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Ultraprocessed foods linked to ovarian and other cancer deaths, study finds

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Eating more ultraprocessed foods raises the risk of developing and dying from cancer, especially ovarian cancer, according to a new study of over 197,000 people in the United Kingdom, over half of whom were women.

Overly processed foods include prepackaged soups, sauces, frozen pizza and ready-to-eat meals, as well as hot dogs, sausages, french fries, sodas, store-bought cookies, cakes, candies, doughnuts, ice cream and many more.

“Ultra-processed foods are produced with industrially derived ingredients and often use food additives to adjust colour, flavour, consistency, texture, or extend shelf life,” said first author Dr. Kiara Chang, a National Institute for Health and Care Research fellow at Imperial College London’s School of Public Health, in a statement.

“Our bodies may not react the same way to these ultra-processed ingredients and additives as they do to fresh and nutritious minimally processed foods,” Chang said.

However, people who eat more ultra-processed foods also tend to “drink more fizzy drinks and less tea and coffee, as well as less vegetables and other foods associated with a healthy dietary pattern,” said Duane Mellor, a registered dietitian and senior teaching fellow at Aston Medical School in Birmingham, UK, in an email.

“This could mean that it may not be an effect specifically of the ultra-processed foods themselves, but instead reflect the impact of a lower intake of healthier food,” said Mellor, who was not involved in the study.

The study, published Tuesday in the journal eClinicalMedicine, looked at the association between eating ultraprocessed foods and 34 different types of cancer over a 10-year period.

Researchers examined information on the eating habits of 197,426 people who were part of the UK Biobank, a large biomedical database and research resource that followed residents from 2006 to 2010.

The amount of ultraprocessed foods consumed by people in the study ranged from a low of 9.1% to a high of 41.4% of their diet, the study found.

Eating patterns were then compared with medical records that listed both diagnoses and deaths from cancer.

Each 10% increase in ultraprocessed food consumption was associated with a 2% increase in developing any cancer, and a 19% increased risk for being diagnosed with ovarian cancer, according to a statement issued by Imperial College London.

Deaths from cancers also increased, the study found. For each additional 10% increase in ultraprocessed food consumption, the risk of dying from any cancer increased by 6%, while the risk of dying from ovarian cancer rose by 30%, according to the statement.

“These associations persisted after adjustment for a range of socio-demographic, smoking status, physical activity, and key dietary factors,” the authors wrote.

When it comes to death from cancer among women, ovarian cancer is ranked fifth, “accounting for more deaths than any other cancer of the female reproductive system,” noted the American Cancer Society.

“The findings add to previous studies showing an association between a greater proportion of ultra-processed foods (UPFs) in the diet and a higher risk of obesity, heart attacks, stroke, and type 2 diabetes,” said Simon Steenson, a nutrition scientist at the British Nutrition Foundation, a charity partially supported by food producers and manufacturers. Steenson was not involved in the new study.

“However, an important limitation of these previous studies and the new analysis published today is that the findings are observational and so do not provide evidence of a clear causal link between UPFs and cancer, or the risk of other diseases,” Steenson said in an email.

People who ate the most ultraprocessed foods “were younger and less likely to have a family history of cancer,” Chang and her colleagues wrote.

High consumers of ultraprocessed foods were less likely to do physical activity and more likely to be classified as obese. These people were also likely to have lower household incomes and education and live in the most underprivileged communities, the study found.

“This study adds to the growing evidence that ultra-processed foods are likely to negatively impact our health including our risk for cancer,” said Dr. Eszter Vamos, the study’s lead author and a clinical senior lecturer at Imperial College London’s School of Public Health in a statement.

This latest research is not the first to show an association between a high intake of ultraprocessed foods and cancer.

A 2022 study examined the diets of over 200,000 men and women in the United States for up to 28 years and found a link between ultraprocessed foods and colorectal cancer — the third most diagnosed cancer in the United States — in men, but not women.

And there are “literally hundreds of studies (that) link ultraprocessed foods to obesity, cancer, cardiovascular disease, and overall mortality,” Marion Nestle, the Paulette Goddard professor emerita of nutrition, food studies and public health at New York University told CNN previously.

While the new UK-based study cannot prove causation, only an association, “other available evidence shows that reducing ultra-processed foods in our diet could provide important health benefits,” Vamos said.

“Further research is needed to confirm these findings and understand the best public health strategies to reduce the widespread presence and harms of ultra-processed foods in our diet,” she added.

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Weight loss surgery extends lives, study finds

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Weight loss surgery reduces the risk of premature death, especially from such obesity-related conditions as cancer, diabetes and heart disease, according to a new 40-year study of nearly 22,000 people who had bariatric surgery in Utah.

Compared with those of similar weight, people who underwent one of four types of weight loss surgery were 16% less likely to die from any cause, the study found. The drop in deaths from diseases triggered by obesity, such as heart disease, cancer and diabetes, was even more dramatic.

“Deaths from cardiovascular disease decreased by 29%, while deaths from various cancers decreased by 43%, which is pretty impressive,” said lead author Ted Adams, an adjunct associate professor in nutrition and integrative physiology at the University of Utah’s School of Medicine.

“There was also a huge percentage drop — a 72% decline — in deaths related to diabetes in people who had surgery compared to those who did not,” he said. One significant downside: The study also found younger people who had the surgery were at higher risk for suicide.

The study, published Wednesday in the journal Obesity, reinforces similar findings from earlier research, including a 10-year study in Sweden that found significant reductions in premature deaths, said Dr. Eduardo Grunvald, a professor of medicine and medical director of the weight management program at the University of California San Diego Health.

The Swedish study also found a significant number of people were in remission from diabetes at both two years and 10 years after surgery.

“This new research from Utah is more evidence that people who undergo these procedures have positive, beneficial long-term outcomes,” said Grunvald, who coauthored the American Gastroenterological Association’s new guidelines on obesity treatment.

The association strongly recommends patients with obesity use recently approved weight loss medications or surgery paired with lifestyle changes.

“And the key for patients is to know that changing your diet becomes more natural, more easy to do after you have bariatric surgery or take the new weight loss medications,” said Grunvald, who was not involved in the Utah study.

“While we don’t yet fully understand why, these interventions actually change the chemistry in your brain, making it much easier to change your diet afterwards.”

Despite the benefits though, only 2% of patients who are eligible for bariatric surgery ever get it, often due to the stigma about obesity, said Dr. Caroline Apovian, a professor of medicine at Harvard Medical School and codirector of the Center for Weight Management and Wellness at Brigham and Women’s Hospital in Boston. Apovian was the lead author for the Endocrine Society’s clinical practice guidelines for the pharmacological management of obesity.

Insurance carriers typically cover the cost of surgery for people over 18 with a body mass index of 40 or higher, or a BMI of 35 if the patient also has a related condition such as diabetes or high blood pressure, she said.

“I see patients with a BMI of 50, and invariably I will say, ‘You’re a candidate for everything — medication, diet, exercise and surgery.’ And many tell me, ‘Don’t talk to me about surgery. I don’t want it.’ They don’t want a surgical solution to what society has told them is a failure of willpower,” she said.

