Weight loss significantly improves physical health but effects on mental health are less straightforward, finds new UCL research funded by Cancer Research UK. In a study of 1,979 overweight and obese adults in the UK, people who lost 5% or more of their initial body weight over four years showed significant changes in markers of physical health, but were more likely to report depressed mood than those who stayed within 5% of their original weight. The research, published in PLOS ONE, highlights the need to consider mental health alongside physical health when losing weight. Clinical trials of weight loss have been shown to improve participants’ mood, but this could be a result of the supportive environment rather than the weight loss itself, as the effects are seen very early on in treatment and are not related to the extent of weight loss. It’s important to note this new result does not mean that weight loss necessarily causes depression directly, as depression and weight loss may share a common cause. However, it shows that weight loss outside the clinical trial setting cannot be assumed to improve mood and raises questions about the psychological impact of weight loss.
A whole industry has grown around testosterone supplementation for ageing men. But neither the benefits nor risks of the practice are clear yet, and they remain the subject of ongoing research.
Beginning in middle age, blood levels of testosterone progressively decrease in some men. At the same time, muscle mass, strength and bone density decrease, while fat mass and disorders of sexual function increase.
Because studies have found an association between these changes and low levels of testosterone (that is, they happen at the same time), there has been a growing trend in many parts of the world, including Australia, for older men to be prescribed testosterone.
But two recent studies – the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study and the European Male Ageing Study (EMAS) – have shown that it’s not actually the ageing process as such that decreases testosterone.
Rather, concomitant increases in chronic disease including obesity, cardiovascular disease, and depression may be responsible.
In obese men, low testosterone increases the likelihood of subsequent development of type 2 diabetes. But in these men, testosterone levels increase with weight loss.
Low testosterone levels are also associated with increased risk of all-cause and cardiovascular deaths in community-based studies of men.
But these effects appear to be driven, at least in part, by underlying health status. So while testosterone treatment for preventing the occurrence of diabetes or cardiac disease may appear theoretically appealing, it’s unclear whether it’s beneficial or safe.
Testosterone deficiency that’s of clinical significance and requiring treatment is known as hypogonadism. True hypogonadism actually affects only 2% to 3% of the male population over the age of 40.
It comes with a set of symptoms that include loss of sexual desire, erectile dysfunction, fatigue, muscle loss and weakness, increased body fat, diminished motivation, sleep disturbance, hot flushes and decreased body hair.
But many of these symptoms may result from other conditions, such as depression or obstructive sleep apnoea, whether or not testosterone is low.
To complicate matters even further, a man may have low levels of testosterone without any symptoms. And the level of testosterone at which different symptoms occur varies within as well as between individuals.
In situations where the testosterone level is low and there are some symptoms, it can be difficult to disentangle cause-and-effect relationships. It is in this group of men that the use of testosterone supplements remains controversial, especially since doubts about its safety remain unresolved.
A 2010 clinical study of testosterone treatment in frail men aged over 65 years with low testosterone was stopped prematurely because the group getting the hormone was found to have more cases of heart attacks, heart failure and atrial fibrillation (irregular heart beats).
High doses (and therefore blood levels) of testosterone seemed to be a factor. But there were no such adverse events in a similar study with less frail men and where lower doses of testosterone were used.
But two more recent large studies that analysed patient records from large databases have suggested testosterone treatment may increase cardiovascular events, such as heart failure, heart attacks and strokes.
The first involved 8,000 men with low testosterone undergoing invasive examination of the arteries supplying blood to the heart muscle in a US Veterans Affairs Hospital.
The other study examined the records of 55,593 men maintained in a US health insurance database. Records of the number of heart attacks in the past year were compared with heart attacks in the 90 days following prescription.
But testosterone levels of these men were not reported, either at baseline or subsequently. Indeed, the conclusions to both these studies are flawed because their analyses were flawed. The first has even been the subject of a complaint to the journal involved.
In another study of case records in a Veterans Affairs Hospital, testosterone treatment decreased the risk of death irrespective of age or the presence of diabetes or coronary heart disease.
But observational studies of this sort – and all these studies fall under that banner – do not provide the evidence required to argue a treatment should be used. We need properly controlled trials to make such decisions, especially in light of possible health harms.
This is particularly important because lifestyle measures resulting in weight loss increase blood testosterone and unequivocally benefit the underlying disease state and prevent the development of type 2 diabetes in men at high risk of the disease. Indeed, a more active lifestyle benefits everyone and has a much wider health impact than any medical intervention.
Until the results of clinical trials become available, we have insufficient evidence to support the use of testosterone beyond the 2% to 3% of the population with unequivocal hypogonadism. And caution should clearly be exercised in men with cardiovascular disease.
Eating soy before menopause may significantly reduce heart problems post-menopause.
Researchers at the Wake Forest School of Medicine fed cynomolgus monkeys a variety of animal protein and soy foods before and after surgical menopause. Those who ate meat and switched to soy afterwards improved in artery health but those who ate soy throughout saw the biggest results.
