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Alice's avatar

I always find it striking how slim the actors look in 1970s - early 1980s television series. They don’t even look as though they achieved slimness through hard work at a gym. Many were eating so-called ‘balanced diets’ which included white bread and potatoes. There were ‘balanced’ meals available for lunch in many a canteen too, and at school. Children mostly ate these meals, cooked on the premises, rather than packed lunches. I don’t have much faith in the idea of re-formulating UPF as I don’t think that it will be improved unless we all expect better quality, and the trouble is that we don’t.

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The Skeptical Cardiologist's avatar

I would agree

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Vefessh's avatar

"Avoid products with more than five ingredients" is underspecified, in my opinion. "Spices" is barely an ingredient at all, even though it can make or break any recipe/product formulation.

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Mike S's avatar

Ok, how many of us had to look up "ad libitum"?

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Richard Feinman's avatar

Actually, I would like to know that. English has a very large number of words (including foreign words) and we grow up in different social environments. Scientists, engineers and other tech people absorb jargon and especially common words with restricted meaning. We are not showing off, or inconsiderate when we use them. We simply don’t know that they’re not in general use. Here’s a few that I run into: intubated, endogenous, en passant, annotations. Of course, the amusing part of this is the tech speak game. If you want to play, do you use a cranial support system? Should be easy but a hint is that if you do use one you might need a cranial support system encapsulation device. But, as originally,do you not know “ad libitum.” On reflection, I would think everybody knows its abbreviation: ad lib. No?

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Mike S's avatar

You are correct. I don't recall ever encountering ad libitum but know ad lib. One thing about my browser's ability to right-click and look something up instantly is that I don't take that moment to think it out for myself. I didn't make the connection to ad lib when I read the words but had the ah-ha moment when I said it aloud in my head.

Thanks for the food for thought. I'm ordering your book today.

My wife (quite successfully) acts as my cranial support system encapsulation device.

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Richard Feinman's avatar

Thanks for ordering the book. I’m not sure you’ve got it on tech-speak though. A cranial support system is a pillow and the encapsulation device…but the metaphor is good. (We make fun of tech-speak after all). It is valuable in some circumstances. A friend who worked at NIH described problem of everything ordered had to go out on bid unless it was a unique object as in the ‘rotary device for bringing 3/8-inch dowel to sharp point’ that he ordered.

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Ryan McCormick, M.D.'s avatar

Great observations and discussion, and bringing it all home with Michael Pollan is spot on. Going to focus even more on following these tenets. I pack my daughter’s lunches, and I know I’m doing a better job than most (even as I stuff some bars in there) as her friends make fun of her healthy lunches. Some of the parental capitulation to kids’ addiction to UPFs is so disheartening and undermines community in some ways. My kid is the “freak” who eats apples and hummus and actual cheese.

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Margaret Taylor's avatar

And thank you for calling out Fredrick Stare and his evil cohort at Harvard. His (and his university’s) cynical use of the media to tout his soda and breakfast cereal patrons while attacking the nascent natural foods movement should not be forgotten. The damage they did to public health is now multi-generational.

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The Skeptical Cardiologist's avatar

I don't hammer on less meat. The evidence that the average American should reduce meat or saturated fat is lacking. Perhaps when the average Sat Fat consumption was 18% that made sense but at current 10% most have already cut back considerably and won't benefit from further reduction.

The 4 core randomized controlled trials the AHA used to support its 2017 declaration that we should all lower saturated fat intake were small, weird, fatally flawed studies.

Red meat helps us meet protein goals.

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H. Robert Silverstein, MD's avatar

In the Blue ZOnes, those with the lowest protein intake = 10% and mostly legumes had the greatest longevity. The saturated fat of meat inhibits Glut 4 receptor producion which is for absorbing glucose, making cells insulin resistant.