“We don’t torture people who have heart disease: ‘Oh, it’s because you ate all that fast food.’ We don’t torture people with diabetes: ‘Oh, it’s because you ate all that cake.’ We tell them they have a disease, and we treat it. Obesity is a disease, too, yet we torture people with obesity by telling them it’s their fault.”

Most of the people who choose bariatric surgery — around 80% — are women, Adams said. One of the strengths of the new study, he said, was the inclusion of men who had undergone the procedure.

“For all-causes of death, the mortality was reduced by 14% for females and by 21% for males,” Adams said. In addition, deaths from related causes, such as heart attack, cancer and diabetes, was 24% lower for females and 22% lower for males who underwent surgery compared with those who did not, he said.

Four types of surgery performed between 1982 and 2018 were examined in the study: gastric bypass, gastric banding, gastric sleeve and duodenal switch.

Gastric bypass, developed in the late 1960s, creates a small pouch near the top of the stomach. A part of the small intestine is brought up and attached to that point, bypassing most of the stomach and the duodenum, the first part of the small intestine.

In gastric banding, an elastic band that can be tightened or loosened is placed around the top portion of the stomach, thus restricting the volume of food entering the stomach cavity. Because gastric banding is not as successful in creating long-term weight loss, the procedure “is not as popular today,” Adams said.

“The gastric sleeve is a procedure where essentially about two-thirds of the stomach is removed laparoscopically,” he said. “It takes less time to perform, and food still passes through the much-smaller stomach. It’s become a very popular option.”

The duodenal switch is typically reserved for patients who have a high BMI, Adams added. It’s a complicated procedure that combines a sleeve gastrectomy with an intestinal bypass, and is effective for type 2 diabetes, according to the Cleveland Clinic.

One alarming finding of the new study was a 2.4% increase in deaths by suicide, primarily among people who had bariatric surgery between the ages of 18 and 34.

“That’s because they are told that life is going to be great after surgery or medication,” said Joann Hendelman, clinical director of the National Alliance for Eating Disorders, a nonprofit advocacy group.

“All you have to do is lose weight, and people are going to want to hang out with you, people will want to be your friend, and your anxiety and depression are going to be gone,” she said. “But that’s not reality.”

In addition, there are postoperative risks and side effects associated with bariatric surgery, such as nausea, vomiting, alcoholism, a potential failure to lose weight or even weight gain, said Susan Vibbert, an advocate at Project HEAL, which provides help for people struggling with eating disorders.

“How are we defining health in these scenarios? And is there another intervention — a weight neutral intervention?” Vibbert asked.

Past research has also shown an association between suicide risk and bariatric surgery, Grunvald said, but studies on the topic are not always able to determine a patient’s mental history.

“Did the person opt for surgery because they had some unrealistic expectations or underlying psychological disorders that were not resolved after the surgery? Or is this a direct effect somehow of bariatric surgery? We can’t answer that for sure,” he said.

Intensive presurgery counseling is typically required for all who undergo the procedure, but it may not be enough, Apovian said. She lost her first bariatric surgery patient to suicide.

“She was older, in her 40s. She had surgery and lost 150 pounds. And then she put herself in front of a bus and died because she had underlying bipolar disorder she had been self-medicating with food,” Apovian said. “We as a society use a lot of food to hide trauma. What we need in this country is more psychological counseling for everybody, not just for people who undergo bariatric surgery.”

Managing weight is a unique process for each person, a mixture of genetics, culture, environment, social stigma and personal health, experts say. There is no one solution for all.

“First, we as a society must consider obesity as a disease, as a biological problem, not as a moral failing,” Grunvald said. “That’s my first piece of advice.

“And if you believe your life is going to benefit from treatment, then consider evidence-based treatment, which studies show are surgery or medications, if you haven’t been able to successfully do it with lifestyle changes alone.”

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Intermittent fasting may not be as helpful for losing weight as once thought, study finds

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Are snacks before bed your vice? Or do you prefer to wait a few hours after you wake up to eat?

The timing of meals may not have as big an impact on weight as once thought, according to a new study.

The study tracked the portion sizes and eating times of 547 people, in addition to data on their health and weight, over the course of six years. The data showed no association between an interval of the day in which people had their meals and their weight, according to the study published Wednesday in the Journal of the American Heart Association.

Restricting eating times, as seen in diet trends such as intermittent fasting, has been a popular method to try to lose weight in recent years.

But the researchers found no association between restricting eating times and weight loss, said principal investigator of the study Dr. Wendy Bennett, an associate professor of medicine in the division of general internal medicine at Johns Hopkins School of Medicine. That included how long people ate after waking up, how long their window of eating was throughout the day and how close to going to bed they ate, she noted.

Instead, smaller meals were associated with weight loss, she said.

“Based on other studies that have come out, including ours, we are starting to think that timing of meals through the day most likely doesn’t immediately result in weight loss,” Bennett said, adding the caveat that for some people, timing meals may be a useful tool in tracking nutrition.

The results of this study should be taken with a grain of salt, experts cautioned.

There were few racial and ethnic minorities among the participants, noted Dr. Fatima Cody, associate professor of medicine at Harvard Medical School. There are also many social determinants of health, such as stress and people’s environment, that could be added to the data, Cody added.

Those factors could be important for getting a better look at the effects of meal timing, added Alice Lichtenstein, professor of nutrition science and policy at Tufts University.

“I suspect that if they looked more closely at the data, that there would be subgroups (where timing of meals) may have had a significant effect,” Lichtenstein said.

This study was observational, Bennett noted, meaning that they looked at existing patterns for the study instead of making changes to a randomized group. Further work on this topic is underway, she added.

The big takeaways are that there is no one strategy that works for all people when it comes to nutrition, and that quality of the food counts, Lichtenstein said.

“If you make some effort to consume a healthy diet, you make some effort to be physically active, you’re less likely to have diabetes, chronic kidney disease, obstructive pulmonary disease and hypertension,” Lichtenstein said.

It’s the boring stuff no one wants to hear, she added, but there is no getting around eating fruits and vegetables and getting physical activity when it comes to weight management.

For some people, trying intermittent fasting or restricting eating intervals can be a helpful way to take note of personal tendencies, but many people can’t sustain it for enough time to see long-term change — or keep off any weight they lose, Lichtenstein added.

Cody, who is an obesity medicine physician at Boston’s Massachusetts General Hospital Weight Center, doesn’t like to focus too strongly on either calorie restriction or intermittent fasting, she said. Instead, she wants her clients to look at the nutritional value of the food they are eating.

To the body, 100 calories of gummy bears is not the same as 100 calories of oatmeal with fruit and nuts, she added.

But different approaches work better in different lifestyles, and everyone should work with their own doctor and their own body without stress and shame, Cody said.

If a nutrition strategy works for someone else, she said, “it just means someone’s body responded and the other one didn’t. It doesn’t mean you’re flawed. It just means that’s just not what your body needed.”

