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How To Cope With Multiple Chronic Illnesses
Source: Photo by Ivan Aleksic on Unsplash
"How do you do it? You live with migraine, POTS (Postural Orthostatic Tachycardia Syndrome), IBS (Irritable Bowel Syndrome), and two herniated discs in your lower back?
"What?! You also lived with severe endometriosis before a total hysterectomy and a follow-up surgery so the doctors could remove the live tissue left behind?"
"Well, how do you do it, living with fibromyalgia, chronic fatigue syndrome, and Crohn's disease?"
These are the plights of me and one of my close friends. I'm sure if you are reading this post, you have your own scenario or a loved one who does.
Any of us who lives with multiple chronic illnesses faces the realities of the very definition of chronic: Chronic diseases are defined broadly as conditions that last one year or more and require ongoing medical attention or limit activities of daily living or both.
If we have the flu, a "bug," or even something like an urinary tract infection, we may be greatly affected in a variety of ways, but we know that without further complications, we will be cured and likely return to our previous health status. If living with chronic illness or illnesses, though, we can instead develop additional symptoms and long-term consequences, some physical and some psychological. Not only do we suffer then, but so do our family and friends.
Several chronic illnesses bring with them fatigue and anxiety, both of which can affect us in so many ways:
So, for those of us suffering from several chronic illnesses, how do we cope, how do we help others understand, and how do we maintain hope for a better future?
The obvious response is to find the appropriate health care, but that often means a specialist for each of the separate illnesses from which we suffer. The problem is that the medical specialists are not always able (or willing) to communicate with each other. The ideal response would be to have one medical professional who understands each of us as a whole patient, and who could oversee the labyrinth of symptoms, medications, side effects, and treatments. Again, this would be ideal, and we know we sometimes wait for weeks or months to see each specialist, and it's increasingly difficult to see a general practitioner, as well; we often see a physician's assistant on most visits. Medical professionals are overworked and in many areas in short supply.
Given these limitations, the question remains: How can we cope? There are no easy answers, no "one size fits all" solutions. I can only share some of what works to ease the pain and its consequences:
Ultra-processed Foods Linked To Developing Multiple Health Conditions
It's no secret that ultra-processed foods are unhealthy and no shortage of studies detailing their impact on human health. Ultra-processed foods are usually mass-produced and include packaged breakfast cereals, cookies, reconstituted meat products, instant noodles, and sweetened sodas.
Lesser known is the association between specific ultra-processed foods and the risk of multiple health conditions or multimorbidities.
A large new study examined ultra-processed food consumption and the co-occurrence of two or more chronic diseases like cancer, heart disease, and type 2 diabetes.
High consumption of certain ultra-processed raised the risk of cancer and cardiometabolic multimorbidity, the findings show. But not all of the foods had the same effect — breads, cereals, and plant-based products were not associated with a higher risk.
"It is already a substantial burden for the patient, and for health professionals, handling one disease, but having a disease along with another disease makes it much harder," study author Heinz Freisling, PhD, a scientist with the Nutrition and Metabolism Branch (NME) at the International Agency for Research on Cancer (IARC), told Healthline.
"Identifying risk factors that can inform the prevention of multimorbidity involving diseases such as cancer, diabetes, and heart disease, is what motivates our work."
The results of the study, co-funded by World Cancer Research Fund International and other cancer research groups, were published on November 13 in The Lancet.
The large cohort study examined data from the European Prospective Investigation into Cancer and Nutrition (EPIC) study of 266,666 participants (60% female) across seven European countries.
Participants were free of cancer, heart disease, and type 2 diabetes at the time of recruitment.
Using questionaries, researchers assessed participants' food and drink consumption over a baseline period of the previous 12 months. After a median of 11.2 years of follow-up, 4,461 participants (39% females) developed multimorbidity of cancer and cardiometabolic diseases, such as stroke and diabetes.
The results show the strongest association of multimorbidities and consumption of ultra-processed animal-based products and artificially and sugar-sweetened beverages.
"Our study highlights the importance of ensuring universal access to fresh and less processed foods," said lead study author Reynalda Córdova, a PhD student at the Vienna Doctoral School of Pharmaceutical, Nutritional and Sport Sciences, in a statement.
A unique finding of this study shows that not all ultra-processed foods were deemed unhealthy.
"Plant-based UPFs [ultra-processed foods] or breads and cereals were not associated with an increased risk," Freisling said. "Although it is challenging to separate such subgroups from an overall dietary UPFs pattern, I think it is worthwhile to consider a more nuanced subgroup analysis of UPFs in future studies."
Freisling also noted that a key takeaway of the study is that it is unnecessary to avoid all ultra-processed foods. "Their consumption should be limited, and preference be given to fresh or minimally processed foods," he said in a statement.
