Ultraprocessed foods engineered to target reward centers
Dear Doctors: Why is ditching junk food so hard? I know I should have an apple instead of a doughnut, but when I crave a snack, I don’t reach for the fruit bowl. Making and then breaking the promise to eat healthy makes me feel like a failure. How can a junk food addict like me get back on track?
Dear Reader: In framing your question, you used two revealing words — “crave” and “addict.” And based on what is now known about ultraprocessed foods, that’s no accident.
We humans are hardwired to seek fat, carbohydrates and salt, which are crucial to survival. In naturally occurring foods, these nutrients are present in optimal forms, ratios and quantities. But the snack, fast and convenience foods that have hijacked the modern palate are flavor bombs. Packed with fat, sugar and salt in amounts not seen in nature, they are specifically engineered to target the reward centers of our brains. That’s a big part of why we find these types of foods so irresistible.
There’s an ongoing back-and-forth about whether junk food is actually addictive. What’s not up for discussion, though, is that too much highly processed food in the daily diet is damaging to both short- and longterm health. As we’ve discussed here before, that includes weight gain, obesity, poor blood sugar control, an increased risk of Type 2 diabetes, high blood pressure, cardiovascular disease and increased risk of certain cancers. And to top it off, ultraprocessed foods contribute almost nothing to our basic nutritional needs.
Willpower plays a role in changing to a healthier diet, but you’ll also need to be strategic. It’s important to know how much salt, fat and sugar are added to your favorite foods. That means becoming a student of food labels and, quite likely, changing some of your buying habits. The FDA now requires all restaurants with more than 20 locations to provide nutritional information, so you can also do this when eating out.
As with any new project, you’ll have the best chance of success by planning ahead. Shop from a list, and eat and cook from a preplanned menu. Make a conscious effort to add fruit, vegetables and leafy greens to your diet. Be sure to get high-quality protein and healthful fats, which help you to feel satisfied, with each meal. Identify trigger foods, and never keep them in the house.
When it comes to cheats and treats, we’re realists. The goal is to build eating habits you’ll stick with long-term. For those in good health, we believe that 80% being good about diet and 20% “cheat” is OK. For anyone with diabetes, hypertension or any kind of cardiac issues, it’s a maximum of 10% treat eating. But even in that cheat category, choose the whole-food versions of your favorite treats.
You’re making a big change in your life. Be realistic and know you’ll have good and bad days. Please be kind to yourself if you slip, and start anew with the next meal. Big changes like this take time, so be patient.
FIT TEST GOOD ALTERNATIVE FOR THOSE WHO WON’T GET COLONOSCOPY
Dear Doctors: I’m a 72-year-old man, and I was supposed to get a colonoscopy last year. I was surprised when my insurance company sent me an at-home kit to do a colon cancer screening. It was a lot easier than a colonoscopy, but my question is, can it be accurate?
Dear Reader: The athome test kit that you received in the mail is known as a fecal immunochemical test, or FIT. As with a colonoscopy, it is a diagnostic tool that looks for signs of colon cancer. The FIT test kit contains the materials you need to collect a small sample of stool and instructions on how to use them. You also get a pre-paid mailer to send the sample to a laboratory, where it gets tested for the presence of microscopic amounts of blood. Some people receive the results of their FIT test in a letter, and others are asked to log onto a web portal.
It’s not surprising that survey results show a decisive majority of patients agree with you in preferring the at-home FIT test to a colonoscopy. The former takes just a few minutes in the privacy of your own home. The latter involves a multi-day process.
The colonoscopy process begins with the use of a laxative solution to completely void the bowel. This allows any polyps or other abnormalities to be easily visualized. Before the procedure, the patient is given medications to help them relax, and asked to lie on their left side on an examination table. The physician then introduces a thin, flexible tube through the anus and into the rectum and colon. Known as a colonoscope, it has a tiny light and a camera, and is used to examine the length and breadth of the colon. The procedure typically takes between 30 and 60 minutes.
Due to the COVID-19 pandemic, diagnostic screening tests were routinely canceled. During this time, some insurance companies and health care providers closed the gap by switching to the use of FIT tests. Studies show that, for someone of average risk, the FIT test is a good alternative to colonoscopy. There is also evidence that people unwilling to undergo a colonoscopy will complete a FIT test. Considering that only half of adults stick to the suggested colon cancer screening schedule, and 30% skip screening altogether, the FIT option is beneficial.
As for accuracy, the data are still being collected. As we mentioned, the FIT test detects blood in the fecal sample. If the test comes back positive for the presence of blood, the individual is then asked to follow up with a colonoscopy. However, it’s possible for polyps to be present in the colon but to not be bleeding at the time that the test is taken. That would lead to a negative test result. On the flip side, the FIT test is also prone to false positives, which trigger the need for a follow-up colonoscopy. Depending on your own health and your personal medical history, it’s a good idea to discuss your future colon cancer screening strategy with your health care provider.
BYPASS SURGERY REQUIRES RECUPERATION AND LIFESTYLE CHANGES
Dear Doctors: My brother-in-law is 57 years old, and he is getting coronary bypass surgery. I don’t want to bother him or my sister with a lot of questions right now, but I do want to understand what is happening. Why is this surgery needed, and how is it done? Will it fix whatever is wrong?
Dear Reader: Facing major surgery is stressful and often frightening, both for the individual and for the family. It’s thoughtful of you to recognize that and to spare your brother-inlaw and sister from having to make explanations at this time. It’s also possible that, by understanding both the surgery and the reasons it is needed, you’ll be better able to offer support if either of them seeks it.
Let’s start with a bit of basic anatomy. The pumping action of the heart sends oxygenated blood to all of the cells of the body. It receives its own supply of blood, also loaded with oxygen, from a network of vessels known as the coronary arteries. When someone needs bypass surgery, it means that one or more of the coronary arteries has become either narrowed or blocked. This is most often due to accumulations of a fatty, waxy substance known as plaque.
A narrowed coronary artery causes symptoms such as chest pain or discomfort, nausea, cold sweats, lightheadedness, shortness of breath, becoming easily fatigued and chronic exhaustion. Diagnosis is made with a physical exam, certain types of blood tests, stress tests and a variety of scans of the heart and coronary arteries.
Over time, decreased blood flow due to a narrowed coronary artery taxes the heart. It weakens the heart muscle, increases the risk of stroke and can lead to heart failure. This is a serious condition in which the heart is no longer able to perform well enough to maintain good health. A coronary artery that becomes completely blocked will cause a heart attack.
For some patients, a procedure known as angioplasty can be an option. In an angioplasty, a thin tube is threaded into the arterial blockage and a tiny balloon is used to press back the plaque. This is followed by the placement of a small mesh coil, known as a stent, to keep the artery open.
Sometimes, due to the small size of a coronary artery or the degree or placement of the blockage, angioplasty isn’t possible. In those cases, bypass surgery may be needed. This involves taking a portion of a healthy blood vessel from elsewhere in the body and attaching it to the coronary artery, just above and below the blockage. This gives the circulating blood a new pathway. The procedure itself typically takes from three to six hours. Recovery, which begins with a post-op hospital stay, averages from three to four months.
It’s important to understand that while this surgery can ease symptoms and lower the patient’s future risk of heart attack or stroke, it doesn’t cure coronary artery disease. Your brother-in-law will be expected to make and maintain lifestyle changes, including adopting a healthy diet, doing regular exercise and not smoking.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla. edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.