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Updated childhood obesity treatment guidelines include medications, surgery for some young people

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Updated American Academy of Pediatrics guidelines for treatment of obesity urge prompt use of behavior therapy and lifestyle changes, and say surgery and medications should be used for some young people.

The guidelines, published Monday in the journal Pediatrics, are the first comprehensive update to the academy’s obesity treatment guidelines in 15 years. They provide guidance for treatment of children as young as 2 and through the teen years.

The guidelines acknowledge that obesity is complex, and tied to access to nutritious foods and health care, among other factors.

Treatment for younger children should focus on behavior and lifestyle treatment for the entire family, including nutrition support and increased physical activity. For children 12 and older, use of weight loss medications is appropriate, in addition to health behavior therapy and lifestyle treatment, AAP says. Teens 13 and older with severe obesity should be evaluated for surgery, according to the guidelines.

“There is no evidence that ‘watchful waiting’ or delayed treatment is appropriate for children with obesity,” Dr. Sandra Hassink, an author of the guideline and vice chair of AAP’s Clinical Practice Guideline Subcommittee on Obesity, said in a statement. “The goal is to help patients make changes in lifestyle, behaviors or environment in a way that is sustainable and involves families in decision-making at every step of the way.”

For children and teens, overweight is defined as a body mass index at or above the 85th percentile and below the 95th percentile; obesity is defined as a BMI at or above the 95th percentile.

Myles Faith, a psychologist at the State University of New York at Buffalo who studies childhood eating behaviors and obesity, praised the new report both for acknowledging that the causes of childhood obesity are complex and that its treatments must be a team effort.

“It’s not one cause for all kids,” he says. “There’s not been this kind of report to say that there are more options and that we shouldn’t automatically discount the possibility of medication, that we shouldn’t discount the role of surgery. For some families, it might be something to consider,” said Faith, who was not involved in the creation of the guidelines.

The new guidelines do not discuss obesity prevention; it will be addressed in another AAP policy statement to come, it says.

“These are the most comprehensive, patient-centered guidelines we have had that address overweight and obesity within childhood,” Dr. Rebecca Carter, pediatrician at the University of Maryland Children’s Hospital and assistant professor at the University of Maryland School of Medicine, said in an email Monday.

“New to these recommendations are several new medication management strategies that have proven very successful in the treatment of obesity as a chronic disease for adults, and are now being recommended for use in children and adolescents,” Carter said. “This is a major step in allowing overweight and obesity to be considered as the chronic diseases that they are.”

She added that the recommendations also are a “major step forward” in helping both parents and medical teams “take ownership” over a child’s long-term health risks related to overweight and obesity.

“They give a variety of tools to help families feel empowered that there are ways to treat these medical conditions, and that there are nuanced causes for these conditions that go beyond easy solutions and certainly take our focus away from outdated or unhealthy dieting strategies,” Carter said.

The new guidelines are designed for health care providers, but Carter said parents should talk with their children’s doctor if there are concerns about weight, and discuss strategies to optimize health and monitor changes.

“It is also appropriate to do this in a child-focused manner, taking care not to stigmatize them or make them feel bad about their body, while empowering the child to feel they have the tools needed to keep their body healthy over time.”

The new guidelines are a “much-needed advancement” to align holistic care with current science, Dr. Jennifer Woo Baidal, assistant professor of pediatrics and director of the Pediatric Obesity Initiative at Columbia University in New York City, said in a separate email Monday.

“Uptake of the new guidelines will help reverse the epidemic of childhood obesity,” she said. “More work at policy levels will be needed to mitigate policies and practices that propagate racial, ethnic, and socioeconomic disparities in obesity starting in early life. Although the guidelines support advocacy efforts of pediatricians, we as a society need to voice our support for healthful environments for the nation’s children.”

AAP says more than 14.4 million children and teens live with obesity. Children with overweight or obesity are at higher risk for asthma, sleep apnea, bone and joint problems, type 2 diabetes and heart disease, according to the US Centers for Disease Control and Prevention.

Separate research, published last month in the American Diabetes Association journal Diabetes Care, suggests that the number of young people under age 20 with type 2 diabetes in the United States may increase nearly 675% by 2060 if current trends continue.

Last month, the CDC released updated growth charts that can be used to track children and teens with severe obesity.

Growth charts are standardized tools used by health care providers to track growth from infancy through adolescence. But as obesity and severe obesity became more prevalent in the last 40 years – more than 4.5 million children and teens had severe obesity in 2017-2018, the agency says – the charts hadn’t kept up.

The growth chart in use since 2000 is based on data from 1963 to 1980 and did not extend beyond the 97th percentile, the agency said. The newly extended percentiles incorporate more recent data and provide a way to monitor and visualize very high body mass index values.

The existing growth charts for children and adolescents without obesity will not change, the CDC said, while the extended growth chart will be useful for health care providers treating patients with severe childhood obesity.

“Prior to today’s release, the growth charts did not extend high enough to plot BMI for the increasing number of children with severe obesity. The new growth charts coupled with high-quality treatment can help optimize care for children with severe obesity,” Dr. Karen Hacker, director CDC’s National Center for Chronic Disease Prevention and Health Promotion, said in a statement. “Providers can work with families on a comprehensive care plan to address childhood obesity.

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Here’s how to eat to live longer, new study says

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You can reduce your risk of an early death for any reason by nearly 20%, just by eating more foods from your choice of four healthy eating patterns, according to a new study.

People who more carefully followed any of the healthy eating patterns — which all share a focus on consuming more whole grains, fruits, vegetables, nuts and legumes — were also less likely to die from cancer, cardiovascular illness, and respiratory and neurodegenerative disease.

The results of the study, published Monday in the journal JAMA Internal Medicine, show “there is more than one way to eat well and derive the attendant health benefits,” said Dr. David Katz, a lifestyle medicine specialist who was not involved in the study.

People often get bored with one way of eating, study coauthor Dr. Frank Hu said, “so this is good news. It means that we have a lot of flexibility in terms of creating our own healthy dietary patterns that can be tailored to individual food preferences, health conditions and cultures.

“For example, if you are eating healthy Mediterranean, and after a few months you want to try something different, you can switch to a DASH (Dietary Approaches to Stop Hypertension) diet or you can switch to a semi-vegetarian diet,” said Hu, a professor of nutrition and epidemiology and chair of the department of nutrition at the Harvard T.H. Chan School of Public Health. “Or you can follow US dietary guidelines and create your own healthy eating plate.”

The study followed the eating habits of 75,000 women participating in the Nurses’ Health Study and more than 44,000 men in the Health Professionals Follow-up Study over 36 years. None of the men and women had cardiovascular disease at the start of the study, and few were smokers. All filled out eating questionnaires every four years.

“This is one of the largest and longest-running cohort studies to examine recommended dietary patterns and the long-term risk of premature deaths and deaths from major diseases,” Hu said.

Hu and his team scored participants on how closely they followed four healthy eating styles that are in sync with current US dietary guidelines.

One is the Mediterranean diet, which stresses eating fruits, vegetables, whole grains, nuts, legumes, fish and a high amount of olive oil, Hu said. “This dietary pattern emphasizes healthy fats, especially monounsaturated fat, in addition to plant-based foods and moderate alcohol,” he said.