The results mirror other studies but emphasise the health benefits of eating soy before the onset of menopause.
Many people eat badly because far too much of their energy is provided by nutritionally worthless junk foods and drinks. Part of the problem is the push by the food industry to get us to buy food that…
Many people eat badly because far too much of their energy is provided by nutritionally worthless junk foods and drinks. Part of the problem is the push by the food industry to get us to buy food that may be bad for us but good for its business.
In the 1960s, we had between 600 and 800 foods to choose from, many of them only available at the right season. But that was before supermarkets became widespread.
Now, the typical supermarket stocks about 30,000 items with whole aisles devoted to sweetened drinks, confectionery, savoury snack foods, biscuits, cakes and pastries, sugary breakfast cereals and substitute bars, and drinks full of added sugar.
Any one of these foods may contribute only a small percentage of total kilojoules, but there are so many of them that together they contribute 35% of adults’ kilojoules (41% for children), as well as 41% of saturated fat (47% for children) and 47% of consumed sugar (54% for children).
Of course, we must take responsibility for what we choose, but when sugary, salty, fatty items dominate what is offered in supermarkets, school and work canteens, sporting venues, service stations, motel dining rooms, clubs and even hospitals, they become the easy choices.
The food industry also uses advertising and promotions to “normalise” the consumption of highly-processed foods and drinks, and its lobbying power to resist regulation.
The Australian food, drink and manufacturing industry is worth A$111 billion with the big end of town represented by the Australian Food and Grocery Council (AFGC).
This powerful lobby group is representative of just 120 food companies out of more than 2,000, but well over 80% of the dollar value of food sold in Australia. The majority of its members are large companies manufacturing highly-processed foods and drinks.
No one quibbles with the fact that companies are in business to make a profit. But sadly the profitability of many food companies comes from a type of “value adding” that could more accurately be dubbed “value padding”.
Sugar, refined starches and fat are cheap additives used to dilute more nutritious ingredients. Many fruit drinks, for instance, contain just 25% fruit juice with added sugar and water to replace the fruit juice.
This kind of fruit drink is cheaper to buy than 100% juice but not as cheap as you might expect from a product that’s only one quarter juice. The juice drink is therefore much more profitable for the manufacturer.
Breakfast cereals that are high in sugar should be cheaper because sugar is usually cheaper than the grain it replaces. But as the sugar content of breakfast cereals goes up, so does the price. And we’re getting an increasing range of sweet products.
Fish is not cheap but because fish fingers may contain just 51% fish – the rest being cheap “coating” – they can generate huge profits. The coated product may appear cheaper, but remember that you’re only getting half the fish, so you’re paying through the nose for the company’s profits.
Meat pies with more meat but less fat and salty gravy would be much more nutritious, but less profitable for the pie seller. Salty water is also pumped into deli meats and marinaded chicken portions and other meat products – making them less nutritious – but more profitable for the seller.
The more additives in your yoghurt, the cheaper the product is to produce – and the less nutritious for the consumer.
Foods with high levels of sugar, cheap fats, refined starches, salt and various additives to provide flavour and colour are profitable – and more palatable for most consumers. That’s because tastes like this encourage our survival mechanism to kick in and ensure we feast in case of future famine.
For highly or ultra-processed foods, profitability depends on devoting as much as possible of the price on packaging and marketing while keeping the costs of basic ingredients as low as possible. Indeed, it’s been estimated that 50% of the budget for many of these foods goes on packaging, 40% on marketing and 10% on ingredients.
Ultra-processed products have been described as:
characteristically formulated from ‘refined’ and ‘purified’ ingredients freed from the fibrous watery matrix of their original raw materials. They are formulated to be sensually appealing, hyper-palatable, and habit-forming, by the use of sophisticated mixtures of cosmetic and other additives, and state-of-the-art craft packaging and marketing. Further, ultra-processed products are ‘convenient’ – meaning ready-to-eat (or drink) or ready-to-heat.
Unsurprisingly, nutritionists and public health experts assert there’s no such thing as a healthy ultra-processed product – and this is the crux of the problem: such products may be good for big food business but they’re terrible for health.
Ultra-processed foods are widely available in convenience stores, vending machines, service stations and sporting venues. They’re designed for consumption while we are out at work or play or driving or being entertained – and we’re encouraged to see them as an integral part of life. Some are even fortified with micronutrients to give them a false halo of goodness.
Sugar, added starches, saturated fat and salt are cheap so the more you can add, the more budget left for the task of persuading customers, including children, to choose your product. This has not changed over the last decade.
Marketing costs are tax deductible in Australia, so, in effect, we subsidise the marketing of junk foods and drinks – and it works.
Basic foods, such as fruits and vegetables, which have no packaging or value padding, have only a small or no budget for promotion. And their consumption is correspondingly low (and falling).
Meanwhile foods padded with worthless ingredients are dominating the diet, increasing the costs of meals and making us sick.
Dr Colin Holloway 