In recent years, there’s been increasing hype about the potential health risks associated with so-called “ultra-processed” foods.

But new evidence published this week found not all “ultra-processed” foods are linked to poor health. That includes the mass-produced wholegrain bread you buy from the supermarket.

While this newly published research and associated editorial are unlikely to end the wrangling about how best to define unhealthy foods and diets, it’s critical those debates don’t delay the implementation of policies that are likely to actually improve our diets.

What are ultra-processed foods?

Ultra-processed foods are industrially produced using a variety of processing techniques. They typically include ingredients that can’t be found in a home kitchen, such as preservatives, emulsifiers, sweeteners and/or artificial colours.

Common examples of ultra-processed foods include packaged chips, flavoured yoghurts, soft drinks, sausages and mass-produced packaged wholegrain bread.

In many other countries, ultra-processed foods make up a large proportion of what people eat. A recent study estimated they make up an average of 42% of total energy intake in Australia.

How do ultra-processed foods affect our health?

Previous studies have linked increased consumption of ultra-processed food with poorer health. High consumption of ultra-processed food, for example, has been associated with a higher risk of type 2 diabetes, and death from heart disease and stroke.

Ultra-processed foods are typically high in energy, added sugars, salt and/or unhealthy fats. These have long been recognised as risk factors for a range of diseases.

It has also been suggested that structural changes that happen to ultra-processed foods as part of the manufacturing process may lead you to eat more than you should. Potential explanations are that, due to the way they’re made, the foods are quicker to eat and more palatable.

It’s also possible certain food additives may impair normal body functions, such as the way our cells reproduce.

Is it harmful? It depends on the food’s nutrients

The new paper just published used 30 years of data from two large US cohort studies to evaluate the relationship between ultra-processed food consumption and long-term health. The study tried to disentangle the effects of the manufacturing process itself from the nutrient profile of foods.

The study found a small increase in the risk of early death with higher ultra-processed food consumption.

But importantly, the authors also looked at diet quality. They found that for people who had high quality diets (high in fruit, vegetables, wholegrains, as well as healthy fats, and low in sugary drinks, salt, and red and processed meat), there was no clear association between the amount of ultra-processed food they ate and risk of premature death.

This suggests overall diet quality has a stronger influence on long-term health than ultra-processed food consumption.

When the researchers analysed ultra-processed foods by sub-category, mass-produced wholegrain products, such as supermarket wholegrain breads and wholegrain breakfast cereals, were not associated with poorer health.

This finding matches another recent study that suggests ultra-processed wholegrain foods are not a driver of poor health.

The authors concluded, while there was some support for limiting consumption of certain types of ultra-processed food for long-term health, not all ultra-processed food products should be universally restricted.

Should dietary guidelines advise against ultra-processed foods?

Existing national dietary guidelines have been developed and refined based on decades of nutrition evidence.

Much of the recent evidence related to ultra-processed foods tells us what we already knew: that products like soft drinks, alcohol and processed meats are bad for health.

Dietary guidelines generally already advise to eat mostly whole foods and to limit consumption of highly processed foods that are high in refined grains, saturated fat, sugar and salt.

But some nutrition researchers have called for dietary guidelines to be amended to recommend avoiding ultra-processed foods.

Based on the available evidence, it would be difficult to justify adding a sweeping statement about avoiding all ultra-processed foods.

Advice to avoid all ultra-processed foods would likely unfairly impact people on low-incomes, as many ultra-processed foods, such as supermarket breads, are relatively affordable and convenient.

Wholegrain breads also provide important nutrients, such as fibre. In many countries, bread is the biggest contributor to fibre intake. So it would be problematic to recommend avoiding supermarket wholegrain bread just because it’s ultra-processed.

So how can we improve our diets?

There is strong consensus on the need to implement evidence-based policies to improve population diets. This includes legislation to restrict children’s exposure to the marketing of unhealthy foods and brands, mandatory Health Star Rating nutrition labelling and taxes on sugary drinks.

These policies are underpinned by well-established systems for classifying the healthiness of foods. If new evidence unfolds about mechanisms by which ultra-processed foods drive health harms, these classification systems can be updated to reflect such evidence. If specific additives are found to be harmful to health, for example, this evidence can be incorporated into existing nutrient profiling systems, such as the Health Star Rating food labelling scheme.

Accordingly, policymakers can confidently progress food policy implementation using the tools for classifying the healthiness of foods that we already have.

