- In today's podcast, we're gonna talk about how to not lose muscle while taking GLP1 agonist medications, whether exercise really is the best treatment for osteoarthritis, and how processed foods are really affecting our health. Let's get started. Welcome back team to the Building Lifelong Athletes podcast. Thanks so much for stopping by. I really appreciate it. For those of you who don't know me, my name is Jordan Rennicki, and I'm a dual board certified physician in family and sports medicine. And the goal of this podcast, keep you active and healthy for life through actionable evidence informed education. And so here we're doing a little bit of research review. We're gonna talk about three recent articles and the main points for them and kind of my takeaway. So let's dive in right away to them. So first things first we're gonna talk about is we're looking at GLP1 specifically, how to maintain muscle while on them. They're obviously the hottest craze right now. The incretinimimetic drugs or IMDs, essentially these are drugs like semiglutide and tricepatide and they're used for obesity and diabetes. What they mean by incretin, so incretin hormones are things like glucagon like peptide, GLP1 or GLP1 and gastric inhibitory peptide or GIP. And these incretinimetics, they stimulate insulin release, they slow gastric emptying and suppress the appetite. That's kind of how they work. And this has been rapidly adopted by everyone in medicine. It's crazy. I would say before, just a couple months ago, maybe a year or so ago, I rarely prescribed a weight loss medication. And then over the last year, year and a half, things have just blown up and it's probably the most asked about medication in my clinic. Everyone is talking about these these days. So I just wanted to talk about a little bit here and they've been rapidly adopting, meaning everyone's prescribing like crazy. There's not enough of them. People can't get them in the stores at the pharmacies. They can't get them 'cause they're out and they've been all over the place used by everybody, but it's kind of outpaced the ability for professional societies to update their clinical guidelines. And so we're kind of getting out there on a limb and people are just doing things and we're figuring all that together. And so that's what we're trying to figure out here is, hey, how can we use best practices, learn from here? So essentially the idea of this paper was to explore the muscle loss though, specifically that was associated with rapid weight loss caused by these IMDs and then propose strategies to minimize muscle loss. And the reason we care so much is 'cause muscle is important, right? We, if you lose muscle, you're losing muscle mass and it's losing function and can lead to negative health outcomes like reduced metabolic health, weight regain, and a compromised quality of life. So this is why we care so much about it. And low muscle mass often is unrecognized and usually independently associated with an increased risk of mortality and morbidity, reduced quality of life, increased risk of type 2 diabetes and other health outcomes. And so in and of itself, a low muscle mass is associated with bad outcomes. So that's why we care so much because if we are taking these medications and we lose weight, that's cool, but if we lose a lot of muscle mass, that may lead to a lot of issues as well. And so that's what we're kind of looking at here. We wanna talk about what's the actual mechanisms, right? So these IMDs, these DLP1 drugs and other medications, they help with weight loss by reducing appetite and slowing gastric emptying as well, but muscle loss is a consequence of caloric restriction, right? And the thing is it's gonna happen. When you lose weight, whether it's through exercise or nutrition or bariatric surgery or these medications, you will lose muscle. That's just how it goes because you're in a caloric deficit. Specifically, I would say there's very rare circumstances where it lose a little bit. Maybe some people are able to hold on to all of it, but odds are you're gonna lose some muscle. The question is how much? That's the million dollar question. And specifically on this slide here, there's a nice photo and explains there's multiple reasons for muscle loss. Not things necessarily do only to these medications, but also associated with them. So things like aging. As you age, you tend to have less muscle mass. That's what happens. If you have a preexisting low muscle mass, obviously that plays a role. Comorbidities like type 2 diabetes, a history of weight recycling, meaning, hey, you consistently gain weight, lose it, all that stuff. Inadequate protein intake may play a factor as well. Reduced appetite from these medications, GI side effects, and then physical inactivity, which can sometimes all be associated. So it's much more complicated than just like, hey, you take medication and you lose muscle. There's lots of things going on as well. But it is something that we have seen and that's why we're worried about it. And specifically looking at this, this step one trial, the Cermont trial, what they had here is they essentially had, this is a trial of semi-glutide and trisepatide. This was a clinical trial. And these participants lost 10% or more of their muscle mass during the 68 to 72 week treatment, which equates to about 20 years worth of age-related muscle loss. That's why they