148. Big Tobacco's Role in Our Unhealthy Eating Habits, The Gray Zone of Legal but Unregulated Semaglutide, and more.

Did you know that the big tobacco companies aren't just known for what they do in the smoking industry, but also for other things? Are you aware there’s currently a shortage of weight loss drugs?  Have you ever thought about how the food you eat might be impacting your mental health? Do you ever think about the best time to exercise? 

In this week’s episode of Health Bite, we are going to talk about some of the top food, nutrition, and weight loss headlines in the news. So let’s dig into this week's bite.

What you’ll learn from this episode:

• Find out the role of big tobacco and how they have significantly contributed to the obesity epidemic in America
• What’s going on with the weight loss drug shortage and the gray zone of legal but unregulated Semaglutide 
• Find out what the latest studies say about the connection between ultra-processed foods and depression
• When is the best time to exercise and why it’s a factor you need to consider so you can  maximize your weight loss

“Make small changes in the way you live, because small changes can have a huge impact when done consistently.” -Dr. Adrienne Youdim

Every day, we have the opportunity to get to know ourselves more and make better choices. When we continually learn and apply what we've learned, we empower ourselves to make choices that align with our health and wellness goals. 

Remember, you don't have to be perfect to make progress.

Tune in next week for another uplifting story of health and wellness. Stay healthy and well, and don't forget to sign up for my newsletter in the show notes for more valuable insights.

Resources Mentioned:

• Washington Post - Many of today’s unhealthy foods were brought to you by Big Tobacco
• FDA - FDA Warns on Certain Forms of Compounded Semaglutide
• CNN - Artificially sweetened ultra processed foods linked to depression in women
• CNN - Exercising within one time window is best for weight loss

Ways that Dr. Adrienne Youdim Can Support You

1. Join the Monthly Free Mind-Body Workshops: Participate in engaging mind-body practices designed to help manage your stress response. Register here.
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3. Freebie alert. Register for our monthly free MindBody Workshop and receive a downloadable guide on emotional labeling to help you manage your emotions effectively.

Connect with Dr. Adrienne Youdim

• Website :https://www.dradriennespeaks.com/
• Instagram: https://www.instagram.com/dradrienneyoudim/

Transcript

 Welcome back to my monthly Health Bite Newscast, where I'll talk about some of the top food, nutrition, and weight loss headlines in the news. 

This week, we're talking about big tobacco's role in the obesity epidemic, the gray zone of legal but unregulated semaglutide, when is the best time to exercise, and what recent data shows about ultra processed food and depression. I'm your host, Dr. Adrienne Youdim. I'm a triple board certified internist, obesity medicine and physician nutrition specialist that has worked with thousands of patients, not only to help them eat well, but redefine nutrition so that they live well. 

If you're new to this podcast, head over to the show notes and sign up for my newsletter. And I will send you my integrated approach to nourishing yourself, mind and body. I just love this stuff. So let's dig into this week's bite.

Well, I guess it should not have come as a huge surprise, but I must say I was shocked when I saw this headline in the Washington Post this week. 

It read: “Many of today's unhealthy foods were brought to you by big tobacco”. 

Tobacco companies are responsible for the top two causes of death in the US, heart disease and cancer. And it seems not just from their contributions to smoking, but also obesity.

Here's the backstory, in the 1980s, tobacco companies Philip Morris and R.J. Reynolds acquired some of the big names in processed foods: Kraft, General Foods, and Nabisco, which included some of those foods known well to all of us, like Oreos, Ritz crackers, Kraft mac and cheese, Jell-O, Kool-Aid, and Oscar Mayer hotdogs. Yep, all the big players. 

During the time they owned these companies, they had a significant impact on how snack foods were made and marketed, making them both, one: highly palatable, and two: marketed expressly towards children. A study that was published in the Journal of Addiction this week, showed that foods manufactured by these companies were much more likely to contain a toxic combination of fat, sodium, sugar, and other additives that made them “hyperpalatable” compared to similar foods made by their competitors. 