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Richard Feinman's avatar

You mean everybody in the Blue Zone? And is that the only thing that affects insulin resistance? And why is it that so many studies fail to show any harm from saturated fat or red meat? And, most of all, why does AHA, AMA, ADA never confront their critics? I suggested to Walter Willett that we get together and have some kind of conference for years. He and his gang are willing but, like the Supreme Court, there are just a few minor delays. Along which lines the obsessive personal and professional attacks on people recommending carbohydrate restriction goes to motive. The most recent Gu, et al from HSPH has red meat causing diabetes. Do you believe that? Most low-carb, keto people with appropriate credentials are willing to discuss the science. Vegetarian diets are fine for people who do fine on them. I agree with Don Layman that looking at the protein file, it is not obvious why but the data are the data. Vegetarian diets are fine. But for many, it is not sustainable or healthy. By the way, what is the Blue Zone. Why is it blue?

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smileypete's avatar

This is my observation:

If I go for a longer walk locally in the UK, across the park or along the river, obesity basically does not exist.

In all the times I've done it, which is a lot, and I mean a LOT, the number of obese people I've seen is 4 or 5. Which is still heartening in a way, as it shows it's possible for those in that situation.

Sure weight can be lost through diet without exercising in some cases, but it's still markedly inferior.

A skeptical take may be that research tends to only find answers that justify the $$$$ going into it.

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Alice's avatar

My own observation on holiday was that tourists were prepared to walk to buy packs of bottled water, saving them money on the hotel’s. The hotel site, and the location, necessitated a fair bit of walking each day, and within a few days people were putting aside their walking sticks and dancing after dinner!

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The Skeptical Cardiologist's avatar

I would like to believe that long walks in the beautiful countryside mitigate obesity.

I've also noted that when I walk on the beautiful beaches of north San Diego the obesity rate is far less than on the mean streets of St. Louis.

Unfortunately, your observations can also be explained by a third factor, perhaps a desire to stay healthy and fit, that is common to being thin and taking long regular walks-the healthy user bias which permeates and weakens so many observational nutritional and physical activity studies.

In the obesity research world it is clear that the spoon is mightier than the foot.

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smileypete's avatar

'the spoon is mightier than the foot' - I like it!! For some the world of the foot barely... exists... which is a great shame. :-(

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The Skeptical Cardiologist's avatar

Seems like a straight-forward question but actually quite complicated.

It would be nice if PCPs were initiating for this indication.

Most cardiologists have little familiarity with their use.

Until FDA approved and Pharma reps descend on MDs there will be slow uptake. And insurance likely will not cover.

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Steven Bornfeld's avatar

I think it's clear by now that GLP 1-RA and SGLT-2 inhibitors are going to solve all our obesity problems, along with metabolic syndrome, prevent Alzheimer's disease, decrease antidepressant usage, and solve the problems of the Middle East. They sure have done a job on the food company stocks in my portfolio.

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Daniel Hall's avatar

Sounds good to me. Where do I get my GLP 1-RA and SGLT-2 inhibitors?

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The Skeptical Cardiologist's avatar

Haha! The SELECT trail has convinced me I need to start discussing the GLP-1 inhibitors with all my obese secondary prevention patients.

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Sobshrink's avatar

I read Hall's article not long after it was published, and more recently read Van Tulleken's excellent and surprisingly entertaining book, so you're preaching to the choir. The latter makes clear that changing the UPF environment will not be easy for a variety of reasons, and until significant changes are made, many people will continue to get a large portion of their diet from UPF, due to food addiction, and/or food deserts with mainly only UPF available, and/or the inability to pay the higher prices for unprocessed foods. (I was surprised to read in Van Tulleken's book that UPF is the cheapest food, and he does a good job of explaining why). Some folks wonder if foods can be engineered to be more healthy and less addictive, and I think this should be explored. I think we also need to study sweeteners like allulose and stevia to see if they are more helpful or harmful, because I'm not sure how realistic it is to tell people to give up all sweets except fruit. I'm also wondering what you meant by "the misleading health claims of low fat diary." If overconsumption of calories is a problem, isn't it better to eat low or nonfat dairy? I'm not talking about suger-loaded yogurt, but rather plain nonfat yogurt, and nonfat or low fat cheeses. You're saying those are unhealthy? It's hard enough for older folks to get enough protein as it is, and taking those off the table will make it even harder. What about the studies showing the health benefits of whey protein? Hope to hear more about these issues in your future posts! :)

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Richard Feinman's avatar

“Changing the UPF environment will not be easy” is similar to Mel Brooks’s explanation of why it took so long to win World War II: Churchill keep saying that we were fighting the Nar-zees and nobody knew who they were.