said, they said, hey, this amount of weight loss is 10% loss in muscle. That is what we expect to see over 20 years of time. So they're saying, hey, in this 68 to 50 or 72 week, like that experiment, they lost as much muscle as they would over the next 20 years just by general aging. And so that's pretty crazy. Then even crazier thing was that overall though, the numbers were consistent with other means of weight loss, things like bariatric surgery. So when we're stepping back, when you're losing enormous amounts of weight, right? You know, looking at 10, 15, 20% above percent of your total body weight, that's a lot of weight. And, you know, similar to bariatric surgery. And they're finding that the numbers in terms of how much muscle you're losing was similar to those bariatric surgeries. So this isn't necessarily just a GLP. One thing, this is a rapid weight loss and profound weight loss thing. And the implications for this though, is that lower muscle mass does reduce metabolic rate. It increases the risk of weight regain. And then also may lead to weight cycling, like we talked about, which is kind of gaining weight, losing it and kind of going back and forth. And then it may lead to something called sarcopenic obesity, which is where you will have, since you lost your muscle mass, but you still have obesity. So if we're just losing a little bit of weight, right? Just losing some weight and you lose predominantly muscle, like are you in a better metabolic state than when you, before you lost that weight? And then the question is maybe not. And that's the biggest takeaway here, is if you're just losing muscle, that's certainly not good. And here on the slide here, there is also another image I just wanna talk about that. That is essentially the pattern of weight loss on these meds. It shows that when you're on the medication, life is good. Essentially, that's what it is. You lose weight and things are looking good, but then once you stop, we tend to see an increase in their weight and increase with appetite and energy intake. And so it's kind of this, hey, what we're finding here is that when you're on these medications, you kind of gotta be on them long-term. Obviously, we do not have a long drive record using these for weight loss specifically, and there might be some ideas with cycling it, you go on for a certain period of time and off again, and we're gonna learn a lot more, I guarantee you about that. But it seems like right now when you stop it, we tend to have some weight regain. And so that's another concern of ours as well as being on these forever, what does it have to do with everything? And so what are actually nutritional strategies for muscle maintenance? That's a big thing, right? So how can we do it? When we're on these medications, it's gonna start taking off some weight by the mechanisms we already talked about, right? Decreased gaseous emptying, increased satiety, all those things. But how do we hang on to as much muscle as possible? Well, first things first is getting adequate protein. So the big thing is they're recommending about 1.0 to 1.5 grams per kilogram of body weight. And it depends on how much to lose. This is a general ballpark, right? Like if you have an enormous amount of weight to lose, if you're having a BMI over 40, 45, something like that, it may be more to use the ideal body weight, 'cause then all of a sudden you're gonna be eating 300 plus grams of protein a day, which is excessive and very hard to do and expensive, and so lots of things there. So that's a general ballpark for people who are kind of in the general overweight to let me know on the smaller side of obese stage. But like I said, this is not medical advice anyway, so talk with someone if you're doing it. But overall, that's the general goal. So one, 1.5 gram per kilogram of body weight. A lot of times people say, "Hey, what you should do is just go for like one gram for your overall weight." Once again, that can be enormous, so I wouldn't recommend that. But they're saying, "Hey, the long story short of this is, hey, we want you to have adequate protein intake, 'cause we're giving your body what it needs to maintain muscles, right? So we need protein to hang on to muscle mass. That's really important. Protein supplementation or oral nutritional supplements may be required to meet these needs. So some people say, "Hey, I just can't stomach eating that much chicken breast," or something like that. You might be like, "Hey, I can't be as boring as you, Jordan, and eat chicken breast consistently." And that's okay. I realize I am a very boring person and that is my life. But you may need a supplement with protein powders or anything like that. And on top of that, they also mentioned micronutrient intake is, you need to make sure that's sufficient to support muscle function. They were incredibly vague on this though. They just pretty much said, "Yeah, you should take micronutrients in." Okay, well, that's super unhelpful. But once again, if we're stepping back, health-promoting diet, that's what we're hoping for, right? We're not just using these medications as a get-out-of-jail-free card. Like, "Hey, I can do whatever I want, eat whatever I want." No, we still wanna do it in the context of a health-promoting diet, being physically active, all that stuff. So if we're having a health-promoting diet, hopefully we're getting a micronutrient