What does “hyperpalatable" mean? Basically, it means super yummy and much more likely to trigger overeating and overconsumption. 

In essence, these combinations of sugar, salt, and fat coupled with the highly processed and refined nature of these foods made them really absorbable, like a rocket triggering pleasure-seeking centers of the brain in a way that promotes addictive potential towards them. 

Now, you might say, Okay, that's what processed snack foods are all about. But again, what this study showed was the foods that were being kicked out of these companies while they were under the purview of these tobacco ownership had a much more addictive potential and addictive combination of the very things that made them more palatable and more addictive. 

Researchers found that over a hundred foods that were among the best-selling owned by either Philip Morris or R.J. Reynolds between the 1980s and early 2000s. 

They compared the nutritional information of these foods to similar products that were sold by competing brands not owned by tobacco companies, and they found that the tobacco-owned foods were 80% more likely to contain potent combinations of carbs and sodium that made them hyperpalatable. 

Tobacco-owned brands were also nearly 30% more likely to contain potent combinations of fat and sodium. So again, these foods were manufactured in a particularly toxic way that triggered significant addictive potential. The article goes on to say that internal documents revealed that they made an intentional move to use flavors developed for cigarettes in food, beverages, and other products. 

Case in point, R.J. Reynolds, just after releasing this internal document, purchased the brand Hawaiian Punch, which at the time, you may not know, was a cocktail mixer used for alcoholic beverages.

But after significant market research on children and their mothers, they rebranded Hawaiian Punch by adding child-friendly flavors and a cartoon mascot named Punchy. RJR also purchased Nabisco, which at the time owned two of the most popular cookies, Oreos and Chips Ahoy, and then created the third most popular cookie, Teddy Grahams.

Remember those? They were marketed under the guise of being a healthy alternative made with wholesome ingredients like graham flour, when in reality, they only contained two grams of graham flour in a single ounce serving. They were also responsible for bringing Snackwells to market. 

Remember Snackwells? That was the fat-free cookie that was released at the height of our fat-free craze. It was like the superstar cookie of that time. What they didn't disclose was that while this cookie was low fat, it was also very high in sugar and calories.   Obviously not helpful to the diet consumer that they were marketing to. 

Not to mention the fact that people tend to consume more of foods they believe are not fattening than they otherwise would of food that was fattening. So if you think that a food is “nonfat”, you're going to have more of that thing than if you believe that it was high fat or high calorie like these cookies were. 

This phenomena was so closely linked to the Snackwell cookie that it actually was coined as the Snackwell effect. Indeed, ownership of these food brands by Big Tobacco not only correlated with a rise in hyperpalatable food, but also the rise of obesity and obesity-related complications like diabetes and heart disease. 

As the authors and researchers state, while the tobacco companies no longer own these food brands, these findings matter because many of the ultra-processed foods that we eat today were engineered by an industry that wrote the playbook on products that are highly palatable, addictive, and appealing to children. 

Seriously, that is disturbing. I have to admit, I am not the stickler you may think me to be. My kids may disagree, but you can find snack foods in my pantry. I'm choosy, but I'm not a Puritan. But as I report this story, I'm going to have to have a conversation with my kids at dinner tonight. I don't expect that they will completely reject snack foods, but let them be educated and see if they make more informed choices.I wonder if you'll have a conversation as well. All right. On to more fun news. 

So, interesting stuff. Even if you're not a user of Ozempic and Wegovy, you likely have heard of the shortages by now. 

Given their blockbuster efficacy for weight loss, there was an unanticipated demand for these drugs. One would argue, why was it unanticipated? But it was, and it's resulted in ongoing shortages in the supply chain. So in response, compounding pharmacies have tried to fill in the gap. Now, compounding pharmacies are specialized pharmacies that can make their own cheaper versions of drugs, including semaglutide. And what you might ask or question to yourself is, is this legal? And the funny thing is that yes, it is. 

