An Interesting, Alarming Look at Ultra-Processed Foods
 
UPFs, or ultra-processed foods—like packaged snacks, sugary drinks, instant meals and fast food—are often renowned for their convenience, low cost and pleasant taste, but they could be taking a major toll on our health, even more than we once thought. Today, I am sharing an interesting study I came across, supported by the Intramural Research Program of the National Institutes of Health, National Institute of Diabetes & Digestive & Kidney Diseases, which demonstrated the negative effects of UPFs on our health.
 
I was particularly intrigued when this nutrition-based RCT (randomized controlled trial) surfaced within the current discussion around UPFs. Nutrition research is rarely conducted as an RCT, resulting in a mountain of conflicting observational studies where associations between variables are identified but causation cannot be drawn. The lack of RCT makes nutrition research particularly confusing and is often compounded by publication bias, media interpretation, reductionist thinking and self-interest.
 
Note that the generalizability of this study is limited due to the lack of consumer choice and the in-patient nature of the study design. Further, the sample size was small, the time in each study group was short and a washout period between groups was absent. But the implications remain interesting and something to consider when we make choices about what we’re consuming.
 
(Keep in mind, this study is from 2019, so its discussion around UPFs precedes the current political climate.)
 
Let’s take a close look at this study and the findings:
 
THE VARIABLES:
The study examined 20 weight-stable participants: 10 males and 10 females aged 18-50, all who were admitted to the NIH Clinical Center for a continuous 28-day period. For a two-week period, participants were randomly assigned a UPF diet (as defined by NOVA) or an unprocessed diet. After two weeks, without a washout period, they switched diets. All 20 participants completed the study.
 
Each participant was provided with three meals a day. The weekly per-person costs of these diets were estimated to be $106 for the UPF diet and $151 for the unprocessed diet. The foods presented among the two diet groups were matched for calories from sugar, fat, sodium, fiber and macronutrients. Participants were instructed to eat as much as they wanted within a one-hour window for each meal. Snacks were also made available for each diet group.
 
MEASURING THE VARIABLES:
Participants wore continuous glucose monitors (CGMs) to track glucose, accelerometers to track energy expenditure (calculated as METs), and spent one day a week in a respiratory chamber to track energy components. Fasting blood was drawn at baseline and on the final days in each diet group.
 
Participants also responded to surveys assessing appetites, sensory experience and palatability.
 
To offset deconditioning from sedentary behavior, participants performed three, 20-minute cycle sessions at a controlled intensity.
 
THE OUTCOMES:
While on the UPF diet, participants consumed 500 more daily calories per day than when on the unprocessed diet, which correlated with an increase in calories consumed per minute in the UPF diet group. The extra calories consumed were from carbohydrates and fat (notably, not from protein).
 
Not surprisingly, participants showed increases in weight and body fat mass when on the UPF diet and reductions in weight and body fat mass when on the unprocessed diet. While on the UPF diet, fat oxidation was reduced, while insulin secretion and blood glucose increased.
 
While on the unprocessed diet, appetite-suppressing hormone PYY levels increased, along with free fatty acids and free T4, while hunger hormone ghrelin, adiponectin, total cholesterol, hsCRP and Total T3 levels decreased.
 
UPFs AND BRAIN HEALTH
Last month, in Concierge Choice Physicians members’ only wellness program, Motivated Mondays, CCP closely examined the role of UPFs on cognitive health. UPFs have been associated with a number of health concerns, including cardiovascular disease, diabetes, and mental health disorders. In this study, a well-controlled RCT, we see it corresponding in a linear, stepwise fashion with weight gain via increased calorie consumption. In addition, even in the short term, the biomarkers hint at the potential for additional inflammatory and metabolic health concerns.
 
WHAT ALL OF THIS MEANS FOR US:
With all this in mind, strongly I encourage you to eat and identify real, unprocessed food.
 
To help, you can ask yourself the following three questions we should ask ourselves before adding a food item to our grocery baskets:
 

1. Did my grandmother eat this food?
2. Could I recreate this food at home in my kitchen?
3. Are the ingredients on this label available right here in the grocery store?

 
If your answer is no to any of the above questions, try to avoid it.
 
As your concierge physician, I am always available to you, especially when it comes to helping you make healthier choices. Feel free to reach out with your individual questions. 

​As our loved ones age, the reality of their evolving needs comes into view and that may include playing an advanced role in their care. You may already know from personal experience that family caregivers are essential contributors to the healthcare system. In fact, it is estimated that 1 in 5 adults in the U.S. provide unpaid care to a family member or friend, many of whom are given little to no advanced notice. In order to help manage stress, expectations and provide the best care possible, you can anticipate the call to care by considering the following tips, resources and self-care advice.
 
Becoming A Caregiver
 
Patience is often the most important—and toughest—practice in caregiving. Keep in mind your loved one’s emotional needs and focus on/promote their dignity and independence as much as possible. Be an active listener and be attentive to your loved one’s verbal and non-verbal cues. Researching their diagnoses and speaking with their doctors (when appropriate) about their condition can help you to better understand what is needed from you in the management of their care.
 
