Should national nutrition policy target "Ultra-Processed Foods" (UPF) as many advocate? I consider concerns in a @NEJM Perspective Like 'The Emperor's New Clothes' 👉We're rolling out a red carpet, but the evidence is threadbare! LINK: https://t.co/iDjaGzdbES 1/21 🧵👇

In a new blog post, @davidludwigmd & @TyBealPhD explain why revoking the FDA's "Generally Recognized as Safe" designation for refined carbs would destabilize the nation's food supply. They outline a better path forward:

"a combination replacement (using both fat and protein) yielded the most comprehensive cardiometabolic benefits, including reductions in blood pressure, inflammation, and endothelial dysfunction" "The carbohydrate-insulin model provides a framework for these results ..." 2/2

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LOW-CARB DIETS Start of my career: "They don't work for wt loss" Then: "You'll be a lean corpse" Now: versus higher carb, IMPROVED * Body comp * BP * TG * VLDL * ApoB-A1 ratio * endothelial markers * inflam markers * overall CVD risk (yes LDL up) 1/2 https://t.co/P5Iuqwuo1z

Heard this snippet around the medical center today. With light edits, a lovely haiku ...

Ultimately we need long-term trials that provide mechanistic insights ... ... by aiming to separate any potential novel effects of UPF from conventional factors known to affect body weight This is Study Design 101 For more, see my blog (no paywall) https://t.co/CMju62rSSx 9/9

Of course, this study doesn't prove that UPF prevents obesity ... ... just as prior studies don't prove UPF causes obesity. Based on food selection, trials can be designed (and biased) to make UPF look good or bad. This isn't rigorous science or firm foundation for policy 8/9

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Among foods consumed, ED was clearly not higher with UPF-Low NQ (contrasting to prior studies) What happened? 👉LOWER (!) calories intake on UPF-Low NQ If replicated over 3 meals + 1 snack, would approach the 500 kcal/d seen in prior studies ... in the OPPOSITE DIRECTION 7/9

The meals were designed to have the same: Protein, fat, carbs BUT LOWER energy density for the UPF-Low NQ (last column) 6/9

The researchers compared 3 meals in a cross-over design, with a washout period of several days between them. 1. Non UPF, high nutrition quality (High NQ) 2. UPF, high nutrition quality (High NQ) 3. UPF, low nutrition quality (Low NQ) 5/9

Are these trials of UPF simply rediscovering the energy density "wheel" of nutrition science? So ... what would happen if a trial studied UPF with the same or lower energy density? 👉A new preprint paper addresses this very question https://t.co/fpfRDWdnHU 4/9

In the Cell Metab 2019 trial, energy density (ED, calories per gram of solid food) was nearly double on the UPF versus an "unprocessed" diet. Many studies show that ED has a BIG short-term effect on food intake (This effect weakens with time) https://t.co/wUFE9nrCnp 3/9

In these trials, the UPF diet differed from the non-UPF diet in many ways that could bias the results. So, conventional factors may account for the effects, rather than anything novel/unique to ultra-processing itself, such as: Protein Sugar Fiber And ** ENERGY DENSITY ** 2/9

NEW CLINICAL TRIAL Ultra-processed food (UPF) PREVENTS obesity ...?😱 I've previously argued existing trials are biased by unfair diet comparisons https://t.co/ltMZK3uQhy For example – Is it fair to compare a burger & fries vs salmon & a massive portion of green beans? 🧵1/9

Adults (average BMI 25) ate: 2 cups fruit daily or none for 8 wk (8-wk "washout period" - pretty good, all considered) Fruit (including bananas, apples, oranges, watermelon) 👉 ⬆️ some blood nutrients 👉BUT insulin resistance better without the fruit https://t.co/nHyu1Y3NO1

The notion of "ultra-processed" food is so complicated, not even @FDA knows how to define it. There's a simpler way: 👉Focus on the main health offenders – refined grains, sugar and other highly processed carbs In print today Free access (requires email) https://t.co/fP6VdfM3jy

"Launching another broad public health prevention campaign based on ambiguous observational studies and weak clinical trials risks a redux of the low-fat diet debacle," @davidludwigmd writes.

The importance of the perspective on ultra-processed foods that @davidludwigmd offers in this essay can not be overemphasized. Please share widely! "This is a fragile foundation for national nutrition policy. For now, health officials should focus on the industrial products for

Will targeting "ultra-processed food" make Americans (and the rest of the world) healthier? 👉I argue there is a better way. https://t.co/fP6VdfM3jy

In @NatureMedicine, Mary Putt (@UPennDBEI), @davidludwigmd & Walter Willett (@HarvardChanSPH) discuss concerns for the validity of short-term dietary crossover trials https://t.co/wF8wnfIWWw

In a Perspective, David S. Ludwig, MD, PhD (@davidludwigmd), writes that the Nova food-classification system has advanced efforts to address modern diets of highly processed foods, but it’s unclear whether it can be codified at a national level to support public health. Read the