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Daniel Hall's avatar

"It's hard enough for older folks to get enough protein..." Amen.

If we are supposed to eat mostly plants, less meat & dairy (Pollan's premise - I've not read the book only excerpts ) Is there a logical, reasonable place for "foods" which have undergone obvious processing but are high in protein and / or fiber or both such as ground flaxseed, protein powder (mostly whey)... fit into a healthy diet for seniors?

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Richard Feinman's avatar

Those of us who are opposed to using UPF in scientific discussion (rather than colloquially over coffee or something) don’t see logical or reasonable as part of the picture. If you have the desirable food and you grind it up, is it UPF. If you then pour digestive enzymes on it is it UPF? How about after that, you pour acid on it and agitate it. Finally, if you add emulsifying agents and more enzymes, is it UPF?

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The Skeptical Cardiologist's avatar

Appreciate the review of CVT's UPF book.

As to dairy, it is important to understand that dairy fat, although high in saturated FA, does not increase risk of ASCVD. Also, the idea that removing the dairy fat will lead to less overall calories consumed is unsupported by real world data. The misinformation about the improved healthiness of low fat or skim dairy fats is what I have tried to counter in multiple posts on my blog website. I have moved to a position in the last few years that adequate protein intake is a significant issue as we age and if you are having difficulty with that it might make sense to focus on the lower fat dairy products as a useful addition. But removing the fat is a significant industrial processesing technique which is often accompanied by adding sugars which contain none of the great nutrients the fat had.

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Sobshrink's avatar

Thanks for your response. I have read others who say the same as you regarding dairy fat does not increase risk of ASCVD. Where I get confused is that it does seem to increase my LDL-C, but maybe that's just when I eat butter. I guess I need to experiment and see if just full-fat yogurt (plain, no sugar) and full fat cheese, but no butter, would increase my LDL-C. I understand that eating more dairy fat doesn't necessarily mean eating more calories, since it's satiating and could lead to eating fewer calories of other foods. Unless there is UPF around! :(

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Richard Feinman's avatar

Nina Teicholz wrote (Substack?) that we should refer to Junk Food because it is colloquial — does not contain scientific-sounding words and everybody knows what it means roughly. That way, we would not continue to discuss what it is about something for which there is no definition that causes harm although we don’t know which harm. Most of all, skeptics (curmudgeons ?) would not have to keep restraining themselves from arguing with people who they otherwise think are doing useful scientific work.

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Richard Feinman's avatar

Nina just suggested the term Junk Food. All of the criticism of UPF is my own opinion. The term has no meaning because it is made of two words that are so vague and encompassing that it could mean anything.

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David Brown's avatar

There's much discussion regarding nutrient density, processed foods, and food as medicine these days. But what if the global obesity epidemic is a nutrient toxicity problem? That said, these web searches bring up narratives that suggest nutrient toxicity is what caused the global increase in obesity and diabetes.

Annadie Krygsman The Importance of

The importance of a balanced ω-6 to ω-3 ratio

Anna Haug Individual Variation

poultry consumption and human cardiometabolic health

Dietary arachidonic acid as a risk factor 2016

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Sobshrink's avatar

Yes, obesity and diabetes are due to excess food consumption, but that doesn't address WHY food consumption/calories have increased so much in the past few decades. But Hall's research clearly shows the why: when humans are allowed to eat ad libitum (i.e., real life), they automatically consume significantly more when the food is ultra processed vs not processed, and it can't be explained by anything about the food other than the level of processing.

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Richard Feinman's avatar

Explanation is what’s missing. The processing is over before you put it in your mouth. And not all processing is the same.