The next is called the healthful plant-based diet, which also focuses on eating more plant products but gives negative points for all animal products and any alcohol.

“It even discourages relatively healthy options, like fish or some dairy products,” Hu said, adding that the eating plan frowns on unhealthy plant-based foods such as potato products.

“So you can imagine that vegetarians are probably on the higher end of this diet score,” he said, “and people who eat a lot of animal products or highly processed carbohydrate foods would be at the lower end of this score.”

The Healthy Eating Index tracks whether people follow basic US nutritional guidelines, which stress healthy, plant-based foods, frown on red and processed meat, and discourage eating added sugar, unhealthy fats and alcohol, Hu said.

The Alternate Healthy Eating Index was developed at Harvard, Hu said, and uses the “best available evidence” to include foods and nutrients most strongly associated with a lower risk of chronic disease.

“We explicitly included nuts, seeds, whole grains and lower consumption of red and processed meats and sugar-sweetened beverages,” he added. “A moderate consumption of alcohol is allowed.”

After each person’s eating pattern was scored, the participants were divided into five groups, or quintiles, from highest to lowest adherence to one or more of the eating patterns.

“The highest quintile of diet quality as compared to the lowest was associated with a roughly 20% reduction in all-cause mortality,” said Katz, president and founder of the nonprofit True Health Initiative, a global coalition of experts dedicated to evidence-based lifestyle medicine.

The study also found reductions in risk of death from certain chronic diseases if people improved their diet over time, Hu said.

Participants who improved the health of their diet by 25% could reduce their risk of dying from cardiovascular disease by a range of 6% to 13% and dying from cancer by 7% to 18%, he said. There was up to a 7% reduction in risk of death by neurodegenerative disease, such as dementia.

“Respiratory disease mortality reduction was actually much greater, reducing risk by 35% to 46%,” Hu said.

The study relied on participants’ self-reports of food preferences and therefore only showed an association, not a direct cause and effect, between eating habits and health outcomes. Still, the fact that the study asked about diets every four years over such a long time frame added weight to the findings, Hu said.

What is the takeaway of this large, long-term study?

“It’s never too late to adopt healthy eating patterns, and the benefits of eating a healthy diet can be substantial in terms of reducing total premature deaths and different causes of premature death,” Hu said.

“People also have a lot of flexibility in terms of creating their own healthy dietary pattern. But the common principles — eating more-plant based foods and fewer servings of red meat, processed meats, added sugar and sodium — should be there, no matter what kind of diet that you want to create.”

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Mediterranean diet named best diet for 2023

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The gold medals are piling up. For the sixth year in a row, the Mediterranean style of eating earned the title of best overall diet, according to 2023 ratings announced Tuesday by U.S. News & World Report. Meals from the sunny Mediterranean also ranked first in the categories of diet best diet for healthy eating and best plant-based diet, the report said.

In two new categories added for 2023, the Mediterranean tied with the cholesterol-lowering TLC (Therapeutic Lifestyle Changes) and flexitarian diets as best family-friendly diet, and with DASH (dietary approaches to stop hypertension) for best bone and joint health diet.

“We’re always looking for more health conditions that we can address. But often there’s not enough scientific data examining diet X and condition X,” said Gretel Schueller, managing editor of health for U.S. News & World Report, who oversees the annual diet ranking.

“However, bone and joint health is an area where there’s a fair amount of scientific literature,” Schueller said. “We also recognize our population is aging so focusing on diets that can increase the quality of life among older individuals is an important element.”

Also new this year: Reviewers only ranked 24 diets instead of the 40 or so diets analyzed in past years. Five diets from the original list — vegetarian, vegan, Nordic, the traditional Asian and the glycemic index — were integrated by judges into the Mediterranean and other diets due to their underlying plant-based principles.

“The take-home message here is the recognition that the Mediterranean diet is really not just about the foods around the Mediterranean,” Schueller said. “You can take the the lessons and the approach of the Mediterranean eating pattern and apply it to any cuisine in any country.”

That approach is reflected within two new diets — Keyto and Pritikin — that were added to the review for 2023, Schueller said. (Yes. that’s Keyto with a Y.)

“We recognize that more and more people are eating sort of a plant-forward or plant-based diet or at least trying to,” she said. “The keto with a Y diet is supposed to be a flexible, low-carb Mediterranean plan.

“The Pritikin diet focuses on low-fat, high-fiber eating of whole foods, and is fairly flexible,” she added. “We are seeing a push towards eating more whole, unprocessed foods, which I think is a great thing.”

Numerous studies have found the Mediterranean diet can reduce the risk for diabetes, high cholesterol, dementia, memory loss, depression and breast cancer. The diet, which is more of an eating style than a restricted diet, has also been linked to stronger bones, a healthier heart and longer life.

The diet features simple, plant-based cooking, with the majority of each meal focused on fruits and vegetables, whole grains, beans and seeds, with a few nuts and a heavy emphasis on extra-virgin olive oil. Fats other than olive oil, such as butter, are consumed rarely, if at all, and sugar and refined foods are reserved for special occasions.

Red meat is used sparingly, usually only to flavor a dish. Eating healthy, oily fish, which are packed with omega-3 fatty acids, is encouraged, while eggs, dairy and poultry are eaten in much smaller portions than in the traditional Western diet.

Social interactions during meals and exercise are basic cornerstones of the Mediterranean style of eating. Lifestyle changes that are part of the diet include eating with friends and family, socializing over meals, mindfully eating favorite foods, as well as mindful movement and exercise.

Just as they did in 2022, the DASH and the flexitarian diet tied for second place in best overall diet. Similar to the Mediterranean style of eating, these diets reduce or eliminate processed foods and stress packing your plate with fruits, vegetables, beans, lentils, whole grains, nuts and seeds.

The DASH diet emphasizes limiting salt intake in its goal to reduce blood pressure, while the flexitarian diet, true to its name, allows an occasional indulgence of meat or poultry.

A panel of 33 experts examined top diets and ranked them in several categories: Did the diet include all food groups; was it evidence based; are needed foods available at any supermarket; how easy is the diet to prepare, and did it use additional vitamins or supplements.

“We focused on quality over quantity,” Schueller said. “Our reviewers felt there are some diets out there that are so wacky they’re not worth giving time to, such as the Dukan diet, which we no longer rank.”

The worst diet award went to the raw foods diet this year, at least in part due to the lack of nutritional completeness, which has raised safety concerns among the reviewers. Because followers can only eat unprocessed foods that haven’t been cooked, microwaved, irradiated, genetically engineered or exposed to pesticides or herbicides, reviews consider the diet almost impossible to follow.

The popular keto diet, along with the modified keto, was ranked 20 out of the 24 diets, followed by Atkins, SlimFast and Optavia. These diets emphasize eating high-protein or high-fat foods with minimal carbohydrates and receive low rankings because they are extremely restrictive, hard to follow and eliminate entire food groups.