Because when the FDA declares a shortage of a drug, like they have on semaglutide, then compounding pharmacies are legally allowed to make knockoffs. They are not regulated, meaning that no one is watching or ensuring the ingredients or the process or anything of these drugs. So it's basically taking the word of a compounding pharmacy, which could be a problem because given the money-making potential of these drugs, pharmacies have popped up all over the US and online. 

According to a Washington Post investigation, and yes, I was reading a bunch of Washington Post this week, many of these pharmacies, over 24 of them per their reports, bypass doctors completely and sell directly to consumer. I mentioned in prior newscasts that the active ingredient of semaglutide in many of these compounded formulations are salts, also known as semaglutide sodium, which is NOT the same formulation as what the FDA tested and approved, and it has been expressly deemed by the FDA as not being shown to be safe or effective. 

Another crazy fun fact? that some of these pop-up pharmacies and online stores, because some of them are just online stores bypassing the pharmacy, are selling research-grade semaglutide. 

This is a type of drug which is not even tested for safety, purity, or quality in humans, and is not recommended for patient use. It seems crazy to me that this is both allowed by the FDA, while at the same time they have issued a warning against it, stating, “purchasing medicine online from unregulated, unlicensed sources can expose patients to potentially unsafe products”. 

You think? As far as I'm concerned, I would not do it. And I have counseled my patients who have asked the very same. Look, I get it. I understand the frustration of having your medication swiped like a rug from underneath your feet. But I encourage patients, this shortage is not going to last forever. Production is increasing. and other similar drugs are both in the pipeline and sitting before the FDA as we speak awaiting approval. So my take is be patient and sit tight, but do not obtain an unregulated product from an unlicensed source and inject that drug in your body. All right. 

Over the past year, I have shared several studies linking processed and ultra-processed foods to a whole range of conditions, including heart disease, cancer, Alzheimer's disease. 

You can scroll back to prior podcasts and listen to the news bite there. But this week, a study was released, published in the Journal for the American Medical Association in JAMA, linking ultra-processed foods to depression. This was a prospective study called “The Nurses Health Study.”  They looked at over 31,000 women over the course of 15 years. These women were middle-aged in the range of age 42 to 62 and were free of depression at the start of the study. And they had their diet assessed every four years. 

Researchers then characterized these nurses' food diaries and the amount of ultra-processed foods that they consumed and divided the foods into categories. They looked at ultra-processed grain food, sweet snacks, ready-to-eat, like microwavable meals, fats and sauces, ultra-processed dairy products, savory snacks, processed meat, beverages, and artificial sweeteners. 

So basically looking at the whole gamut of types of ultra-processed foods. And then they screen them over these 15 years for depression, defined as whether the clinician diagnosed them as having depression or whether they were taking antidepressants. 

When they went and reviewed the data, this is what they found, that ultra processed foods and specifically artificial sweetened beverages and artificial sweeteners were associated with a higher risk of depression. 

So again, linking specifically artificial sweeteners to a higher likelihood of having depression in this group of almost 32,000 women. Something interesting to note is that participants with a high intake of ultra-processed food had, not surprisingly, a greater BMI, they were also more likely to be smokers, and they were more likely to have comorbidities like diabetes, hypertension, high cholesterol, and were less likely to exercise regularly. 

So one could question that these factors like their smoking or the fact that they don't exercise, that these other factors that we call confounders or confounding variables were really the factors to blame, not the ultra processed food. But any good study will account for confounding variables, as they did in this study. 

And even after they accounted for these factors, the association between artificial sweeteners and depression remained. I do think, though, that it's mindful to note these other unhealthy habits that were paired with the use of artificial sweeteners. And to just question, what is the correlation behind these things in these behaviors in total? Now, we may ask, what is the connection? Why is it that ultra processed foods or artificial sweeteners and depression is associated? 

