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• Ultra-processed foods could be driving an increase in preventable deaths, a global study reports.
• For every 10% increase in ultra-processed food consumption in total daily energy intake, the risk of all-cause mortality rose by 2.7%.
• Ultra-processed foods have been associated with 32 adverse physical and mental health outcomes.

Preventable deaths tied to ultra-processed food consumption increase significantly relative to their contribution to a person’s overall diet.

A global study published on April 28 in the American Journal of Preventive Medicine found that for each 10% increase in the contribution of ultra-processed foods (UPFs) to total energy intake, the risk of mortality from all causes rises by 2.7%.

In the United States alone, that’s more than 124,000 preventable deaths each year.

“UPFs affect health beyond the individual impact of high content of critical nutrients (sodium, trans fats, and sugar) because of the changes in the foods during industrial processing and the use of artificial ingredients, including colorants, artificial flavors and sweeteners, emulsifiers, and many other additives and processing aids, so assessing deaths from all-causes associated with UPF consumption allows an overall estimate of the effect of industrial food processing on health,” Eduardo Augusto Fernandes Nilson, DSc, lead investigator of the study and a researcher at the Oswaldo Cruz Foundation (Fiocruz) in Brazil said in a press statement.

Thousands of deaths linked to UPFs

As part of the study, Nilson and colleagues analyzed data from nationally representative dietary surveys along with mortality data from eight countries.

The countries included were the United States, the United Kingdom, Australia, Brazil, Canada, Chile, Colombia, and Mexico.

The years studied varied by country, ranging from 2010 to 2018. The average contribution of ultra-processed foods to the total energy intake also varied among countries.

The lowest consumption of ultra-processed foods was in Colombia (2015) and Brazil (2017–2018), where less than 20% of total energy intake was made up of ultra-processed foods.

In Chile (2010) and Mexico (2016), the intake increased to 20–30% of total energy intake. In Australia (2011–2012) and Canada (2016), the ratio of ultra-processed food intake increased significantly, with UPFs comprising 37.5% of daily energy intake in Australia and 43.7% in Canada.

In the United States (2017–2018) and the United Kingdom (2018–2019), the contribution of UPFs to total energy intake exceeded 50%. These nations had the highest number of premature deaths associated with UPFs, with nearly 18,000 in the U.K. and more than 124,000 in the United States.

Christopher Gardner, PhD, a nutrition scientist and professor of medicine at Stanford University, said the findings are an important addition to the research into ultra-processed foods. Gardner wasn’t involved in the study.

“The authors showed that regardless of the general consumption levels, there were consistently higher mortality levels among the subset of the population within each of those countries who consumed the most vs. the least UPF. In other words, even in a country where only 15% of the food being sold was UPF, those consuming the most vs. the least had detectably different rates of mortality,” he told Healthline.

 “It would/should be easier to see that difference in a country like the U.S. or U.K. where the general consumption rate is much higher. Helpful to note that they also found it across the range of consumption levels in different countries. That is an interesting and important addition the field of knowledge about UPF. They should get credit for adding that to our knowledge base.”

Multiple physical, mental health impacts

Whilst there is no universally accepted definition of ultra-processed foods, the term is typically used to describe foods that are ready to eat or heat and are made in industrial settings, using little or no whole foods.

Ultra-processed foods are often considered convenient, highly palatable, and contain ingredients to make them more appealing. These may include coloring, emulsifiers, thickeners, flavoring, bulking agents, antifoaming agents, and sweeteners.

In many high income countries, ultra-processed foods already account for more than half of the average daily energy intake.

A 2024 review involving nearly 9.8 million participants concluded that a diet of ultra-processed foods is associated with 32 adverse physical and mental health problems, including:

• depression
• obesity
• cardiovascular disease
• some types of cancer
• diabetes

“It is concerning that, while in high-income countries UPF consumption is already high but relatively stable for over a decade, in low- and middle-income countries the consumption has continuously increased, meaning that while the attributable burden in high-income countries is currently higher, it is growing in the other countries,” Nilson noted in a press statement.

“This shows that policies that disincentivize the consumption of UPFs are urgently needed globally, promoting traditional dietary patterns based on local fresh and minimally processed foods,” he continued.

High in calories, low in nutrients

Dana Hunnes, a senior dietitian and assistant professor at the UCLA Fielding School of Public Health, said the findings are an important reminder of the benefits of reducing consumption of ultra-processed foods. Hunnes wasn’t involved in the new study.

“The consumption of UPFs contribute quite significantly to an increased risk of death (and disease) and that we should all work harder (and encourage greater regulation) to reduce the consumption of UPFs both in our own lives and in the food systems as well,” she told Healthline.