Despite keto’s low overall rating, reviewers gave the keto diet first place for best short-term weight loss diet, Schueller said, quickly adding that these diets are not considered healthy as a lifestyle.

“These are the diets for someone who’s got a wedding or an event they want to go to in the next few months,” she said. “Will you lose weight in the short term? Absolutely. Will you keep it off for the next two years? Probably not.”

In the category of best (long-term) weight-loss diet, WW (formely called Weight Watchers) came in first, with DASH and TLC tied for second. WW also got top honors in the best (commercial) diet program, followed by NOOM and Jenny Craig.

Flexitarian and TLC shared the gold in the category of easiest diet to follow, while the Mediterranean and DASH diets tied for third.

The DASH diet took top honors as best diet for heart health and for people with diabetes, followed by the Mediterranean, flexitarian and Ornish diets. The Ornish diet was created in 1977 by Dr. Dean Ornish, founder of the nonprofit Preventive Medicine Research Institute in California.

The Ornish diet is combined with stress-management techniques, exercise, social support and smoking cessation, and according to Ornish is the only scientifically proven program to reverse heart disease without drugs or surgery

Want to make the Mediterranean style of eating one of your goals this year? Sign up for CNN’s Eat, But Better: Mediterranean Style newsletter, an eight-part series that guides you in a delicious expert-backed eating lifestyle that’s good for your health.

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Mediterranean diet named best diet for 2023

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CNN
 — 

The gold medals are piling up. For the sixth year in a row, the Mediterranean style of eating earned the title of best overall diet, according to 2023 ratings announced Tuesday by U.S. News & World Report. Meals from the sunny Mediterranean also ranked first in the categories of diet best diet for healthy eating and best plant-based diet, the report said.

In two new categories added for 2023, the Mediterranean tied with the cholesterol-lowering TLC (Therapeutic Lifestyle Changes) and flexitarian diets as best family-friendly diet, and with DASH (dietary approaches to stop hypertension) for best bone and joint health diet.

“We’re always looking for more health conditions that we can address. But often there’s not enough scientific data examining diet X and condition X,” said Gretel Schueller, managing editor of health for U.S. News & World Report, who oversees the annual diet ranking.

“However, bone and joint health is an area where there’s a fair amount of scientific literature,” Schueller said. “We also recognize our population is aging so focusing on diets that can increase the quality of life among older individuals is an important element.”

Also new this year: Reviewers only ranked 24 diets instead of the 40 or so diets analyzed in past years. Five diets from the original list — vegetarian, vegan, Nordic, the traditional Asian and the glycemic index — were integrated by judges into the Mediterranean and other diets due to their underlying plant-based principles.

“The take-home message here is the recognition that the Mediterranean diet is really not just about the foods around the Mediterranean,” Schueller said. “You can take the the lessons and the approach of the Mediterranean eating pattern and apply it to any cuisine in any country.”

That approach is reflected within two new diets — Keyto and Pritikin — that were added to the review for 2023, Schueller said. (Yes. that’s Keyto with a Y.)

“We recognize that more and more people are eating sort of a plant-forward or plant-based diet or at least trying to,” she said. “The keto with a Y diet is supposed to be a flexible, low-carb Mediterranean plan.

“The Pritikin diet focuses on low-fat, high-fiber eating of whole foods, and is fairly flexible,” she added. “We are seeing a push towards eating more whole, unprocessed foods, which I think is a great thing.”

Numerous studies have found the Mediterranean diet can reduce the risk for diabetes, high cholesterol, dementia, memory loss, depression and breast cancer. The diet, which is more of an eating style than a restricted diet, has also been linked to stronger bones, a healthier heart and longer life.

The diet features simple, plant-based cooking, with the majority of each meal focused on fruits and vegetables, whole grains, beans and seeds, with a few nuts and a heavy emphasis on extra-virgin olive oil. Fats other than olive oil, such as butter, are consumed rarely, if at all, and sugar and refined foods are reserved for special occasions.

Red meat is used sparingly, usually only to flavor a dish. Eating healthy, oily fish, which are packed with omega-3 fatty acids, is encouraged, while eggs, dairy and poultry are eaten in much smaller portions than in the traditional Western diet.

Social interactions during meals and exercise are basic cornerstones of the Mediterranean style of eating. Lifestyle changes that are part of the diet include eating with friends and family, socializing over meals, mindfully eating favorite foods, as well as mindful movement and exercise.

Just as they did in 2022, the DASH and the flexitarian diet tied for second place in best overall diet. Similar to the Mediterranean style of eating, these diets reduce or eliminate processed foods and stress packing your plate with fruits, vegetables, beans, lentils, whole grains, nuts and seeds.

The DASH diet emphasizes limiting salt intake in its goal to reduce blood pressure, while the flexitarian diet, true to its name, allows an occasional indulgence of meat or poultry.

A panel of 33 experts examined top diets and ranked them in several categories: Did the diet include all food groups; was it evidence based; are needed foods available at any supermarket; how easy is the diet to prepare, and did it use additional vitamins or supplements.

“We focused on quality over quantity,” Schueller said. “Our reviewers felt there are some diets out there that are so wacky they’re not worth giving time to, such as the Dukan diet, which we no longer rank.”

The worst diet award went to the raw foods diet this year, at least in part due to the lack of nutritional completeness, which has raised safety concerns among the reviewers. Because followers can only eat unprocessed foods that haven’t been cooked, microwaved, irradiated, genetically engineered or exposed to pesticides or herbicides, reviews consider the diet almost impossible to follow.

The popular keto diet, along with the modified keto, was ranked 20 out of the 24 diets, followed by Atkins, SlimFast and Optavia. These diets emphasize eating high-protein or high-fat foods with minimal carbohydrates and receive low rankings because they are extremely restrictive, hard to follow and eliminate entire food groups.

Despite keto’s low overall rating, reviewers gave the keto diet first place for best short-term weight loss diet, Schueller said, quickly adding that these diets are not considered healthy as a lifestyle.

“These are the diets for someone who’s got a wedding or an event they want to go to in the next few months,” she said. “Will you lose weight in the short term? Absolutely. Will you keep it off for the next two years? Probably not.”

In the category of best (long-term) weight-loss diet, WW (formely called Weight Watchers) came in first, with DASH and TLC tied for second. WW also got top honors in the best (commercial) diet program, followed by NOOM and Jenny Craig.

Flexitarian and TLC shared the gold in the category of easiest diet to follow, while the Mediterranean and DASH diets tied for third.

The DASH diet took top honors as best diet for heart health and for people with diabetes, followed by the Mediterranean, flexitarian and Ornish diets. The Ornish diet was created in 1977 by Dr. Dean Ornish, founder of the nonprofit Preventive Medicine Research Institute in California.

The Ornish diet is combined with stress-management techniques, exercise, social support and smoking cessation, and according to Ornish is the only scientifically proven program to reverse heart disease without drugs or surgery

Want to make the Mediterranean style of eating one of your goals this year? Sign up for CNN’s Eat, But Better: Mediterranean Style newsletter, an eight-part series that guides you in a delicious expert-backed eating lifestyle that’s good for your health.