Still, many people opt for ultra-processed foods out of convenience, to meet nutritional requirements, or for economic reasons.
Kelsey Costa, a registered dietitian nutritionist and nutrition consultant for the National Coalition on Healthcare, said when choosing "healthier" ultra-processed foods, you should consider their nutritional content and level of processing.
"Read food labels to avoid hidden sugars, excessive sodium, and other harmful additives," she told Healthline.
"Whole-grain cereals are a better choice compared to sugary cereals because they're less processed and packed with beneficial fiber and nutrients. Similarly, choosing whole-grain or sprouted bread over white bread can provide the body with complex carbohydrates and essential nutrients."
Costa said that for vegetarians and vegans, minimally processed tofu and tempeh may be healthier than heavily processed plant-based products like meatless deli slices and cheese substitutes. She noted that these often contain high levels of sodium, preservatives, and other additives.
Ultra-processed foods undergo an additional stage of processing compared to processed foods. They're often loaded with artificial flavors and sweeteners and have a very long list of ingredients. Examples include:
Recent research has linked ultra-processed food consumption to various conditions like heart disease and cancer.
Other research has shown that ultra-processed foods are "addictive substances" that only lead people to crave more of them.
The new study found a particularly strong association between ultra-processed animal-based foods and artificial sweeteners and a heightened risk of multimorbidities. Here's a closer look at the effects of ultra-processed foods on the body.
Ultra-processed animal productsCosta explained that animal products are often high in saturated fats, which can increase low-density lipoprotein (LDL) cholesterol or "bad" cholesterol and contribute to atherosclerosis.
"Certain chemicals found in red and processed meats, both natural and added, increase their carcinogenic potential," Costa continued.
"One such chemical, heme, present in red meat, forms harmful compounds during digestion that can damage bowel cells, potentially leading to colorectal cancer. She said a similar process occurs with processed meat, exacerbated by nitrite and nitrate preservatives.
Over time, Costa explained that continued consumption of these products may cause:
These ailments may lead to the development of multiple chronic conditions.
"Given these associated health risks, it is advisable to limit the consumption of animal products while exploring more plant-based dietary options for a healthier lifestyle," she said.
Artificial sweetenersArtificial sweeteners have been linked to obesity, which may increase the risk of developing other chronic conditions.
The World Health Organization (WHO) recently classified a common artificial sweetener, aspartame, as a potential carcinogen although the amount people would have to consume to put them at risk for cancer was extremely high.
Costa noted that erythritol, another popular sweetener, has been linked to an elevated risk of heart attack and stroke.
"Moreover, consumption of these chemical alternatives has been linked to adverse effects on gut health, potentially disrupting the balance of beneficial bacteria in our digestive system," Costa said, adding that imbalances in gut bacteria may lead to:
"This disruption of the gut microbiota's balance may also contribute to weight gain and heighten the risk of metabolic diseases such as type 2 diabetes," Costa said.
"Additionally, high sugar intake can result in insulin resistance, a key factor in the development of type 2 diabetes, and contribute to increased inflammation and high blood pressure, both of which are risk factors for heart disease."
Costa said that ultra-processed foods should ideally be consumed in moderation and not relied upon as the primary source of nutrition.
"The frequency of consuming "safer" ultra-processed foods can also vary based on factors such as individual nutritional needs, health goals, and lifestyle," she said.
"A practical approach might be to include these foods in your diet a few times a week rather than daily. This allows for greater emphasis to be placed on whole and minimally processed foods that are rich in essential nutrients and devoid of harmful additives. It's crucial to remember that dietary guidelines are not one-size-fits-all, and individual dietary habits should align with personal health circumstances and nutritional needs," she continued.
Costa recommended limiting saturated fat, added sugar, sodium, and other harmful compounds and additives in ultra-processed foods.
Whenever possible, choose a well-balanced diet with whole and minimally-processed foods, such as:
A new study found a strong link between consumption of certain ultra-processed foods like meats and artificial sweeteners and a heightened risk of multimorbidities.
Other common ultra-processed food groups, like breads and cereals, did not impact risk and may not cause harm to health.
Health and nutrition experts recommend choosing whole and minimally processed foods whenever possible to reduce your risk of developing chronic diseases.
Consumption Of UPFs Increases The Risk Of Cancer And Cardiometabolic Multimorbidity
In a recent study published in The Lancet Regional Health, researchers investigated the association between ultra-processed food (UPF) consumption and the risk of multimorbidity from cancer, cardiovascular disease, and type 2 diabetes.
Study: Consumption of ultra-processed foods and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study. Image Credit: Daisy Daisy/Shutterstock.Com
In the past two decades, the number of people with multiple chronic diseases has significantly risen, particularly in high-income countries. It is now emerging in low- and middle-income regions.