intake there as well. But that's just something I wanted to mention. And then they mentioned physical activity as well. I wanna talk about the physical activity recommendations. And you've probably heard these multiple times on this podcast, I'm gonna go over them again. Essentially what they're looking at is just resistance training, right? So resistance training, anaerobic training, and they mentioned flexibility as well, but not that important. But resistance training, at least a couple of times a week, full body, that's really going forward, two or three sessions per week, full body, using all the main muscle groups, that's a big thing. And this is like the biggest take-home and foot stomp here is the studies have shown that it helps retain muscle during caloric deficits in patients with obesity or after bariatric surgery. So in previous studies where people had a lot of weight loss resistance training seems to be the key to hanging on to that muscle mass. And so like if you had to prioritize one while losing weight I would prioritize resistance training. That'd be probably it. That being said, we're building lifelong athletes here. And so you should be active and doing all the things here. And so I'd also say, from a physical activity standpoint, we also wanna make sure we're hitting our 150 minutes of moderate or 75 vigorous per week. That's the general goal. So those are the physical activity guidelines. And flexibility, if you have time and wanna do it, that's fine, they recommend it. It's part of the guidelines, but I usually don't include those 'cause that's just not nearly as important. If you're like, hey, I have 30 minutes, should I spend it stretching? Absolutely not, do not do that. Go lift weights, go do something that gets you out of breath. Something like that is way better. But regardless, exercise is gonna be very, very important and good for you regardless of the quote unquote success. So evidence does suggest that when you're on this therapy, these drugs, when it's accompanied by supervised exercise, then those who adhere to the adverse effects during treatment usually decrease. And then also it also helps after you stop the medication, right? So if you're exercising and you stop medication, they have better results after that as well. And so really, once again, I'm a shill for big exercise. I'll admit it, they're sending me lots of money, but no, big exercise, exercise is the best thing you can probably do for your health. And it makes sense that why we wanna do that as well. And really, as I was mentioning before, it really is a comprehensive obesity treatment, right? So the ideal way to lose weight is that we're gonna do multiple modalities, right? It's not just one thing. The goal here is to reduce as much fat as possible while retaining muscle mass and hopefully minimizing obesity-related complications. That's what we're going for. And so we're gonna have, take those medications, then we're gonna be exercising, specifically resistance training, doing cardiovascular training, all those things. So it's really, really kind of a multi-pronged approach. And then on top of that, in these studies, we did look at body composition. This is where we get this data from, right? So we looked at body composition. The gold standard they use is DEXA or dual X-ray absorptimetry, which is a mouthful to say, so we say DEXA. You can use MRI as well. Or you can use bioelectrical impedance. All those are used. DEXA is kind of the gold standard in studies. MRI is probably the best, but so impractical 'cause it's expensive and takes forever. And bioelectrical impedance is pretty variable. And so that one depends on the device you have. But at the end of the day, this is not something we're routinely doing in clinic. Insurance won't pay for you to get a DEXA scan to see how you're doing for your muscle mass. So we're kind of just doing the eyeball test, right? Seeing, hey, how are you doing? What does your muscle mass look like? Maybe hips are comfortable seeing how we're going, but most people aren't tracking this, studies are. And that's why the studies are doing this so that they can say, hey, when we see the weight loss, this is what we see. When we add on resistance training, this is what we see. So that's why we're taking this data that, hey, when we resistance train with weight loss, we tend to stave off some of that stuff. And so that's something that we think about. And they also have different muscle function tests they can look at, things like grip strength or physical performance measures, like the get up and go, sit to stand, lots of that stuff. So what they found though overall is that, hey, when you resistance train, the odds of you losing a lot more fat, it goes down. So we want you to resistance train. That's the big thing here. Get your protein intake. And going forward, there are definitely ongoing studies that are gonna look at, they're gonna look at long-term effects of these medications on muscle mass and how to prevent muscle loss. That's really important. Also gonna talk about potentially additional medications like androgen receptor modulators or myostatin inhibitors, which is a podcast for another time. But essentially you could just not lose muscle by just taking another pill. And I mean, once again, we're getting crazy here, but that's what we're looking at. But overall, we really wanna just develop a