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Hydration linked with lower disease risk, study finds

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You may know that being adequately hydrated is important for day-to-day bodily functions such as regulating temperature and maintaining skin health.

But drinking enough water is also associated with a significantly lower risk of developing chronic diseases, dying early or being biologically older than your chronological age, according to a National Institutes of Health study published Monday in the journal eBioMedicine.

“The results suggest that proper hydration may slow down aging and prolong a disease-free life,” said study author Natalia Dmitrieva, a researcher in the Laboratory of Cardiovascular Regenerative Medicine at the National Heart, Lung and Blood Institute, a division of NIH, in a news release.

Learning what preventive measures can slow down the aging process is “a major challenge of preventive medicine,” the authors said in the study. That’s because an epidemic of “age-dependent chronic diseases” is emerging as the world’s population rapidly ages. And extending a healthy life span can help improve quality of life and decrease health care costs more than just treating diseases can.

The authors thought optimal hydration might slow down the aging process, based on previous similar research in mice. In those studies, lifelong water restriction increased the serum sodium of mice by 5 millimoles per liter and shortened their life span by six months, which equals about 15 years of human life, according to the new study. Serum sodium can be measured in the blood and increases when we drink less fluids.

Using health data collected over 30 years from 11,255 Black and White adults from the Atherosclerosis Risk in Communities study, or ARIC, the research team found adults with serum sodium levels at the higher end of the normal range — which is 135 to 146 milliequivalents per liter (mEq/L) — had worse health outcomes than those at the lower end of the range. Data collection began in 1987 when participants were in their 40s or 50s, and the average age of participants at the final assessment during the study period was 76.

Adults with levels above 142 mEq/L had a 10% to 15% higher chance of being biologically older than their chronological age compared with participants in the 137 to 142 mEq/L range. The participants with higher faster-aging risk also had a 64% higher risk for developing chronic diseases such as heart failure, stroke, atrial fibrillation, peripheral artery disease, chronic lung disease, diabetes and dementia.

And people with levels above 144 mEq/L had a 50% higher risk of being biologically older and a 21% higher risk of dying early. Adults with serum sodium levels between 138 and 140 mEq/L, on the other hand, had the lowest risk of developing chronic disease. The study didn’t have information on how much water participants drank.

“This study adds observational evidence that reinforces the potential long-term benefits of improved hydration on reductions in long-term health outcomes, including mortality,” said Dr. Howard Sesso, an associate professor of medicine at Harvard Medical School and associate epidemiologist at Brigham and Women’s Hospital in Boston, via email. Sesso was not involved in the study.

However, “it would have been nice to combine their definition of hydration, based on serum sodium levels only, with actual fluid intake data from the ARIC cohort,” Sesso added.

Biological age was determined by biomarkers that measure the performance of different organ systems and processes, including cardiovascular, renal (relating to the kidneys), respiratory, metabolic, immune and inflammatory biomarkers.

High serum sodium levels weren’t the only factor associated with disease, early death and faster aging risk — risk was also higher among people with low serum sodium levels.

This finding is consistent with previous reports of increased mortality and cardiovascular disease in people with low regular sodium levels, which has been attributed to diseases causing electrolyte issues, the authors said.

The study analyzed participants over a long period of time, but the findings don’t prove a causal relationship between serum sodium levels and these health outcomes, the authors said. Further studies are needed, they added, but the findings can help doctors identify and guide patients at risk.

“People whose serum sodium is 142 mEq/L or higher would benefit from evaluation of their fluid intake,” Dmitrieva said.

Sesso noted that the study did not strongly address accelerated aging, “which is a complicated concept that we are just starting to understand.”

“Two key reasons underlie this,” Sesso said. The study authors “relied on a combination of 15 measures for accelerated aging, but this is one of many definitions out there for which there is no consensus. Second, their data on hydration and accelerated aging were a ‘snapshot’ in time, so we have no way to understand cause and effect.”

About half of people worldwide don’t meet recommendations for daily total water intake, according to several studies the authors of the new research cited.

“On the global level, this can have a big impact,” Dmitrieva said in a news release. “Decreased body water content is the most common factor that increases serum sodium, which is why the results suggest that staying well hydrated may slow down the aging process and prevent or delay chronic disease.”

Our serum sodium levels are influenced by liquid intake from water, other liquids, and fruits and vegetables with high water content.

“The most impressive finding is that this risk (for chronic diseases and aging) is apparent even in individuals who have serum sodium levels that are on the upper end of the ‘normal range,’” said Dr. Richard Johnson, professor at the University of Colorado School of Medicine, via email. He was not involved in the study.

“This challenges the question of what is really normal, and supports the concept that as a population we are probably not drinking enough water.”

More than 50% of your body is made of water, which is also needed for multiple functions, including digesting food, creating hormones and neurotransmitters, and delivering oxygen throughout your body, according to the Cleveland Clinic.

The National Academy of Medicine (formerly known as the Institute of Medicine) recommends women consume 2.7 liters (91 ounces) of fluids daily, and that men have 3.7 liters (125 ounces) daily. This recommendation includes all fluids and water-rich foods such as fruits, vegetables and soups. Since the average water intake ratio of fluids to foods is around 80:20, that amounts to a daily amount of 9 cups for women and 12 ½ cups for men.

People with health conditions should talk with their doctor about how much fluid intake is right for them.

“The goal is to ensure patients are taking in enough fluids, while assessing factors, like medications, that may lead to fluid loss,” said study coauthor Dr. Manfred Boehm, director of the Laboratory of Cardiovascular Regenerative Medicine, in a news release. “Doctors may also need to defer to a patient’s current treatment plan, such as limiting fluid intake for heart failure.”

If you’re having trouble staying hydrated, you might need help working the habit into your usual routine. Try leaving a glass of water at your bedside to drink when you wake up, or drink water while your morning coffee is brewing. Anchor your hydration habit to a location you’re in a few times per day, behavioral science expert Dr. B.J. Fogg, founder and director of the Stanford University Behavior Design Lab, previously told CNN.

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Dr. Sanjay Gupta: 6 keys to keeping sharp in 2023

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Editor’s Note: CNN Chief Medical Correspondent Dr. Sanjay Gupta is a practicing neurosurgeon and the author of the new book, “12 Weeks to a Sharper You: A Guided Program.”



CNN
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At least once a year, we read a sparkling headline about some promising new drug that might help patients with Alzheimer’s disease. And at least once a year, we also hear about failed drug trials and reversals of promises that a cure-all is in sight. I wrote a book about how to keep your brain sharp that came out two years ago. Since then, not much has changed in our understanding of how we can preserve our memories, and the lessons remain as relevant as ever. But one thing has become abundantly clearer: Preventing and even treating forms of dementia are largely driven by lifestyle and the choices we make daily. You are not necessarily doomed to whatever fate you think sits stuck in your genes. If there’s one fact that’s increasingly apparent in scientific circles, it’s that our lifestyle choices contribute mightily to our aging process and risk for disease, likely as much – or perhaps even more – than our genetics.