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David Brown's avatar

That may be true of humans. But how do you explain this: The rising incidence of childhood obesity and T2D, high blood pressure, hyperinsulinemia and dyslipidemia are particularly worrisome as these children often mature to be obese adults. This risk of developing obesity and T2D has largely been blamed on the increased consumption of energy dense foods and fat intake, particularly saturated fat, but it is interesting to know that the mean fat intake of the human population has not increased much in the past 50 years... In addition, laboratory and other domesticated animals have also been subject to the increased prevalence of obesity, despite having largely unchanged living conditions for many years." https://www.intechopen.com/chapters/41405

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Sobshrink's avatar

"... but it is interesting to know that the mean fat intake of the human population has not increased much in the past 50 years." Exactly! What has changed? The amount of UPF consumption. I agree that the rising incidence of all those conditions in children is extremely worrisome. I would recommend the Van Tulleken book if you're interested in how UPF is being marketed to kids (be prepared to be outraged), and the article below is also informative. Once again, the Hall study shows that even when macronutrients are held constant (including fat), a diet high in UPF compared to non-UPF increases consumption when people are free to eat as much as they want, leading to excess calorie intake. Most UPF's are engineered to be highly palatable, making them addictive to some people. Again, I refer you to the Van Tulleken book for the how and why food industry does that. I don't know about lab animals, because they are highly bred for certain traits, but I believe that typical rat and mice chow is UPF, as is cat and dog kibble. Decades ago our pets were mainly fed "real food" in the form of table scraps.

https://lordslibrary.parliament.uk/impact-of-ultra-processed-food-on-childrens-health/

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Susan Scheid's avatar

This is terrific, and I love being reminded of Pollan’s food rules. Real food is so much better! I look forward to your future posts on this.

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H. Robert Silverstein, MD's avatar

Great information here as usual: here are some of the guidelines I use. As a starting point, I use the word "field": 'foods exactly as they grow up out of the ground and in the field'. Translated: unprocessed grains-vegetables-beans-fruit-nuts-seeds (GVBfns) at the 80+% level which correlates with only 4 of our 32 teeth for tearing meat and the remainder of our biology being essentially vegan. The huge EPIC study showed that animal protein intake correlated with breast and prostate cancer as well as lymphomas. Pre-technological societies are 80% gathers (organic unprocessed whole foods = GVBfns)/10-20% hunters and no matter how long they live have no high blood pressure, diabetes, high cholesterol, cancer of the breast-uterus-prostate-colon-pancreas, diverticulitis, constipation, ... . Fermented foods are recommended and essentially, following these guidelines 80+%, "anything once in a while" = usually a few times per month or year. You might enjoy the relevant published article "The Unhappening of Heart Disease" that discusses all of this in further detail. HRS, MD, FACC

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Richard Feinman's avatar

It was pointed out by Mike Eades that the organ that evolved for being able to tear meat apart was the brain which allowed us to make tools, sharpen stones for cutting, and fashion food processors. The evidence that vegetarian and vegan diets are valuable is the number of people that describe how it has helped their health and well-being. That it might not be the best for everybody is seen in the number of people who describe how they were vegetarians and could not control their weight or diabetes or well-being until they switched to a low-carb diet. And while the number in the first group is smaller than the number in the second group, the first group is more didactic, more hostile and exerts greater political power. To me, this is an argument against the universal benefit of vegetarian diets, not an argument for. I can’t remember the EPIC study but would be glad to discuss it unless Dr. Silverstein is absolutely sure that it is correct and nothing could change his mind.

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H. Robert Silverstein, MD's avatar

The human brain also created the atomic bomb, heroin. murder, ... That we can think something up and do it, does NOT make it correct. The diet is typical of 85% of pretechnological cultures who, when they do live to longevity, have NONE of our diseases. I have seen countless cases of diseases stopping or being reversed by being 85+% whole foods vegan. It is NOT necessary to be absolutely vegan--that is a straw man argument

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Cu's avatar

Thank you. Do you have a link to the article?

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Chris Sivewright's avatar

What about Huel and Jimmy Joy?

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