Assess what is needed in terms of time management and organizational needs, including coordinating doctor’s office visits and household maintenance. If your loved one has more than one caregiver, define the roles of each contributing person, keeping in mind distance, time, resources and skills/experience. This can help you prioritize and anticipate the management of certain items and avoid future conflicts.
 
Document everything, including your loved one’s routines, diagnoses, medications, healthcare professional care team, emergency contacts and other important phone numbers, and upcoming appointments. You may consider keeping a care journal to organize these items. In addition, it will be important to organize medical records and legal documents (such as power of attorney documents, medical directives and wills) in one place.
 
Among the approximately 53 million Americans in caregiving roles, 70% offer unpaid elder care assisting adults aged 65 and older. However, in certain circumstances, one can be paid to provide caregiving to a family member.
 
Adult daycares and home healthcare programs may be available to support the person you are caring for. Medicare, Medicaid, veterans' benefits or private health insurance may pay for a portion or all of the costs depending on income, degree of disability and other factors.
 
You may also be able to enroll the person you’re caring for in long-term care insurance, which covers the costs of care for individuals who are no longer able to care for themselves and/or have cognitive impairments. Long-term care options may include home care, assisted living, skilled nursing care facilities or residential facilities. Consult with your loved one’s insurance agent to determine if they qualify for long-term care insurance.
 
For end-of-life care, hospice is excellent at providing durable medical equipment (DME) and nursing (in some instances, care time may be limited). Patients usually incur little-to-no out-of-pocket costs for Hospice care, but insurance coverage varies across networks and among individuals, so be sure to research costs.
 
Organizing Yours and Your Loved One’s Affairs Ahead of Time
 
It is not uncommon to find your loved one’s affairs in disarray or organized in a fashion that is only meaningful to them. You can get ahead of the entanglement of affairs with Advance Care Planning. The National Institute on Aging has an excellent resource to aid in advance care planning, with checklists and information to help you get organized before caregiving becomes necessary. I also addressed advance care planning in greater depth in my June 2023 blog, which you can find in my blog archives.
 
An often-overlooked consideration for caregivers is access to password-protected devices and social media accounts. If you do not secure those early on, you may need a court order to access them in the future. Apple devices allow a legacy contact designation.
 
And if you anticipate becoming a loved one’s Power of Attorney, research or speak with an attorney about the laws in your state regarding Power of Attorney designations.
 
Taking Care of Yourself
 
As with the oxygen masks on an airplane, we must prioritize our own wellbeing in order to properly care for others. Studies show the degree of a caregiver’s psychological, emotional and physical stress varies by gender and age, with women and caregivers 50 and under experiencing greater stress. Depending on your personal circumstances (like distance from the person you’re caring for, your employment and finances, for example) as well as the severity of disease or disability of the person you are providing care for, caregiving can take many forms and have varying impacts. Being prepared and staying organized can help you to manage the stressors you may encounter.
 
In addition to the usual self-care advice to sleep, move, eat right and keep your doctors’ appointments (be sure to schedule your exam with me each year and contact me for any other health concerns that arise!), decide what you need for yourself to keep going. Whether it’s a daily walk, a phone call with a friend or a coffee date with friends, try to schedule time for yourself each day. Planning that “me time” into your schedule will help you to actually take the time for yourself, and it may help to reduce any associated guilt you may otherwise experience.
 
Moreover, friends and family members may offer you help. While, for many, your first inclination may be to say, “No, thank you,” I would implore you to consider a genuine offer of help. Accepting help with remedial tasks that take up time and energy (like driving to doctor’s appointments, picking up prescriptions, cooking hot meals, walking the dog, etc.) could help to ease your mental or physical burden.
 
Looking for outside support to help you cope with a loved one’s new diagnosis and/or your new role as their caregiver? Take this quiz to discover the endless free and fee-based resources available, ranging from mental health professionals, group therapy sessions, faith leaders and senior centers, to the VA or AARP. And, of course, feel free to contact me with any questions or concerns about your own health and wellbeing.
 
Becoming a caregiver can be incredibly rewarding yet exhausting. To manage your stress, it can be helpful to focus on the tasks at hand, taking it one day at a time, and determining the best way to break down priorities with a special focus on your loved one’s safety, health and emotional needs, as well as your own. 

​Each year, we spring forward into Daylight Saving Time (DST) the second Sunday in March and we fall back to Standard Time the first Sunday in November. The intention of the extra hour of daylight is to conserve energy, but it has a number of adverse health effects.
 
Beyond a sleep deprived society losing yet another hour of sleep when we spring forward, what is the reason DST is so disruptive to our internal clocks?
 
In essence, every cell in your body has an internal clock that controls your biology on a 24-hour schedule. This is known as the circadian rhythm (CR). The primary driver of the CR is our exposure to lightness and darkness. For optimal functioning, our CR requires exposure to bright light during the day, which keeps us alert and gives us energy during the day, and reduced amounts of light in the evening, which induces drowsiness to get a good night’s rest. However, the opposite happens after DST when it is darker in the morning and lighter in the evening. Your body’s natural CR becomes mismatched with the clock. A misaligned CR will leave you groggy in the morning hours and alert before bed, much like jet lag if you travel west to east.
 
