from doing squats by standing up from sitting in a chair (using a walker if balance is an issue), push-ups and other calisthenics, and weight training using bands, tubes, machines, and free weights.

There are hundreds of programs and thousands of exercises to help build strength using every modality. I think it should all begin with an evaluation by a healthcare professional to test posture and balance, as well as strength. The next step is to see a physical therapist who can evaluate your limitations and put together a plan to get you started safely; it’s hard to keep your positive attitude if you get hurt right away and need to pause. Once you get approval and a plan to train, then getting muscles prepared is important. Calisthenics, which include chair exercises for those with arthritis, are a good place to begin.

Final memo before Christmas on Tuesday with one more place to attack when we’re aging with a vengeance.

What are you prepared to do today?

        Dr. Chet

Aging Stressor: The Cardiovascular System

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The next three Memos before Christmas will identify the three major stressors of aging as I see them and the general solution to them. The first stressor of aging is the changes to the cardiovascular system (CV). Cells wear out in all systems at all ages, but there are some that stop replacing and repairing themselves in the CV. A few examples:

  • The sino-atrial node is the pacemaker of the heart. As we get older, some of the specialized nerve cells of this area are not replaced. That can cause abnormal heart rhythms such as atrial fibrillation.
  • The arteries can become less pliable, called arteriosclerosis, which can cause an increase in blood pressure. (Atherosclerosis, the buildup of plaque in arteries, can be considered a special type of arteriosclerosis and can happen at any age depending on genetics and lifestyle.)
  • The heart muscle can get damaged and be replaced with scar tissue. That automatically weakens the heart, which pumps less blood (called the ejection fraction) and reduces fitness levels.

The solution? CV exercise, also called aerobic exercise: walking, riding an exercise bike, swimming or water aerobics, or pulling a sleigh (just checking to make sure you’re reading.) It doesn’t matter which mode you choose as long as you move your body for 30 to 45 minutes per day most days of the week. You can’t reverse every effect of aging on the CV and other systems, but nothing impacts every system of the body like exercise does. Aging with a vengeance requires aerobic exercise within the limitations you currently have, and the younger you start, the more successful you’ll be.

What are you prepared to do today?

        Dr. Chet

Worst Stressor: Split Decision

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I intended to talk about the single most negative stressor that we face as we age, but I couldn’t pick just one. When I say stressors, I mean things we have to deal with every day, not a singular event such as an auto accident. Smoking would be the easy choice, but it doesn’t impact as many people as it used to. Here are my two choices.

Too Much Weight

Someone asked me a simple question before an Insiders Conference Call: if you could do one thing differently when you were young to improve your health, what would it be? Without hesitation my answer was I would have gotten to a normal body weight and maintained it. Being overfat impacts you as soon as you try to get out of bed: you have to overcome gravity. And it doesn’t stop there.

Every system, every organ, and every cell in your body is impacted by excess fat. Some effects are worse than others, but every cell is impacted in some way. If you can avoid gaining the weight to begin with, that’s ideal. If you’re like me and you didn’t, it’s a lifetime challenge to get to a normal weight and maintain it. I’m still working at it.

If you’re still a youngster in your 20s, 30s, or 40s, don’t postpone weight loss. Do whatever it takes to get to a normal weight (short of drug abuse or eating disorders), then develop a healthy lifestyle to keep your weight down. Even if you’re older, you can still lose weight just as my mother-in-law did in her 80s.

Chronic Pain

There are some people who don’t know what it’s like to face pain every day, but the majority of people face the daily challenge of having their lives impacted by pain as they get older. It may be joint pain in the knees. Lower back pain afflicts many. It may be nerve damage from prior accidents. But as we age, pain is the stressor that may be present all day, every day.

There is no magic wand for this stressor. For some people, if they didn’t have to think about pain, they could do so much more. Instead, it’s trying to find the right everyday changes that can make life bearable.

The Bottom Line

I think you can understand why it was a split decision. In addition, these two stressors affect each other: being overfat can make the pain worse, and having pain can prevent us from exercising to help with weight loss. It doesn’t mean there are no stressors of aging we can deal with—there definitely are. That’s what we’ll talk about in my upcoming program Aging with a Vengeance.

On next week’s Insiders Conference Call, I’ll talk more specifically about the stressors of aging and what we can do about them. Become an Insider by 8 p.m. Wednesday, December 14, and you can join the Insider call at 9 p.m.