“(UPFs) are high in calories, sugar, salt, fat, but low in nutrients. They are stripped of all their naturally occurring health properties. All fiber has essentially been removed, vitamins and minerals found naturally (ie. in the husk of a grain) have been removed, and in their place are chemicals and adulterated “foods” that bare no resemblance to their natural counterpart. By adding calories to the diet without concurrent vitamins, minerals, fiber, and water, we are setting ourselves up for fast digestion/absorption, fat-deposition, insulin resistance, and the chronic diseases associated with all these problems,” Hunnes explained.

Despite this, more than 73% of the food supply in the United States is made up of ultra-processed foods.

For this reason, experts say Americans continue to choose UPFs along with other factors, such as convenience.  

“Convenience is a large predictor of food choices. Due to the availability of fast food and fast-food choices in the supermarket as compared to other countries that prepare more food at home, the US may choose these foods more simply by having increased access to them,” Kanwar Kelley, MD, JD, board certified otolaryngologist (ENT) and co-founder and CEO of Side Health told Healthline. Kelley wasn’t involved in the study.

“Food labeling can also be confusing; a food will not be advertised as ‘ultra processed,’ but instead tries to focus on the positive aspects of the food, such as how much of a particular vitamin it has. This may lead to some confusion,” Kelley said.

A global public health issue

The study authors say their findings prove that mortality attributed to ultra-processed food intake is significant and that addressing the rate of UPF consumption should be a global health priority.

But experts note that changing dietary habits on an individual level can be complicated.

“My perception is that most people are aware of the dangers of UPFs, but choose to ignore this,” Mir Ali, MD, board certified general surgeon, bariatric surgeon, and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA, told Healthline. Ali wasn’t involved in the study.

“Although education at an early age may help people make healthier food choices, most people do not look that critically at their diet and are more apt to choose food based on taste and convenience,” Ali said.

“Whole grains, fresh fruits, vegetables, lean proteins, nuts and dairy are healthier. In general fruits as an alternative to sweets like cookies and ice cream is better. Most people are aware of the dangers of UPFs, though switching to healthier alternatives is very difficult and can be cost prohibitive,” Ali concluded.

• Stress is considered a modifiable risk factor for stroke.
• A new study found that stress may have a more significant impact on stroke risk in females than in males.
• Females were more likely to report higher perceived stress than males, raising concerns about the unique stressors many women may face.

Chronic stress is a common risk factor for stroke, but may not affect everyone the same way.

Stress is inherently subjective. For some people, stress could be caused by an important work deadline, while for others, it could arise from financial strain or family problems.

When stress builds up over time, it becomes chronic stress, which is associated with a host of health problems, from high blood pressure to headaches, and even stroke. 

New research published on March 5 in Neurology suggests that stress is not only a significant risk factor for stroke, but it appears higher for females than males.

The study builds on evidence showing how stress plays a role in stroke risk but also raises important questions about its effects on females compared to males. Female participants in the study reported higher levels of stress, while stress was also more strongly correlated with stroke risk than males.

“This study highlights the importance of recognizing that there are significant gender differences that affect stroke risk throughout life,” Christina Mijalski Sells, MD, a clinical associate professor of neurology and neurological Sciences at Stanford Medicine who wasn’t affiliated with the study, told Healthline.

Stress linked to 78% higher stroke risk in young women

To better understand the association between stroke and stress, researchers from Helsinki University Hospital in Finland took a granular approach by studying stress type, frequency, and intensity.

The study included 426 patients who had experienced a cryptogenic ischemic stroke (CIS), a type of stroke in which blood flow is cut off part of the brain, but the cause is unknown. Those patients were matched with a control group of 426 individuals by age and sex who had not had a stroke.

The participants were younger (18 to 49 years old), with an average age of 41. The group was also almost evenly split, with more males than females (47.7%).

All participants completed a questionnaire to self-assess their stress levels using a validated survey known as the Perceived Stress Scale (PSS). Using the PSS, participants received a numerical score for their stress levels: 0–13 (low stress), 14–26 (moderate), and 27–40 (high). 

Researchers also collected information related to traditional stroke risk such as education level, smoking, alcohol consumption, and obesity.

Those who had experienced a stroke reported higher average stress scores (13) compared to the control group (10). Around 46% of stroke survivors reported moderate-to-high stress levels compared to 33% of those who did not have a stroke.

When researchers controlled for traditional stroke risk factors, a stark contrast emerged between how stress affected males versus females.

