Ultraprocessed Foods: How Bad Could They Be? – Chasing Life with Dr. Sanjay Gupta

Meg Tirrell. How are you doing?

How are the kids?

They’re they’re healthy right now, which is amazing for cold and flu season. Just waiting for the next thing to hit.

Today, I’m sitting down with my colleague and my friend, CNN medical correspondent Meg Tirrell. You know, Meg is a really talented journalist. She writes. She’s on TV all the time. She’s guest hosted a few episodes of this podcast. But as you just heard, Meg’s other full time job, more important job is mom to two young boys. How much do you think about their their diet?

It’s kind of a balance for me between letting my anxiety take over about what they’re not eating and all the nutrients I’m worried they’re not getting, and just making sure they get enough calories.

Like all great reporters, Meg lets her personal curiosity lead the way. And lately, she’s been doing some deep dives on something we see all around us, but definitely don’t know enough about ultra processed foods.

Like, how are you supposed to figure out, like, what’s healthy to eat? Are you supposed to avoid 70% of foods in our food system?

‘And I do want to point out that ultra processed foods contain ingredients that you would not typically find in your kitchen. Some are even made using industrial cooking methods not accessible to the average home chef. Now, Meg has talked about this topic before on the podcast, but I wanted to invite her back to discuss the latest science of ultra processed foods because, in part, the quality of our food supply has been a hot topic during the RFK Jr’s confirmation hearings, and also because Meg recently took this really fascinating reporting trip to the NIH, the National Institutes of Health researchers there are trying to answer two fundamental questions. Number one, what is it that actually makes ultra processed foods so bad for us? And number two, could those ultra processed foods one day be considered healthy? I know, I know. Ultra-processed foods being healthy? Well, the answers could shape U.S. food policy. They could guide how we feed ourselves and our families for a long time to come. I’m Dr. Sanjay Gupta, CNN’s chief medical correspondent, and this is Chasing Life.

Oh, and one more thing. Meg and I took a close look at what goes into some of my favorite foods.

I have heard from my inside sources.

‘Uh-oh, you’re inside sources may not like me, so I’m scared. It was, let’s just say, an enlightening experience. I remember your last time you were on the podcast talking about this. If you can’t buy these ingredients, or if you wouldn’t do this at home yourself, that’s probably a good indication that what you’re eating is ultra processed. Fair?

And when you read these ingredient list, there’s a lot of things on there that you would never buy in a store. You would never add these things to yourself. So you go to the grocery store you’re trying to buy well, for your for yourself, your family, your husband. How much of what you’re buying is likely to be ultra processed?

Unless you’re trying to avoid it the majority of the stuff that you’re going to find is probably ultra processed. I mean, unless you’re going to the bakery section, we don’t know what the freshly baked breads, that might not be ultra processed, but it might be. You don’t know.

I mean, if you asked, would you know? And how would you find out?

Yeah, probably. You could probably ask for the ingredients list and see if there’s any weird thing in there.

I don’t know, but no one does that. Right. Because it seems like I need to go buy my groceries and like, I might do it after talking to you, but it’s where, I guess if you buy, if you eat meat. Going to the to the fresh meat section, you could probably be pretty confident that it’s not ultra processed.

Probably. Deli meat though, you know, might have some preservatives or some other things in it that could make it ultra processed.

It’s really hard.

I’ll ask some version of this question a couple times, but as as difficult and maybe even dire as that all sounds, is it necessarily bad for you?

That’s the question that scientists are trying to answer now. And the studies that we’ve had up until now, there have been a lot of them. Dozens and dozens have showed a lot of negative health effects linked to ultra processed foods. They’re looking back at people’s diets, and they find that people who report eating more ultra processed foods have higher levels of obesity, diabetes, even anxiety, and even things like all cause mortality, which you know, is a confusing thing. It’s like we’re all going to die, but are you going to die sooner if you eat more ultra processed foods? It seems like yeah, maybe. But the problem with these studies is they’re backwards looking. So scientists have just started to try to run these, randomized controlled trials of how people eat. And that requires trapping people so they can’t cheat. So we went down to the NIH, where they’ve been running these studies. Some of the only studies like this in the world, the first one they ran came out in 2019, and that was just looking at ultra processed foods versus minimally processed foods. People had to live at the NIH for a month. You know, half the time they’re on the minimally processed diet and half the time they’re on the ultra processed diet. They were giving them basically identically matched diets based on the nutrients in them. And you know, how the foods looked and things like that. But at the end of this time, they found, that people on average, ate about 500 calories more per day on the ultra processed diet, and over two weeks they gain about 2 pounds. So they were offered the same number of calories on each of the diets, and they ended up eating more calories on the ultra processed diet, perhaps without realizing it, because there’s something about ultra processed foods that just made folks eat more of them and that made them gain weight.