And the answer is that it's not super clear. But one hypothesis is, that artificial sweeteners elicit what's called a pyrogenic transmission in the brain. To be honest, it's super complicated. But suffice it to say that they believe that artificial sweeteners cause changes in neurotransmission and neuromodulation in the brain in a way that's been shown to promote depression. 

So again, these chemicals seem to be causing changes in the neuroscience of the brain in a way that promotes more depression. 

Super fascinating. And last but not least, A study that addresses a question that I always get asked, which is:

When is it best to exercise when it comes to weight loss? Patients always ask me, when should I exercise? When is the best time to exercise? Does it matter if I exercise morning, midday, or night? 

And I've always recommended that people do what is most feasible for them. At the end of the day, we're much more likely to do things if they fit into our way of life. And still, that is what I recommend. 

But a study published earlier this week showed that my preferred time of exercise, and that's the morning, is more likely to be associated with a normal BMI, which is a reflection, of course, of our weight, as well as a lower waist circumference. Now, waist circumference, as you may know, is a measure of abdominal fat, belly fat. That's the kind of fat that is particularly risky because it's associated with cardiometabolic abnormalities. So people with more belly fat are much more likely to have hypertension, high lipids, abnormal blood glucose, diabetes, for example. 

Why? Because that fat that is stored in the gut, it's also called visceral fat, is more harmful, releases more cytokines, more inflammation than the fat that's kind of stored under our skin, in our arms, in our butt, et cetera, et cetera. So the study found that morning exercisers are not only more likely to have a healthy body weight and BMI, but more likely to have a lower waist circumference that's a surrogate for this visceral or abdominal fat. 

The study also found that those who exercise in the morning had a healthier diet overall and lower energy intake throughout the day. But, that there were factors beyond diet that explain this difference. 

So I'll tell you, one of the reasons why I recommend that people exercise first thing in the morning is because it sets you up kind of for success for the day. 

Healthy behaviors beget other healthy behaviors. And so if you start your day off exercising, you're less likely, for example, to eat a donut for breakfast. You're less likely to go out to eat or to overeat. 

And this study showed that, the people who exercise in the morning were more likely to have a healthier diet later on in the day. But they also showed that there was some correlation between morning exercise and normal BMI and waist circumference, which was outside of the diet. 

They suggest that the reason for this is that morning exercise, when done in a fasting state, actually increases fat oxidation in the 24 hours following exercise. What that means is, again, when you exercise first thing in the morning and preferably on an empty stomach, if you can tolerate that, If you're a diabetic, for example, and are at risk for dropping your blood sugar, don't do that. 

But if you don't have any medical conditions and you're okay to exercise in a fasting state, that increases your fatty oxidation for the next 24 hours. And this may be, in part, the link between morning exercise and a normal body weight and waist circumference. Some other things to note in this study, the minimum activity needed to see this association was 150 minutes per week. 

So that's like 30 minutes, five times a week was the amount of exercise needed to see this correlation between morning exercise and reduced BMI and waist circumference. So the take-home messages are these:

1. Try to exercise in the morning if you can  
2. Shoot for 150 minutes per week. However you divvy that up, I recommend 30 minutes a day, five times a week. 

But I do want to say this, at the end, meet yourself where you are at. If you're only able or willing to exercise midday or in the evening, or even if you prefer it that way, then do that. 

At the end of the day, we only do things if and when we are aligned with the activity and the activity is aligned with our preferences and our lifestyle. 

So that's a wrap. I want to remind you that we don't have to be perfect in order to be effective in our pursuit of health and well-being. Use this information to make small changes in the way you live, because small changes can have a huge impact when done consistently. 

And finally, as I mentioned earlier, if you've not done so already, head over to the show notes and sign up for my newsletter, and we will send you my integrated approach to nourishing yourself, mind, and body. Come back next week where I promise to offer you an uplifting story of health and wellness. I can't wait to see you then. Until then, stay healthy and stay well. Bye now.