For females, moderate stress was associated with a 78% increased risk of stroke, while high stress was associated with a 6% increased risk of stroke. There was no observable increase in stroke risk among males.

“To my knowledge, this is the first time this has really been shown: that maybe stress itself can be another factor that lessens the protection that females normally have for cardiovascular disease,” Sarah Lindsey, PhD, an associate professor of pharmacology at Tulane University School of Medicine, told Healthline. Lindsey wasn’t affiliated with the study.

However, while these findings suggest higher stress-related stroke risk among females, the findings are an association and do not imply causation.

“More research is needed to understand why women who feel stressed, but not men, may have a higher risk of stroke,” Nicolas Martinez-Majander, MD, PhD, of the Helsinki University Hospital in Finland, said in a news release. “In addition, we need to further explore why the risk of stroke in women was higher for moderate stress than high stress. Knowing more about how stress plays a role could help us to create better ways to prevent these strokes.”

Are women more prone to stress?

The study raises several important questions about the unique effects stress may have on females and illuminates social factors that may contribute to higher rates of stress.

“As a society there’s increased recognition now of the stress on women who are often the primary parents and potentially balancing multiple roles and responsibilities between work home and family,” Mijalski Sells said.

“Oftentimes women are the default primary parent. As we move to two-income households being more common, they may still be carrying all of that burden from home and child care, in addition to also balancing that full-time work,” she emphasized.

However, she noted that the study only scratches the surface of these social factors. Other important factors such as race, type of work, and whether there are children in the home were not included but are potential contributors to stress.

In addition, because the study findings are an association, it is not understood why moderate stress had a higher association with stroke risk compared to high stress.

Lastly, the study authors evaluated stress levels after participants had already experienced a stroke. The authors asked subjects about their stress levels before their stroke, which could influence the results.

Be that as it may, the number of participants who reported high stress was significantly smaller than those reporting moderate levels, effectively making it an outlier.

“That analysis probably isn’t worth doing because there were not very many patients that reported the high-stress category. So, with the small numbers there, I don’t know that we can really draw many conclusions from that,” Carolyn Cronin, MD, PhD, Division Chief of Neurology at Vanderbilt University Medical Center, told Healthline.

Takeaway

Stress is an important stroke risk factor that may affect females differently than males.

In a new study, females reported higher average stress levels than males. Stress was also a significant stroke risk factor for females, but not males, after controlling for traditional stroke risk factors.

Researchers found that moderate stress levels were associated with a 78% increased risk of stroke in female participants.

While these findings are not fully understood, experts noted many females experience unique stressors compared to males, which could contribute to higher stress levels.

• The CDC is considering changes to its recommendations on vaccines for COVID-19, RSV, HPV, and other infectious diseases.
• Experts say some changes may be warranted, but note that robust vaccination campaigns are still necessary.
• Decreasing vaccination rates can reduce herd immunity and impact those with compromised immune systems and other medical conditions.

Changes could be coming later this year to vaccination policies for COVID-19 and other infectious diseases.

An advisory panel for the Centers for Disease Control and Prevention (CDC) met last week to consider immunization recommendations. The panel was slated to convene in February, but the meeting was postponed after Robert F. Kennedy Jr. was confirmed as secretary of the Department of Health and Human Services (HHS).

Under the direction of the new Health Secretary, members of the Advisory Committee on Immunization Practices (ACIP) (ACIP) discussed the possibility of changing the COVID-19 protocol to recommend updated vaccines only for adults over 65 and those with certain health conditions.

That risk-based assessment would differ from the current CDC recommendation, which calls for all adults and children 6 months of age and older get an annual COVID-19 vaccination. The new policy would be more in line with COVID-19 vaccine recommendations from the World Health Organization (WHO) and other countries.

The advisory panel also discussed the possibility of reducing the number of recommended doses for the vaccine against the human papillomavirus (HPV).

The CDC currently recommends three doses of the HPV vaccine for individuals ages 15 to 26. Children who begin the HPV series earlier, between 9 and 15 years old, require only two doses. Three doses are recommended for immunocompromised individuals ages 9 to 26.

Every year, HPV causes about 36,000 cancers in both men and women in the United States.

The ACIP members voted to recommend that high risk adults ages 50 to 59 get vaccinated against respiratory syncytial virus (RSV). The current CDC policy recommends the RSV vaccine for adults over 75 and adults 60 to 74 who are at increased risk of severe RSV.

The panel is expected to vote on the COVID-19 and other vaccination recommendations in June. In the past, CDC officials have usually implemented the suggestions made by the panel of experts.