Indeed, your everyday experiences – including what you eat, how much you move, with whom you socialize, what challenges you face, what gives you a sense of purpose, how well you sleep, and what you do to reduce stress – factor much more into your brain health and overall wellness than you might imagine. We may never have a drug that everyone can take to avoid, let alone cure, dementia and other neurodegenerative diseases. But we all can access the same toolkit proven to help stack the deck in our favor for a sharp brain for life. The program I outline in my book, and which informed the interactive workbook I have coming out this week – “12 Weeks to a Sharper You: A Guided Program” – features all the practical tools you need to implement in your life today. They can help stave off brain decline, and also help you feel less anxious, sleep better, improve energy, think more clearly, make better decisions, become more resilient to daily stress, and even lose weight and boost immunity – all resolutions most of us aim to make at the transition to a new year filled with hope and high expectations. We all know that change is a challenge, and changing long-established habits takes effort. But it doesn’t have to be tortuous, and it is really not that hard to do. Let me give you six things that will help you in 2023 – your keys to the kingdom of mental sharpness.

Skip the crash diet and simply work on following the S.H.A.R.P. protocol: Slash the sugar and salt; Hydrate smartly; Add more omega-3 fatty acids from dietary sources; Reduce portions; and Plan ahead. The S.H.A.R.P. protocol is the easiest way to gravitate toward healthier foods in general and minimize the amount of processed, brain-busting junk. And if you need just one single thing to focus on here, start with the sugar. The average American consumes nearly 20 teaspoons of added sugar daily, most of that in the highly processed form of fructose, derived from high-fructose corn syrup. My guess is that a lot of this sugar intake comes in the form of a liquid – soda, energy drinks, juices and flavored teas. Swap sugar-laden drinks with water and you’ll take on two steps. That’s how to hydrate smartly.

Physical exertion is the only thing we’ve scientifically documented to improve brain health and function, and it may even slow memory loss. It’s the brain’s only superfood. And it needn’t be formal or require equipment. Walk more, take the stairs, and get up for light activity for two minutes every hour. According to the US Centers for Disease Control and Prevention, cognitive decline is almost twice as common among adults who are inactive compared to those are active. In 2022, a large international study that tracked the health of more than half a million people showed that the simple act of performing household chores like cooking, cleaning and washing the dishes can cut the risk of dementia by a stunning 21%. That put chores as the second biggest protective activity behind more obvious things such as riding a bike. In this same study, regular movement was shown to reduce risk of dementia by 35%, followed by meeting up with friends and family (a 15% lower risk). Again, simple things with huge payoffs.

On a scale of 1 to 10, with 10 being the most extreme, how would you rate your stress level? What if I told you that stress is now considered a trigger for silent neurodegeneration, which occurs years before symptoms develop? Scores of well-designed studies routinely show that chronic stress can impair your ability to learn and adapt to new situations, and subtly erode your cognition. More specifically, stress destroys cells in the hippocampus, the brain site responsible for memory storage and retrieval. So, by reducing stress, you not only help preserve cells vital to memory but you also improve focus, concentration and productivity. Don’t let toxic stress get in the way of keeping sharp. Take breaks during the day to engage in an activity that’s peaceful, meditative and stress-reducing. It can be as easy as walking in nature, journal writing, spending time with a pet, or even daydreaming. Download an app today that will give you a guided tour through a deep breathing exercise you can practice daily. I have a trusty meditative routine that calms me down in 90 seconds or less. I simply close my eyes, pay close attention to my breath, and picture my worries in clear bubbles directly in front of me that float weightlessly up and away.

Find what works for you and make it a part of your day – every day.

Are you getting restorative sleep? Contrary to popular belief, sleep is not a state of neural idleness. It is a critical phase during which the body replenishes itself in a variety of ways that ultimately affect every system, from the brain to the heart, the immune system, and all the inner workings of our metabolism. You can think of sleep as your brain’s rinse cycle for clearing out junk that could contribute to decline and disease. Prioritize sleep as you would anything else important. And start with your bedtime routine. Stop looking at screens a full hour before bed – your smartphone included – and prepare for a good night’s sleep. I bumped my pre-sleep prep time from 30 minutes to an hour and it has made all the difference in my energy and productivity the next day.

Are you learning something new every day that’s cognitively stimulating? Staying mentally challenged is vital, so much so that studies show that someone who retires at age 65 has about a 15% lower risk of developing dementia compared with someone retiring at 60, even after other factors are taken into account. Retire late, or never at all. Choose different routes to familiar destinations. Brush your teeth with the non-dominant hand. Skip the solitary games and crossword puzzles and pick up a new hobby that involves other people. Which brings me to the final key …

We are social creatures who need social connection to thrive, especially when it comes to brain health. Call a friend today. Invite a neighbor over for dinner. Go for a walk with a buddy and talk about your problems. Cherish those relationships. The strength of our connections with others can predict the health of both our bodies and our brains as we go through life. Good relationships protect us. They are a secret sauce to a long, sharp life.

As of 2022, scientists have documented a total of about 75 genes connected to the development of Alzheimer’s disease, but carrying these genes is not a one-way ticket to decline. How those genes express themselves and behave may depend largely on your daily habits. Remember that a disease like Alzheimer’s is multifactorial, made up of different pathological features. Which is why prevention and treatments are increasingly becoming personalized – individualized to a person’s biochemistry, from basic parameters like cholesterol levels, blood pressure and blood sugar balance, to the state of one’s oral health and gut microbiome, relics of past infections, and even how well you can see and hear. To that end, it helps to keep your numbers in check. Fon’t let your cholesterol or blood pressure, for instance, run amok. Same goes for your vision and hearing. In recent years, hearing and vision impairment have been added to the list of modifiable risk factors for cognitive decline.

Your DNA provides your body’s core language, but how that DNA behaves tells the story. In the future, interventional therapies that include a combination of lifestyle habits and drugs may help those stories end well. You’ll also track your risk for cognitive decline over time in the future using a simple app on your smartphone that can help you evaluate your physiology (and your memory) in real time and make suggestions tailored for you. Until we all have that technology at our fingertips, the six keys above afford you a great start and will give you a strong foundation.

The ultimate goal is to build what’s called cognitive reserve, which is what scientists call “brain resiliency.” With more cognitive reserve, you support cognitive function and can lower your risk of neurodegenerative issues. It’s like having a backup set of networks in your brain when one fails or, worse, dies and is no longer functional. In many aspects of life, the more backup plans we have, the more chances for success, right? Well, the same is true for our brain’s hard- and soft-wiring. And perhaps the most important key to establishing that reserve is to do so over time – years or even decades – before your risk for decline increases with advanced age.

Always remember this: Cognitive decline is not necessarily inevitable. Research suggests healthy habits you can incorporate into your daily life can help protect your brain health for the long term. Think of health as a “top-down” project. Focus on your brain and everything else will follow. Happy New Year!