balance for fat loss with muscle preservation while exploring what these medications are doing long-term. That's the big thing. And so overall key message here though for this article is preserving muscle mass during these IMD therapy is critical to improving obesity treatment outcomes and emphasizing protein intake and resistance training as core components of obesity management is really crucial. And of note, it was worth mentioning that this article was funded by two different pharmaceutical companies. Just wanna mention that as well. I don't think it negates anything. They're saying, hey, if you're gonna use our meds, if anything, they're saying, yeah, you're gonna lose some muscle. And so they're kind of alerting things there. Doesn't change the approach. That's pretty consistent with what we find. So that's the first article here. I hope you found that helpful. All right, now we're gonna move on to our next article. We're talking about osteoarthritis in the knee and hip and exercise. And OA or osteoarthritis is a leading cause of disability affecting millions of people worldwide, right? So, but therapeutic exercise or exercise is widely recommended for managing OA in the knee and hip. However, not all patients respond to exercise equally and the factors that influence its effectiveness are still under investigation. And so what we're looking at here is we're gonna try to figure out how can we figure out the people and the patient population that respond best to exercise, who are those people, or is it all the same for everybody? So we're gonna dive in here to this study. So first and foremost, prevalence of OA. OA is a significant cause of disability. Like I mentioned, the global prevalence has been rising due to an aging population and increasing rates of obesity. As I've talked about previously many, many times is that, hey, we are finding that osteoarthritis has a very strong link to metabolic disease and obesity. And since about 1990, we're up about 9% of the prevalence of osteoarthritis. Now about 3,000 people out of every 100,000 have arthritis. And the current treatment guidelines, the international guidelines, including those from the American College of Rheumatology and OA Research Society International recommend therapeutic exercise as a core treatment for hip and OA. But should that be the case, let's dive in. So moving here, the importance of therapeutic exercise. First of all, what is therapeutic exercise? Therapeutic exercise refers to a structured physical activity aimed at improving or maintaining a specific health condition like OA. So therapeutic exercise essentially exercises medicine. We are specifically targeting for it. It includes things like aerobic exercises, strengthening flexibility and balance exercises. And overall, the general benefits for exercise in OA, research has consistently shown that exercise can reduce pain and increase physical function in people with hip and OA. However, the effects are often small, the moderate, and the benefits can actually decline over time. And only about 50% of people who do this get a clinically significant response. So that was actually surprising to me. Only 50% of people get a clinically significant response. A lot of times I'll tell people, "Hey, we wanna exercise as our first line." But knowing here only about a coin flip of people are gonna get that, that's kinda depressing as well. All right, now let's discuss the findings of the meta-analysis here. And this meta-analysis was, included 31 randomized controlled trials, with just over 4,000 people. And the goal was to identify, hey, what specific individual level effects were the biggest changes that we saw on the people who responded to exercise? So the people who had hip and EOA, what things or what people specifically led to the improvement in there. They used individual participant data, which is unique, 'cause a lot of times in big studies, they group everybody together. So they essentially say, "Hey, you include Tom and Martha here, Tom had an amazing benefit, but Martha had nothing. They might just cancel each other out and show no benefit, but Tom definitely had benefit. And so we're trying to figure out what happened there with Tom that we did it." Obviously there's no one named Tom in the paper. That would be very big HIPAA violation. But that's the general idea of why they're using individual data, which is really cool. And overall, there were 37 different exercise modalities that were studied. The duration varied, the delivery method, meaning online, in-person, home-based, that all changed. And on average, therapeutic exercise did reduce pain and improve physical function compared to non-exercise control trials. However, the effect was much smaller than we thought it would be, which is actually interesting. And most people say exercise is the most important thing, and I'll say that myself, but it doesn't seem like for everybody had a big effect. On the group, it looked like a moderate effect. However, baseline pain and physical function did seem to influence things as well, meaning people who had higher pain and worse physical function seemed to benefit more from exercise. So that's kind of like one of the big takeaways is that people who had worse pain and worse function had the most to improve from exercise. So there was significant variability though between the responses that we talked about. So the