Vaccine changes and public health impacts

Experts say changes in vaccine recommendations could impact both an individual’s health and public health in general.

“We’re talking about personal health as well as public health,” David Cutler, MD, a family medicine physician at Providence Saint John’s Health Center in California, told Healthline. “These are respiratory illnesses that can kill people.”

Cutler says relaxing standards for certain vaccinations might also give people an excuse to skip immunizations.

“It can make vaccinations confusing and open to debate,” he said. “It could influence some people on why they shouldn’t get vaccinated.”

Cutler added that a lower vaccination rate could affect herd immunity and increase risk for people with compromised immune systems and other conditions.

“We could have tens of thousands of deaths that were unnecessary,” he said.

Inderpal Randhawa, MD, an internist, immunologist, pediatrician, pediatric pulmonologist, and medical director of the Children’s Pulmonary Institute at MemorialCare Miller Children’s & Women’s Hospital Long Beach in California, noted these panel meetings discuss important public health issues.

“The discussion around vaccine recommendations boils down to a basic question of risk and benefit,” Randhawa told Healthline. “The risk of a disease to one individual versus the risk of a disease to society. The benefit of the vaccine to one individual versus the benefit of preventing disease spread to a community.”

“The facts show reactions and side effects to vaccines do occur and can be serious as we have seen with the COVID vaccine,” he added. “However, the effectiveness at preventing the widespread transmission of disease when at least 90 percent of society maintains immunity (often through vaccine mandates) is also compelling.”

Vaccines still important for COVID-19, RSV, flu

Although the pandemic has subsided, COVID-19 still remains a deadly disease.

The CDC reports that more than 40,000 people in the United States died from COVID-19 in 2024. So far in 2025, the weekly COVID-19 death rate ranges from more than 1,000 in mid-January to less than 200 in mid-April.

“This is still a very serious infectious disease,” Cutler said.

Randhawa says a change in COVID-19 vaccination policy, however, might be warranted.

“COVID-19 will continue to circulate for the next decade or potentially longer. Though widespread native immunity exists, the virus is still a threat to immunocompromised individuals in specific settings,” he said. 

“Maintaining availability of high quality COVID-19 vaccines is critical.  However, widespread use of the vaccine by the general public will likely not be needed.”

RSV is a common respiratory virus that usually causes mild, cold-like symptoms. The CDC estimates that RSV has resulted in more than 3.5 million doctor visits since October 1, 2024, as well as more than 180,000 hospitalizations and at least 10,000 deaths. The illness is particularly serious for infants and older adults.

Cutler said the RSV vaccine is a “very effective vaccine,” although it can produce some side effects.

The flu vaccine wasn’t discussed in depth at last week’s panel meetings, but experts say it is an important component of public health.

They note that influenza presents some unique challenges.

“Influenza is a particularly challenging virus as it mutates in a seasonal pattern. The rate of change to the mutations can impact how quickly influenza can spread,” said Randhawa. “Especially in the elderly, the flu vaccine program is critical.”

Cutler noted that 90% of flu cases occur in the United States between November and March. He said a strong flu season can increase the number of people in emergency rooms and other medical settings, which could make treating other patients more difficult. “It can overwhelm the healthcare system,” he said.

William Schaffner, MD, an infectious disease expert and a professor of medicine at Vanderbilt University in Tennessee, says the public should take advantage of the vaccines and the preventive measures they offer.

“COVID, influenza and RSV viruses cause regular epidemics that result in millions of illnesses, hospitalizations and intensive care unit admissions and thousands of deaths each year,” he told Healthline.

“The vaccines against those viruses, although not perfect, offer protection against the more severe illnesses. The vaccines are safe and I would urge all eligible persons to take advantage of them. They are substantially underused.”

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• The FDA has issued a warning about adverse effects related to a popular hair loss product available through telehealth platforms like Hims & Hers and Ro.
• Males have reported side effects of topical finasteride, including depression, dizziness, and low libido.
• Many consumers reported they were unaware or misinformed about the potential for serious side effects.

The Food and Drug Administration (FDA) issued a public warning about compounded topical versions of a popular hair loss drug sold through telehealth platforms.

In an alert issued on April 22, the FDA reported 32 cases of adverse events between 2019 and 2024 involving consumers who purchased and used topical finasteride. Finasteride is used to treat hair loss and benign prostatic hyperplasia.

However, the agency has not approved any topical formulations of finasteride. Despite this, such products are commonly marketed by direct-to-consumer telehealth companies, including Hims & Hers and Ro.

These products are “potentially putting consumers at risk,” the FDA cautioned in its statement.