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In wake of baby formula crisis, critical report recommends major food safety changes at FDA

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CNN
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To help prevent outbreaks of food-related illness and problems like the formula shortage that left many parents in the US without adequate access to food for their babies, the US Food and Drug Administration needs a clearer mission and a different kind of leadership, and it has to act with more urgency, according to a highly critical new report.

After the agency faced serious criticism for its handling of the formula shortage, FDA Commissioner Dr. Robert Califf commissioned the review of the Human Foods Program in July from the Reagan-Udall Foundation, an independent group of experts.

The need for a review was considered so urgent that Califf asked the group to submit the report in 60 business days – lightning speed for government-focused reports. It was submitted to the FDA on Tuesday.

About 48 million Americans get some kind of foodborne illness every year, according to the US Centers for Disease Control and Prevention. Of those, 128,000 are hospitalized, and 3,000 die. Produce alone in 2019 was responsible for 46% of foodborne illness outbreaks, according to the US Department of Agriculture.

The FDA oversees the safety of 78% of the US human food supply.

It enforces food safety regulations, works with local governments on food safety information, promotes dietary guidelines, and develops food safety information and education, as well as overseeing nutrition labels on most food and being responsible for promoting good nutrition practices to the US public.

The US food supply is generally recognized as safe, the Reagan-Udall Foundation’s report said, but the FDA needs to be much more proactive in dealing with foodborne pathogens in order to protect Americans.

“An approach that is primarily focused on identifying and reacting to acute outbreaks of foodborne illness and death is unacceptable,” the report says.

Americans’ nutrition can also improve, the report says. Most people don’t follow the US dietary recommendations, and more than a million die of diseases that can be linked to diet such as heart disease, type 2 diabetes and cancer each year, according to the FDA

“Relying solely on food labeling and consumer education to drive the needed changes in the food supply is also an unacceptable strategy for reducing diet-related chronic diseases,” the new report says.

The report suggests that the agency needs major reform in order to do a better job managing food in the US. Some of the proposed changes would require congressional approval.

The report has several suggestions for ways to reach these goals. One would create a separate Center for Nutrition within the US Department of Health and Human Services. Another would have the FDA develop a strategy to increase funding for the Human Foods Program, with help from Congress. The agency could also connect its technology systems so they better communicate with each other.

The FDA could seek to amend the Federal Food, Drug, and Cosmetic Act to allow the disclosure of more information to local agencies. Or it could get regulatory authority to request records from food manufacturers in advance or in lieu of inspection.

The report recommends that the FDA explore applying its authority to require infant formula manufacturers, for instance, to keep microbiological testing records that are available on request so there is real-time disclosure of results.

It also suggests that the FDA use its mandatory recall authority more often and that there should be a process by which accommodations are made for products that are considered life-sustaining, like formula. At the moment, food recalls are usually voluntarily initiated by a manufacturer or food distributor.

The report also notes that the food program is run under the leadership of several managers. This “lack of a single, clearly identified person” to lead the program has led to a culture of “constant turmoil” and “indecisiveness and inaction” that has created “disincentives for collaboration,” according to the report.

That turmoil was partly to blame for the agency’s problematic handling of the formula shortage, the report says.

Experts have said the agency failed to act quickly enough on sanitation complaints at an Abbott Nutrition formula manufacturing facility in Michigan, and because of a lack of communication across departments, it didn’t circumvent what became a massive shortage of formula after the plant shut down.

“A review of events indicates that lack of communication and engagement across the Agency accounted, in part, for missteps,” the new report says. “There was little motivation, and apparently no requirement, to share information and interact across the Agency to facilitate critical thinking and proactive decision-making.

“This is especially problematic in a crisis, where decisions should be made quickly and be vetted properly.”

The report suggests that the FDA create a new structure with clear roles and leaders. It also encourages development of a culture that is more transparent, that acts quickly and collaborates.

“The current culture of the FDA Human Foods Program is inhibiting its ability to effectively accomplish this goal” of protecting public health,” the report says.

Califf said Tuesday that the agency has not had the opportunity to review the report in depth but that the report provides “significant observations” and options to consider.

“The work of these independent evaluators will help to inform a new vision for the FDA Human Foods Program,” Califf said in a news release.

Some critics have suggested that food safety takes a back seat to the FDA’s regulations of drugs and medical devices. Califf acknowledged that food policy was important to the agency, citing the decline in life expectancy in the US largely due to chronic diseases that can be improved with good nutrition.

“The Human Foods Program is a top priority for the agency. America’s food supply is as safe as it’s ever been,” he said. “That said, over the past several years, the program has been stressed by the increasing diversity and complexity of the nation’s food systems and supply chain, the ongoing impacts associated with climate change and rapid advances in the science underlying many of the foods we eat today.”

The FDA will inform the public about how it is moving forward on the panel’s suggestions by the end of January and will provide additional updates at the end of February, including on any structural or procedural changes it will make, Califf said.

He said he’s putting together a group of leaders at the FDA that will advise him on how to “operationalize these findings,” and he expects these leaders to be “bold and focused on the transformative opportunities ahead for the FDA’s food program.”

In April, a coalition of 30 organizations that represent industry, local regulators and consumers sent a letter to the FDA asking for the creation of a deputy commissioner for foods with direct line authority over all the agency’s food components.

One of the organizations, Consumer Reports, has called for months for more accountability and focused leadership from the FDA.

“We need strengthened leadership and accountability at the FDA to implement a culture of prevention, respond more quickly to problems as they arise, and take timely action on proposed food safety rules and initiatives,” Brian Ronholm, Consumer Reports’ director of food policy, said Tuesday.

Ronholm called the new report a “very encouraging first step.”

“We cannot afford to tolerate the status quo and let this moment go by without adopting fundamental changes to improve the FDA’s ability to protect the public and ensure our food is safe,” he said in a statement.

The Consumer Brands Association, a trade association for food manufacturers that also signed the April letter, said Tuesday that the lack of a single leader on food policy leads to “a lot of inefficiencies.”

“A siloed approach across FDA makes it harder for industry to engage,” said Sarah Gallo, the organization’s vice president for product policy. “It is just really complicated when you don’t have somebody looking over the different parts of the agency that have some form of jurisdiction over all those things.

“We can’t ignore what happened with the formula crisis,” Gallo added, a tangible example of what can happen when the FDA is not functioning at its best.

Roberta Wagner, vice president of regulatory and technical affairs for the Consumer Brands Association, agreed that if there were one person in charge, they could make sure the inspection and policy parts of the FDA would work together.

Wagner added that the food industry has embraced a more prevention-oriented kind of philosophy when it comes to safety. “Quite frankly, the problem is, FDA’s inspection force has not modernized itself or its approaches to basically mirror that prevention-oriented system and philosophy,” Wagner said.

The FDA food division has its work cut out for it, though, added Wagner, who worked with the agency in several capacities before joining the association.

“Think about it: The FDA has to keep up with hundreds of thousands of farms and facilities,” she said. “If you have these siloed operations, you’re not having these really critical conversations about where we should be and what should we be doing out there.

“We all want an FDA with a strong foods program. We want consumers not to worry about what they’re eating or whether they’re going to be able to get that certain needed food product,” Wagner added.

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