baseline pain severity, we're diving a little deeper here. This analysis revealed that patients with higher baseline pain scores, like I mentioned, benefit more from exercise, with the greatest improvement in those reporting a pain scare above a 40. So on a zero to 100 pain scale, people had a 40. Above there, they seem to have the greatest improvement. And why is this? Well, I don't know, shoulder shrug emoji. Nobody really knows. They think that maybe patients with severe symptoms have a higher potential for improvement, right? So if you have a terrible life, you're super inhibited by arthritis, then you've got more to benefit, right? As someone who says, "Hey, I have a little pain here." That's a lot harder to do. So that's kind of like the main idea why I think this is the case. And on top of that, baseline physical function, individuals with poorer physical function at baseline, once again, showed greater improvement in both pain and physical function following that. And probably the same idea, right? If you are almost bedbound from arthritis, then you have much more to gain than someone who's very, very functional and just has a little achy knee after they exercise. So the difference is what we think that's why what's going on. And overall, this does suggest that therapeutic exercise may be most beneficial for patients with more advanced OA or those who are experiencing a significant functional impairment. That's kind of what we're thinking about. And there were no other factors that really showed significance, which was great because we shouldn't use other factors as a reason not to prescribe exercise, right? So they looked at things like diabetes and obesity and they didn't necessarily see that those things affected it. And so the way I take it is, "Hey, we should be prescribing exercise to almost everyone." And specifically, most people would think the reverse was true, like, "Hey, if you're really having bad OA, we shouldn't prescribe exercise. It might make it worse." Like, well, the data shows it's actually the opposite. It might make it better. And I still think you should prescribe exercise to people who have moderate or mild OA because it's just good for your overall health. And so really there's nobody we shouldn't be prescribing for but maybe our expectations have changed just a little bit. That's kind of one of the big takeaways here. And so the clinical takeaways here is that they indicate that exercise interventions may need to be tailored specifically based on the baseline pain or function levels. In patients with severe pain or physical function, they should be prioritized for therapeutic exercise and they're likely to experience the greatest benefit, which is awesome. And they did see a lot of short-term improvements but the long-term improvements may be a little limited. In clinicians, we should kind of consider incorporating long-term exercise programs and combining therapy exercise with other treatments as well such as weight management and pain relief strategies to kind of improve overall outcomes. And overall, the findings do kind of question the magnitude of expected benefit from exercise, right? And people with near hip OA, it's kind of adding to the growing body of evidence that kind of raises the uncertainty about exercise with osteoarthritis. And I've mentioned before, I'm kind of starting to consider OA as almost a metabolic disease. Not necessarily, you know, if you've had a previous ACL tear and you tear your knee, you're gonna have post-traumatic arthritis most likely. That's not due to metabolic dysfunction but there's a strong correlation. So it's kind of understand that multi-pronged approach, right? Exercise for all the things it does from a metabolic perspective, from a weight loss perspective, then you work on maybe other lifestyle things. It's kind of a, yeah, multi-pronged approach is kind of what I'm thinking. And overall here, diving into physiologic mechanisms as well. Once again, the big thing is we're not quite sure but exercise maybe improves outcomes by enhancing muscle strength, increases joint stability, cardiovascular fitness, and collectively all that could reduce OA symptoms of viadigus as well, probably decreasing inflammation in your body, all those things. And although not all the patients respond to equally exercise, the variability could be due to a bunch of different things that we don't know about as well. So the study didn't find strong evidence that factors like age or BMI significantly moderate the effect. But when we look at this many things, people are very confusing, so it could be a lot of things. And moving on here, there were limitations. Obviously one limitation of this was that we use this individual purchasement data from several, several of the RCTs are missing that data. So it's kind of hard to include all the data. And we had so many different exercises. It's very heterogeneous, meaning the time or the type, the duration, all these things were not quite what's going on and it may affect generalizability in the future. And so more studies are obviously needed, but overall, once again, just kind of taking home the conclusion here is that therapy exercise does provide small but meaningful improvements in pain and physical function for people with near hip OA, especially with those with higher baseline pain or worse function. So especially those who have the