You know, it’s funny going back to these just basic definitions. I think a lot of people, and even as I was thinking about this podcast with you, I was talking to my wife about this. I said, just like, what is your your immediate instinct when you think of ultra processed foods? And she immediately said the additives, like, might they be toxic in some way? Might they be increasing my risk of cancer or something like that? Right? I’m not sure I even got asked this question, Meg, but but how much of this is about the additives are bad versus what they’re doing in terms of making me crave it that’s bad?

We don’t know yet. But now Doctor Kevin Hall at the NIH is running that study.

What we’re trying to understand is what are the mechanisms? What is it about this category of foods that is driving people to overconsume calories, potentially leading to obesity and these downstream consequences?

So he took the results of the first studies, looked at the clues they got from how people chose to eat in that trial. And he has two hypotheses about what might be driving overeating with ultra processed foods. One is their energy density. So how many calories you’re getting in each gram of food you’re eating. And it so happens that ultra processed foods are much more energy dense than minimally processed foods. And he says, really that’s because they take a lot of the water out of them so that they don’t like rot. They’re more shelf stable. And then the other thing he’s hypothesizing is they’re hyper palatability, or we’ve heard the term the bliss point. So it’s this combination of salt, sugar, fat and carbs that’s just the right levels that make us like, not want to stop eating foods. And so what he’s done is with their nutrition team, devised four different diets. One is minimally processed, one is ultra processed, very similar to the first trial. High hyper palatability, high energy dense. And then two other diets that kind of mix. They’re ultra processed, but they vary how hyper palatable they are and how energy dense they are. And what he’s trying to see is, can you eat a diet that’s made up mostly of ultra processed foods, but that doesn’t drive overeating and perhaps all of the other health effects of that, if it’s less energy dense or if it’s less hyper palatable.

And if we can figure that out, then we can provide our, you know, our our colleagues at the FDA, for example, regulators with information about, you know, how they might want to label foods for example.

When he was doing this research, I’m sure these these participants who are in the trial, they they knew why they were they’re being studied. Did you get a chance to talk to any of them? I’m curious what their sort of experience was going through a study like this, because you have to be in the you’re essentially an inpatient, right?

‘Yeah. So we got to meet one of the participants in this trial. There’s only 36 of them. So it was like really cool to get to meet one of these 36 people who’s going to potentially influence the way we think about our food and food policy. Same. Sam Reseda, he’s 20. He is a pre-med student. So he’s in college, which I thought was super cool. So how long have you been here?

Two weeks. How how has it been so far?

It’s been fine. I mean, I have my PlayStation, my electronics. Honestly feels like a dorm room for me.

And, yeah, he’s, he’s allowed to go outside. But somebody has to follow him, you know?

Really make sure you can’t go sneak a Snickers bar.

Go to a vending machine. There was a vending machine strangely close to the metabolic ward. I was like, come on, guys, it’s like, why are you doing this for these people? And they track almost everything you can track about a person. He was wearing a continuous glucose monitor. He’s wearing, like, three trackers of his movement. They were doing stool samples so they could look at what’s going on with this microbiome. They were taking regular blood from him and separating that into all these components to see the effects of food on all kinds of things, including his immune system. And then one of the other things that makes the NIH one of the only places in the world that can do this kind of study is they have one of these things called a metabolic chamber. Participants like Sam come in here for 24 hours at a time, once a week. This room measures literally the air they breathe in and breathe out. They’re trying to measure their metabolism, and the only way they can get them food is they’ve got this little window that, you know, they open on one side, but the food and clothes he opens on the other side.

Kind of sounds like prison.

And he’s in there for 24 hours. I asked him how he feels when it comes out. He’s like, it’s like coming out of one of those, like, cryogenic freezers or like Austin Powers or something.

When you say that this might impact food policy and this is a what if sort of crystal ball question, but what might that look like? You have a study like this that Kevin Hall is doing at the NIH. What could that translate to?

Well, his hope is that he can, you know, generate this evidence. That’ll be good, strong evidence telling us these answers about food. And if he finds, you know, that foods that are super hyper palatable and high in energy density do lead to this overeating, you can provide that information to a regulator like the FDA as they’re considering food policy. Does that change the way you label food? Do you put like, a green light on something that’s low energy density and low hyper palatable and or whatever other metrics that are found to be important, or is it used in a different way by regulators? You know, we’ve we’ve heard about initiatives to try to lower salt in foods, for example. Could you mandate that food companies lower the the bliss point of some of their foods. Can can you do that kind of thing. I mean we, we don’t know. But Kevin Hall wants to provide the information so that regulators can figure out what to do with it, but also so that we as consumers have more information and feel better equipped when we walk into the grocery store. If you could still get these very convenient foods and lower cost foods, but they wouldn’t cause those problems. That could help us a lot without just saying, okay. When you go to the grocery store, you can only go to the vegetable section. You can only go to the, you know, the butcher or whatever it is coming up.