In Europe, around 50 million people suffer from multimorbidity, defined as having at least two chronic diseases. This condition leads to decreased quality of life, disability, functional decline, and high healthcare costs. Identifying preventable risk factors is essential to mitigate its impact.
The global increase in UPF consumption, constituting 50-60% of daily energy intake in some countries, is alarming. UPFs are industrially manufactured, often as packaged foods like cereals, biscuits, reconstituted meat, instant noodles, and sweetened drinks.
Studies link UPF consumption to higher risks of cardiovascular disease, type 2 diabetes, cancer, and obesity, a potential multimorbidity risk factor. Further research is needed to understand how ultra-processed food consumption contributes to the co-occurrence of major chronic diseases such as cancer, cardiovascular disease, and type 2 diabetes, given their increasing prevalence and shared risk factors.
About the studyInitiated between 1992 and 2000, European Prospective Investigation into Cancer and Nutrition (EPIC) study involved approximately 520,000 participants from 23 centers across 10 European countries.
The study primarily targeted adult volunteers aged 35 to 74 years, and notably, the participant demographics varied across centers; for instance, in Norway, Utrecht, France, and Naples, only women were enrolled, and specific groups such as state-school employees in France and members of local blood donor associations in Italy and Spain were included. The Oxford cohort in the United Kingdom (UK) was distinct, with half of its participants following vegetarian or vegan diets.
For this study, after excluding data from France, Greece, and Norway and removing participants with pre-existing conditions like cancer or cardiovascular diseases, a final cohort of 266,666 participants was formed, consisting of 60% women. Participants underwent regular follow-ups every 3-4 years for major disease updates.
The study's ethical approval came from the International Agency for Research on Cancer (IARC) and Institutional Review Boards of each EPIC center, and participants provided written informed consent.
Their dietary habits in the preceding year were precisely recorded using country-specific food-frequency questionnaires, which were then classified into various food groups. A critical aspect of this classification was using the Nova food classification system to identify UPFs.
The study precisely collected data on the socio-demographic and lifestyle factors of participants, including educational level, smoking status, physical activity, menopausal status, and hormone use. Body mass index (BMI) was calculated using measured height and weight.
To ensure data accuracy, a rigorous approach was taken, including complete case analysis and minimal missing data. The outcomes, like cancer incidence and cardiovascular disease, were verified through cancer registries, medical records, and hospital data.
Sophisticated multivariable Cox proportional hazard models were used for analysis, adjusting for factors such as energy and alcohol intake and physical activity.
The study also conducted detailed subgroup analyses on UPFs and their link to multimorbidity alongside extensive sensitivity analyses. While participants were not involved in setting research questions or outcomes, there were plans to disseminate the results publicly.
Study resultsThe present comprehensive study analyzed 266,666 participants, 60% of whom were women. The baseline characteristics revealed that women and men consumed, on average 326 g/day and 413 g/day of UPFs, excluding alcoholic drinks, respectively.
This intake represented about one-third of their daily caloric intake. Over a median follow-up period of 11.2 years, 4,461 participants developed multimorbidity involving cancer and cardiometabolic diseases. The most common multimorbidity patterns observed were cancer in individuals with cardiovascular disease, followed by cancer in those with type 2 diabetes, and type 2 diabetes in individuals with cardiovascular disease.
The study's multivariable-adjusted Cox model highlighted a positive association between higher UPF consumption (per 1 standard deviation (SD) increment, roughly 260 g/day) and the risk of developing multimorbidity, even after adjusting for BMI.
These findings were consistent across transitions from baseline to multimorbidity, with similar patterns observed for individual non-communicable diseases (NCDs) like cancer, cardiovascular disease, and type 2 diabetes. The association was particularly strong for type 2 diabetes, although it was slightly attenuated upon further adjustment for BMI.
An in-depth analysis of UPF subgroups revealed that animal-based products and artificially and sugar-sweetened beverages were positively associated with the risk of multimorbidity. Conversely, ultra-processed breads and cereals showed an inverse association, albeit with some uncertainty.
Other UPF subgroups, including sweets, desserts, savory snacks, and ready-to-eat mixed dishes, did not significantly correlate with multimorbidity risk.
The vitality of these findings was confirmed through various sensitivity analyses that included adjustments for different factors, such as the inclusion of ultra-processed alcoholic beverages and animal-based products. Interestingly, the associations observed were somewhat diminished when accounting for soft drink consumption or focusing on the caloric proportion of UPFs in the diet.
These sensitivity analyses underscore the complexity of the relationship between UPF consumption and multimorbidity and highlight the need for a better understanding of dietary impacts on health.
ConclusionOverall, the study presents a thorough examination of the association between UPF consumption and the risk of multimorbidity, offering valuable insights into the potential health impacts of these foods.
The comprehensive nature of the analysis, including various subgroups and sensitivity tests, contributes significantly to the current understanding of diet-related health risks.
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