most pain or the worst function. However, long-term effectiveness is not sure, but I still think it's probably worthwhile. But tailoring exercise might be the move, meaning, hey, we're going to tailor it for specifically, we should be prioritizing people with more pain or worse baseline function, which is kind of interesting and not necessarily thought. All right, so now let's move on to a article talking about ultra-processed foods and human health. Let's get going. So the paper here is ultra-processed foods and human health and umbrella review and updated meta-analysis of observational studies. This is by Dyadol. And essentially for context here, we are having an increasingly amount of consumption of ultra-processed foods and people are eating lots and lots of processed foods, and we're not sure what the implications are for non-communicable diseases. So things like diabetes, obesity, all that stuff. Obviously spoiler, probably not good, but this kind of looked at it more specifically. And the goal of this article was to evaluate and update the existing evidence in the association of these ultra-processed food consumption on health outcomes. And since we're looking at it, so the United Nations had a decade of action on nutrition between 2016 and 2025, and its emphasis is on reducing non-communicable diseases, linked to diets specifically. So they're kind of saying, hey, we're looking at how do we decrease these non-communicable diseases through diet, and they state that the ever increasing production and consumption of UPFs might represent an actual global crisis. So they're not saying, hey, this might be a problem. They're saying ultra-processed foods might represent a global crisis. That's a big statement to say, and that's coming from the UN. So let's take a look here and say, first of all, what are ultra-processed foods? So ultra-processed foods, these are industrial formulations of substances derived from food or synthesized from other organic sources. So meaning, that's like a really catch-all term of saying like, it's kind of food, but it's really processed and it's kind of a whole deal. But typically they contain little or no whole foods and are ready to consume or heat up. So they're ready to go for you. Whenever they're convenient, there are things in packages. They tend to be high in fat, salt, sugar, which typically kind of have some increased risk with health outcomes. And they may have lower amounts of dietary fiber, protein, or missing a lot of micronutrients. And so missing the good stuff and has lots of the bad stuff. That's typically what it comes down to. And usually these products contain a variety of additional additives as well. And they render the final products hyper-palatable, highly profitable, and ready to consume with a prolonged shelf life. So at the end of the day, they are making, I'm gonna repeat that, foods that are hyper-palatable, highly profitable, and ready to consume. That is what an ultra-processed food is. And that's what we're looking at here, specifically in this study. So how they categorize it, well, there's this NOVA classification system, right? So groups one through four. Group one, these are unprocessed or minimally processed things. Things like fruits, veggies, meats, kind of the good stuff, right? So we're talking about eating an unprocessed diet. We're kind of hanging out here. Moving up to group two, they're a little more processed. Things like oils, fat, salt, and sugar. So things like butter, right? Honey, even olive oil, things like canola oil. Everyone talks about how highly processed those are. That's a whole other discussion in podcasts, but group two is our oils. Moving to three, these are processed foods. Things like bacon, beef jerky, fruit, and fruit syrup. So things that are looking like food, but starting to move away from that. And then four are ultra-processed foods. Things like cookies, ice cream, pre-prepared pizzas, all the good stuff, right? All the super hyper-palatable things. And so this is kind of this NOVA classification. And moving on here, there is a global health crisis and a lot of times there's a link to it. So first of all, how much are we eating? Well, fostered by these characteristics, lobby by the food industry and effective marketing strategies for these processed foods. Consumption has sharply increased worldwide and is now increasingly prominent everywhere, pretty much. And it's accounting for more than 50% of energy intake in many high-income countries like the US and UK. So stepping back here, more than 50% of energy intake is coming from these ultra-processed foods in the US and the UK. That's a big deal. So that's just what they're saying here is about 50%. But what do we already know about their health outcomes? Well, a previous review of UPFs published by Lane et al showed that UPF consumption was associated with adverse health outcomes. Things like overweight, obesity, abdominal obesity, all-cause mortality, metabolic syndrome, depression, all these things were found with that. So we do have a history of seeing that, hey, these ultra-processed foods do seem to be linked with a bunch of bad health outcomes. And so this study specifically, it was an umbrella review and meta-analysis of all these observational studies. And so observational studies have to remember that, hey, we cannot bring any causality from this. It's just an observational