What are you prepared to do today?

        Dr. Chet

The Best Stressor

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Stressors aren’t all the same; they can be positive and they can be negative. I’m going to begin with the single most powerful positive stressor: exercise. It’s not just one type, such as aerobic exercise or strength training. It’s all of them, and there are specific negative stressors that specific types of exercise can address. But no matter what body system or organ you examine, exercise has a beneficial effect.

Can too much exercise cause problems? Yes, but overdoing most positive things can yield negative results. With only 10% to 15% of the U.S. population exercising enough to do themselves any good, we have a long way to go before we have to worry about the majority of our fellow citizens.

I can’t remember who said it, but this quote sums it up quite well: If you’re not exercising regularly, you’re dying prematurely. There are hundreds of types of exercises to address many specific issues, but start with a walk. Right now. That most important muscle, your heart, will love you for it. Saturday, on to the most negative stressor.

What are you prepared to do today?

        Dr. Chet

The Stress Response

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Anyone who studies the stress response will be familiar with the general adaptation syndrome (GAS) that’s depicted in the graphic. The response was developed by the Canadian scientist Dr. Hans Selye over years of experiments; his research focus was the hormonal response to chronic stress. To promote his adaptation concept, Dr. Selye was just as good a marketer as he was scientist. Although we know a lot more today about the hormonal and neural responses to stress, the GAS still applies to chronic stress for the most part.

Stress, both acute and chronic, is going to happen—it’s inevitable. What matters is how we respond to stress. After 35 years as an exercise physiologist, I know there are two ways to prepare for stress of all kinds: exercise and mental preparation.

Exercise

Like the concept of fighting fire with fire, you can fight stress with exercise, which is a stressor. If you examine the hormonal and neural response to exercise, it’s the classic response. (If you want to read more about the particulars of the stress response, please go to reference 1.) What makes exercise different is that we can increase our resistance because we control the amount and intensity of that stress; or in terms of the GAS graphic, we can gradually move that white line up higher.

The side benefit is that it can help when we are exposed to other types of stress as well. For example, while we may still be disrupted by the hustle and bustle of the holidays, it will not have the same impact on our immune or cardiovascular system. There’s no better way to be prepared to deal with stress than regular exercise, and it helps to prepare your mind as well.

Mental Preparation

There are dozens of ways to prepare your mind for how you respond to the stress of life; there are courses to take, books to read, positive affirmations to say, and other techniques such as prayer and meditation. But here’s the thing: you never really know how you’ll respond to stress until you’re exposed to it. There’s a big difference between someone taking your parking space and getting a cancer diagnosis. One is over in a few seconds while the other may alter your life in many ways.

The way your mind responds will also be impacted by prior experiences, both positive and negative. You have to call upon how you responded in the past to know the best way to respond when you face the same or similar stressors. It would certainly help if you had some warning when the stressors would show up.

Aging Causes Stress

Aging is one of the major stressors we face. To get an idea, read the material in the second reference. Near the end of the article, you can read the impact of aging on every organ and system in the body. We can’t stop aging, but we can prepare for it. Remember what I said about when stressors would show up? We have a pretty good idea when that will happen with aging, so we can work to reduce the impact on our bodies. That’s what Aging with a Vengeance is all about. In the next few Memos, I’m going to tell you those areas I think we can impact the most as we age.

What are you prepared to do today?

        Dr. Chet

References:
1. https://www.ncbi.nlm.nih.gov/books/NBK541120/
2. https://medlineplus.gov/ency/article/004012.htm

Here Comes the Stress

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We’ve entered the stress zone for many people: the holiday season, the hustle, the bustle, the people, the shopping, even in the cyber age. But mostly, it’s the people. There seems to be so many of them, and they all seem to congregate wherever you’re going. What seemed so exciting when you were a child isn’t as exciting as an adult.

Here’s a little secret: the time of year doesn’t really matter. Stress will always be there. It just seems worse this time of the year as we bounce from one holiday event to another. In reality, it’s not the stress; it’s how we respond to it that can impact us. And impact us it does, from the nervous system, the endocrine system, the cardiovascular system, and on and on.

What can you do about it? Beginning on Saturday, I’m going to spend some time explaining what the stress response is and how you can deal with it. But something you can do right now is very simple. Take a deep breath in, a real deep breath, and let it out. Do that two or three times. It can reset the vagus nerve and give you some instant relief.

What are you prepared to do today?

        Dr. Chet