Unhealthy diets and obesity are among the largest contributors to poor health. We can’t let the hype and academic debate around “ultra-processed” foods delay implementation of globally recommended policies for improving population diets.

Gary Sacks, Professor of Public Health Policy, Deakin University; Kathryn Backholer, Co-Director, Global Centre for Preventive Health and Nutrition, Deakin University; Kathryn Bradbury, Senior Research Fellow in the School of Population Health, University of Auckland, Waipapa Taumata Rau, and Sally Mackay, Senior Lecturer Epidemiology and Biostatistics, University of Auckland, Waipapa Taumata Rau

This article is republished from The Conversation under a Creative Commons license. Read the original article.

It can be normal to wake up once or even twice during the night to wee, especially as we get older.

One in three adults over 30 makes at least two trips to the bathroom every night.

Waking up from sleep to urinate on a regular basis is called nocturia. It’s one of the most commonly reported bothersome urinary symptoms (others include urgency and poor stream).

So what causes nocturia, and how can it affect wellbeing?

A range of causes

Nocturia can be caused by a variety of medical conditions, such as heart or kidney problems, poorly controlled diabetes, bladder infections, an overactive bladder, or gastrointestinal issues. Other causes include pregnancy, medications and consumption of alcohol or caffeine before bed.

While nocturia causes disrupted sleep, the reverse is true as well. Having broken sleep, or insomnia, can also cause nocturia.

When we sleep, an antidiuretic hormone is released that slows down the rate at which our kidneys produce urine. If we lie awake at night, less of this hormone is released, meaning we continue to produce normal rates of urine. This can accelerate the rate at which we fill our bladder and need to get up during the night.

Stress, anxiety and watching television late into the night are common causes of insomnia.

Effects of nocturia on daily functioning

The recommended amount of sleep for adults is between seven and nine hours per night. The more times you have to get up in the night to go to the bathroom, the more this impacts sleep quantity and quality.

Decreased sleep can result in increased tiredness during the day, poor concentration, forgetfulness, changes in mood and impaired work performance.

If you’re missing out on quality sleep due to nighttime trips to the bathroom, this can affect your quality of life.

In more severe cases, nocturia has been compared to having a similar impact on quality of life as diabetes, high blood pressure, chest pain, and some forms of arthritis. Also, frequent disruptions to quality and quantity of sleep can have longer-term health impacts.

Nocturia not only upsets sleep, but also increases the risk of falls from moving around in the dark to go to the bathroom.

Further, it can affect sleep partners or others in the household who may be disturbed when you get out of bed.

Can you have a ‘small bladder’?

It’s a common misconception that your trips to the bathroom are correlated with the size of your bladder. It’s also unlikely your bladder is smaller relative to your other organs.

If you find you are having to wee more than your friends, this could be due to body size. A smaller person drinking the same amount of fluids as someone larger will simply need to go the bathroom more often.

If you find you are going to the bathroom quite a lot during the day and evening (more than eight times in 24 hours), this could be a symptom of an overactive bladder. This often presents as frequent and sudden urges to urinate.

If you are concerned about any lower urinary tract symptoms, it’s worth having a chat with your family GP.

There are some medications that can assist in the management of nocturia, and your doctor will also be able to help identify any underlying causes of needing to go to the toilet during the night.

A happy and healthy bladder

Here are some tips to maintain a happy and healthy bladder, and reduce the risk you’ll be up at night:

• make your sleep environment comfortable, with a suitable mattress and sheets to suit the temperature
• get to bed early, and limit screens, or activites before bed
• limit foods and drinks that irritate the bladder, such as coffee or alcohol, especially before bedtime
• sit in a relaxed position when urinating, and allow time for the bladder to completely empty
• practice pelvic floor muscle exercises
• drink an adequate amount of fluids during the day, and avoid becoming dehydrated
• maintain a healthy lifestyle, eat nutritious foods and do not do anything harmful to the body such as smoking or using illicit drugs
• review your medications, as the time you take some pharmaceuticals may affect urine production or sleep
• if you have swollen legs, raise them a few hours before bedtime to let the fluid drain.

Christian Moro, Associate Professor of Science & Medicine, Bond University and Charlotte Phelps, Senior Teaching Fellow, Medical Program, Bond University

This article is republished from The Conversation under a Creative Commons license. Read the original article.