study. But they looked at different databases up to March, 2023, but they had to, in the study, have to have some sort of health outcome, right? So they had to have ultra-processed foods looking at a specific health outcome. And this was a meta-analysis of cohort case-controlled or cross-sectional studies looking at UPF consumption. And overall, once again, had to have observational studies with some health outcome. And the key metrics they looked at here, we're looking at summary size effect, confidence intervals, and they're looking at all these different things, looking at, hey, looking at bias, how bias were these as well, and what were the overall outcome of the study? Well, essentially what we find is that the analysis of these 39 meta-analyses, so essentially a analysis of analyses, it included 122 individual studies on 49 unique health outcomes. They did find that ultra-processed food was associated with 25 different health outcomes. The big thing is for convincing evidence, meaning, hey, we're very confident that these are most highly associated with this, is renal function decline and wheezing in children, so essentially kidney problems and wheezing in kids. Highly suggestive evidence, meaning probably has something to do with it, includes diabetes, having overweight, obesity, depression, and common mental disorders as well. And then suggestive evidence for all cause of mortality, cardiovascular mortality, hypertension, cardiovascular events, abdominal obesity, and anxiety. And so just taking a step back there, what they're saying is, hey, we feel very confident that this is linked to renal function decline and wheezing in children. We also still feel pretty darn confident that diabetes, overweight, obesity, depression, those things, and then things that we think also play a role, things like mortality are the big thing. So a lot of big players there, a lot of big health outcomes that we're finding with ultra-processed food, but overall, this is not a huge surprise, right? We've done this time and time again that we think that ultra-processed foods, the more people eat, the less health-permanent diet they generally have, so not altogether surprising. Moving on here, looking at additional outcomes, they did have some weak evidence for colorectal cancer, Crohn's disease, inflammatory bowel disease, and metabolic syndrome. And then overall, though, one of the big takeaways is that a lot of the studies were classified as low or very low quality using the grade system. So this is kind of the problem you have with meta-analyses and lots of large observational studies. It's very hard. It's a lot of heterogeneous data. It's hard to definitively make an amazing paper, but hey, we use what we got. And so one of the questions they had was, well, what's actually causing this, right? What's the mechanism behind the harm? And at the end of the day, it's nothing groundbreaking, right? So these super-colorkally dense foods lead to weight gain and then metabolic syndrome. And what is metabolic syndrome? Remember, it's waist circumference greater than 35 inches in men, or 35 inches in women, 40 in men, excuse me, hypertension with blood pressure diagnosed of 130 over 85, high blood sugar, fasting over 100, high triglycerides greater than 150, or low HDL less than 40 for men, less than 50 for women. And so these really, really super dense, calorically dense things, they make you gain weight. That's like the least shocking news of the day, right? Like, hey, when you gain weight, you have worse metabolic outcomes. That's the least shocking news. And that's what they're kind of finding here. And the thing is these are designed to be hyper-palatable, right? Salt and the texture, they go, like they're scientists, right? They are trying to make the most delicious thing ever. I mean, you go and some of these things are crafted in lab and that's really what's kind of the big thing. And they're trying to do it because it's very good, right? It sells for them and it's very important. So once again, am I calling every single person who works for big food or big agriculture bad? No, that's not what's happening at all. But it's 2024, people have found a way to make these things incredibly addictive, essentially, where, hey, you eat that and you're like, wow, your senses just light up, right? 'Cause we've designed with the salt and the fat and the texture just make you want more and more. And so they're doing that. And then by doing that, you eat a lot, right? 'Cause how do you eat just one chip, right? You keep going, you keep going. So that's the big thing as well. And what they have mentioned as well is they talk with wheezing. They might've thought mechanism-wise that maybe some of the additives in the food may be causing an immune response, which triggers inflammation in the airways. That's gonna be impossible to definitively know looking at these studies, especially they're all observational. That is more speculative than anything. So I'm not saying, hey, this is what's happening. But that's the way to think of it. Think of, hey, maybe eating excess amounts of calories and some of these additives may increase information and oxidative stress. And I will say once again, there's probably mechanistic studies showing this is an option and this is where they extrapolate from there saying, hey, this might happen, may create inflammation, all that. But also when