A misaligned CR will not only interfere with your sleep patterns, but also disrupt the appropriate timing of the release of hormones which impact hunger/satiety, mood, immunity, and metabolism.


Many agree we should skip the bi-annual time change, and just change the clocks once per year. There are several national petitions circulating to stop “falling back” but most scientists agree eliminating “spring forward” would make more sense, because Standard Time is more closely aligned with our CR.
 
As of now, no changes have been made so we will be switching to DST next weekend, so how can we prepare for Daylight Saving Time?
 

• Starting Tuesday night, March 4th, go to bed 15 minutes earlier each evening than the night before until the change happens. This will make that initial hour-long loss of sleep less challenging.
  
  
• Consider a lighter schedule on Sunday, March 9th  and Monday, March 10th  to allow your body to adjust.
  
  
• On Sunday and Monday limit naps to 20 minutes in duration. This will help to avoid a bad cycle of not sleeping and trying to catch up on sleep and then again not sleeping,
  
  
• From the time you rise until just after dinner, get as much exposure to daylight as possible.
  
  
• Monitor caffeine consumption. How quickly you metabolize caffeine is genetic, so you know best if it stimulates you and keeps you awake at night. If it does, make your last dose of caffeine 8 hours from your planned bedtime, as half of it should be metabolized by then. Did you know? There is little actual caffeine in chocolate. If you find chocolate stimulating, it is likely the effect of theobromine, a component of the cacao bean and in highest concentration in dark chocolate.
  
  
• Avoid alcohol at night. It may help you to fall asleep faster, but you likely won’t stay asleep through the night, interfering with the deep restorative stages of sleep.
  
  
• Exercise! Just avoid it close to bedtime when it might interfere with sleep.
  
  
• In conjunction with your concierge physician, consider eating within a restricted window of 8 hours a day (optimized if those 8 hours are during daylight hours).
  
  
• Lastly, as the night draws to a close, start to dim the artificial lights. This means dimming the overhead lights, reducing screen time/adjusting brightness and logging off 1-2 hours before bedtime, and ditching the TV. Consider a paperback book or a journal for entertainment before bed instead.

 
With these tips and tools, you can adjust your circadian rhythm and conquer the fog and grog of Daylight Savings.

​Well, we’ve made it halfway through what has been an undeniably challenging decade. Hopefully, the second half compensates with some relative peace and quiet. I know many of my members report developing or slipping back into some less health-promoting habits and are looking to make some changes in the New Year. That’s right, the often-joked-about New Year’s resolutions.
 
Rather than rehashing the trite SMART goals, let’s talk about some statistics and the more unusual approaches to succeeding at your resolutions, which can help put things into perspective for you.
 
Resolution Stats

• Those that make resolutions are ten times more likely to change their behavior than people who do not—so make one!
  
  
• Resolutions that incorporate a new behavior are more likely to succeed than those which avoid an old behavior.
  
  
• People who choose one resolution are more likely to succeed than those who set multiple goals.
  
  
• Those who anticipate and plan for obstacles are more likely to succeed than those who do not.

 
Approaches

• For built-in motivation, align your resolutions with your values. For example, if your resolution is to sleep more, tie your resolution to the pitfalls of excessive social media consumption or TV use. If you watch less TV and spend less time scrolling at night, you are more likely to hit the hay earlier.
  
  
• There is no reason to swallow the elephant whole. Take smaller bites! In other words, break the resolution down into smaller resolutions. For example, one study found that those who resolved to volunteer 200 hours a year were more likely to reach and even exceed that goal if they broke down that resolution into volunteering 4 hours a week, instead.
  
  
• Tie the resolution to a reward so it’s associated with pleasure and not seen as a chore. If you resolve to hit the gym 5 days a week, plan a small donation to your favorite charity if you successfully hit your goal.
  
  
• On the flip side, tie a “punishment” to a backslide, so it’s associated with pain. Using the example above, if you miss your weekly gym goal, make a donation to a charity not aligned with your belief system—ouch!
  
  
• Some say misery loves company. Hold yourself accountable to another person by setting the resolution with a friend or a group (can be virtual). You will be less likely to backslide if you know you are there to support others. Camaraderie is a great motivator!
  
  
• Think like a Marine – Improvise, Adapt and Overcome. Life rarely goes as planned, so pivot when challenged, as there is usually more than one path to victory. Using our gym example, what happens if your car is in the shop, and you cannot drive to the gym? Go walking for the time you would spend at the gym so that you’re still getting exercise, just in a different environment.
  
  
• Moreover, if you journal your progress, you will be able to reflect upon and learn from past successes or challenges.
  
  
• Seek professional guidance-there is no harm in hiring a coach! Consider the cost your financial accountability partner!

 
And, of course, I will use this opportunity to remind you of the Motivated Mondays program available to you via my partnership with Concierge Choice Physicians. If you were enrolled last year, you will be auto enrolled for 2025. If you are a new member or have not previously participated in Motivated Mondays, then you’ll soon receive an email inviting you to participate.
 
Good luck and, as always, feel free to comment below or reach out directly with any personal questions or concerns.