According to the agency, users of compounded topical finasteride reported side effects similar to those associated with the oral form of the drug, including depression, fatigue, insomnia, and decreased libido.

“Some consumers expressed they became very depressed, suffering with pain and their lives were ruined because of these symptoms,” the FDA noted in its warning.

In many cases, consumers said they were not properly informed about these risks, or were even assured by prescribers that topical use carried no risk of side effects. Unlike pharmaceutical companies, telehealth platforms are not held to the same regulatory standards and are not required to disclose potential side effects in their advertising.

Anthony Oro, MD, PhD, Eugene and Gloria Bauer Professor of Dermatology at Stanford Medicine, told Healthline that the reported side effects were consistent with expectations.

“There’s no surprise about the adverse effects, because those are the same that have been seen with the oral medicine,” Oro said. “The disconnect is that people may think because it’s topical that it’s safe and can be used widely at different concentrations without any problems.”

Healthline contacted Hims & Hers and Ro to comment on the FDA warning but did not receive a response.

The FDA alert underscores broader concerns about compounded medications, which the agency does not review or approve. As telehealth services make these products more accessible, experts warn that patients may be unaware of the potential risks.

Risks of compounded finasteride for hair loss

The FDA warning is the latest high-profile incident involving compounded finasteride.

In March, the Wall Street Journal published an investigation detailing adverse effects reported by men who had purchased the drug through telehealth platforms.

Among those interviewed was U.S. Army Sgt. Mark Millich, 26, who said he experienced symptoms such as anxiety, dizziness, and slurred speech. He also reported severe sexual side effects, including reduced libido and genital shrinkage.

Oral finasteride has been FDA-approved for over three decades and is generally well tolerated. However, it is known to carry potential side effects, including:

• erectile dysfunction
• reduced sex drive
• ejaculation disorder
• depression
• dizziness

“Most of the side effects the FDA is seeing for topicals correspond to those that are known from the approved oral formulation. It’s not that there’s a new adverse side effect that are being reported,” said Oro.

Some males also reported long-lasting sexual and psychological effects long after ceasing to take the drug, a condition referred to as post-finasteride syndrome (PFS). Despite these reports, PFS is a hotly debated and controversial phenomenon within the medical community.

Additionally, the FDA notes that there may be additional risks to using a topical form of the drug, including:

• localized irritation
• erythema
• dryness
• stinging or burning

The FDA also warns that since topical finasteride is applied directly to the skin, it may inadvertently transfer to others through contact, an issue with potentially serious consequences.

The drug is contraindicated during pregnancy due to its potential to cause abnormalities in a developing male fetus.

Compounded drugs are not FDA-approved, and there is often little data to determine safety.

Some compounded formulations also combine finasteride with another popular hair loss treatment, minoxidil, due to their synergistic effects on hair growth.

While both minoxidil and finasteride are individually FDA approved, the safety profile of a compounded drug containing both is unclear.

Inadequate warnings about topical finasteride side effects

While the reported symptoms from the FDA’s warning align with known side effects of oral finasteride, the key concern is that consumers either were not informed of the risks or were led to believe they didn’t apply to topical versions of finasteride.

“A lot of people have a misconception that because it’s topical it’s not going to be absorbed systemically,” said Oro.

Such a misconception appears to be propagated by telehealth companies.

On Ro’s website under side effects related to topical finasteride, the company states, “Because topical finasteride does not enter the bloodstream in the same way or quantity oral finasteride does, there’s reason to assume that topical finasteride could come with a lower risk of systemic effects, including sexual side effects.”

Hims describes the potential side effects of topical finasteride as “minimal”, such as skin irritation and itching, typically localized to where the medicine is applied. The company also cites a study supporting the claim that “topical finasteride also comes with a lower risk of sexual side effects than oral finasteride due to its localized use.”

According to the FDA alert, consumers were unaware of the potential side effects of finasteride. The FDA encourages healthcare providers to educate patients on the risks of using compounded finasteride.

With the proliferation of telehealth platforms and expanded access to compounded medications, Oro told Healthline that nothing can replace the doctor-patient relationship required for informed decision-making.

“You need to have someone who understands the medication and the patient — when it is appropriate to use and when you need to stop,” said Oro. “There’s a trend now where you have access to medication without a long-term relationship between the patient and the provider, and we are seeing some of the ill effects of that now.”

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On 19 May 2016, I was admitted to Barnet General Hospital with measles.

I’d started to feel unwell a few days prior to this with a sore throat and temperature, but didn’t think it was anything serious so started a self-care routine of taking paracetamol and warm fluids with some rest.