we eat too many calories, we also know that's a pro-inflammatory state as well and these oxidative stress. And so is it these additives? Is it extra calories? Who knows kind of playing a role, but either way, what I thought was also interesting is that they did say that these ultra processed foods, they may be playing a role in mental health, meaning leading to a decreased mental health. So having issues like depression or anxiety, which are super interesting. And they also mentioned non-nutritive ingredients as well. Things like non-chloric sweeteners, like aspartame. They say maybe that artificial sweeteners can inhibit the synthesis and release of neurotransmitters. This is once again in study. So what they're saying is, hey, we see these correlations, right, of decreased mental health in people who eat these processed foods. Why is that? They're saying, oh, from previous studies, things like in the lab, in vitro, maybe we saw a decreased amount of neurotransmitters after eating aspartame or artificial sweeteners. So they're kind of suggesting that it may be the cause. They're not saying by any means, hey, we know this definitively, we're proving it, but these are just some ideas throwing out there, which is kind of interesting. And at the end of the day though, like really what's happening, we know for a fact though, is that the consumption, really into a overconsumption, and that's really what it comes down to. We're eating way too many calories, leading to lots of issues in body weight, you know, increased body weight and adiposity is not good. It leads to lots of issues down the line. So that's something we're thinking about and looking at as well. And so looking onto the implications for this health and practice. So this is something we should be talking about in dietary counseling. So we should be asking our patients, hey, like, what does your diet look like? You know, and asking and seeing, hey, how much processed food are you eating per day? And sometimes this is tough. And here's the biggest thing is, this is not like a single thing, right? Like, hey, you should make someone feel bad 'cause we're eating processed food. 'Cause this is a public health issue, right? We might need public health policies to take this. We might need to have taxation on these. We might have more pronounced food labeling, you know, to alert people of this. And unfortunately here in America specifically, anything like that, like taxation or food labeling probably won't go over well with the lobby and just Americans being good old fashioned and stubborn, specifically with taxation. You know, that's the big thing. If you tax these foods, people in America would, first of all, boycott that and they say, I wanna eat what I wanna eat. You can't tell me what I wanna eat. And hey, you know what, that's fine. What did Ron Swanson say in one of his Parks and Recs episode like, this is America. If you wanna eat what you want, blow up to 400 pounds and die of a heart attack, that's fine, you can do that. That's beautiful. And I don't think it's beautiful, but I understand that. But we have to understand that this is very tricky, right? So the food environment is a huge challenge. And so it may take public health measures to help mitigate that. That's a whole other podcast. I'm not opening in the can of worms on that, but this is some things to talk about. We may need to think about at a higher level, right? It's talked about food labeling as well. Some places are starting to do that, like in California, but maybe having a thing, hey, this contains ultra processed foods, or essentially, you know, it's almost like a tobacco warning. Hey, this includes this to alert people that, do I think it'll change? I'm not sure. With all that stuff, it's like, okay, that's great. What do we actually do? Well, I think the biggest thing is we need to focus on eating a whole minimally processed foods. Like those are the big things. Your diet should consist of things that are whole and minimally processed. That's really, really like the basis of everything. And yeah, so that's kind of what we, all these scary things we should do, like we know what we should be doing though. And so this is just what we're looking at here. And specifically, there are research gaps for this. You know, this is lots of limitations as well. There's high heterogeneity between these studies, meaning lots of different studies. We were relying on observational data and lots of health surveys, which we don't know how good it is long-term for that. It may not be representative of their long-term diet. And on top of that, they did call for more high quality cohort studies and randomized controlled trials to confirm the things they're finding and establish a safe level for UPF consumption. So they're saying, hey, can we find, is there a safe level of ultra processed food consumption? They're not necessarily sure. But this does conclude this podcast. Thanks so much for stopping by. I really appreciate and listening. I appreciate your time. If you spent time with me, that means the world to me. And if you did enjoy this, it would also mean the world to me if you either left a five star review or share this with a friend. That's the best way to get it out. But hope you learned something today. Hope you enjoyed it. Either way, thanks so much. Now get off your phone and get outside. Have a good rest of your day.