Meg and I are going to discuss some of those challenges of food regulation, and also, importantly, what lessons you should take to the grocery store the next time you go. I remember I interviewed Michelle Obama years ago when she was very focused on food, and it was a wide ranging discussion. But one of the things that sort of jumped out at me was this idea that, you know, if you’re trying to feed a family of five and you go to McDonald’s, you know, you can buy a lot of calories for cheap. And I don’t know how much of that just the cost of calories has driven sort of where we are now. But, you know, 20, 25 bucks and you can feed your family that night versus going and buying all these, less processed, minimally processed, highly watered, dense foods that are, I think, agreeably good for you but just aren’t going to leave your kids satisfied. There’s still going to be maybe hungry because there wasn’t enough calories in that. How much do you think this is just about cost?

I think a lot of it is about cost. In the first study, they also looked at the costs to prepare the diets, and these were being prepared by chefs. So we’re not even talking about the time it took to prepare these diets. But the cost, it was significantly more expensive to eat a minimally processed diet than an ultra processed diet. I think it was like almost 50%.

Really that much more.

Yeah. But, you know, it’s it’s convenient. It’s less expensive to eat ultra processed foods. I mean, having to prepare an entire meal for minimally processed foods can take hours. I mean, I’m not a very good cook. I try to do it like on weekends, but it’s really hard. And one of the things that really made me feel better was I asked Kevin Hall how he feeds his own family. He’s got little kids. Yeah, he still gives them chicken nuggets, you know? And for me, I’m like, oh, I’m on the Applegate farm ones. Those are fine, right? Like, you know, I’m sure there’s like different degrees of, like, ultra processed chicken nuggets. I’m just happy they’re eating chicken. I hope it’s chicken.

Yeah. Our definition of what is acceptable and even healthy changes when you have kids. I think for sure. And I will admit that I found myself eating my kids food often. You know, cleaning up their plate when they hadn’t eaten there. There is. That’s a mix of why I gained weight. Maybe I’m starting to lose weight a little bit now because my kids have just gotten older.

Not eating their scraps anymore?

I’m not eating the scraps anymore. You know, one thing that comes up a lot and you may or may not know the answer to this, but, you know, people will often say to me, like, I’ll go to Italy or I go to Europe and I’ll, I’ll eat basically the same foods, like I have pasta dinners. I might even have some dessert and things like that. And I find myself feeling better, not gaining as much weight. Maybe even losing weight despite having the same diet. I guess the question is, how unique is the United States and all this?

‘It’s not unique. But it is – We do have a lot of our calories from ultra processed foods. It is sort of happening all over the world. But you also do hear about how in Europe they have a different approach to regulating additives in food and regulating all sorts of things, you know. I think it’s called the precautionary principle, where they actually think, okay, we should figure out what this does, maybe before we allow it to be in our products. Whereas in the United States, we often sort of allow things to come in and then we we see what effect they have. And, I think a lot of folks think that that is potentially a problem.

Yeah. You know, it’s interesting, I think, for for physicians and people in the health care field, precautionary principles, is almost all the part of our DNA. Like, why wouldn’t we just do that. And then you find for certain products, foods, but also things like makeup and things like that. They have these these different supply and production chains in Europe for some of these products versus the United States. So they were even in Canada where they won’t they won’t include certain ingredients in their foods. And so and I think the, the instinct, I think in the United States is often to say, well, that’s why why are we doing this here? And that’s terrible there, but it’s more nuanced than that. I mean, you know, part of the reason, like even the Fruit Loops, that’s come up a lot recently because of what RFK has been saying about that, I think people intuitively is like, yeah, why why are Fruit Loops have more chemicals than in Canada? And what the what the cereal manufacturers will say is, “look, we know, first of all, you’re not telling us something we don’t know.” But also we’ve tried this and people didn’t buy the products.

And and I guess that again, I don’t know there’s an answer to this, but but fundamentally, even if we learn all these things from Kevin Hall’s study and all this. People like what they like. And they like the choice. And they’re going to eat what they want to eat anyway, right? Even if they’re informed by new labeling or whatever. How optimistic do you think he is? Or maybe even you are, that this will actually lead to to any kind of measurable change?

I think the cereal thing is super interesting, because if you have a situation where you’re pressuring a company into removing something and that’s all you’re doing, you’re just pressuring them, you’re not requiring them to remove something, okay? They try it. Sales go down 10%. So they brought it back, you know, and sales bounced back okay. If you require them to do it they can’t bring it back afterwards. So that’s the question. It’s like how are you going to deal with these things? Just pressuring companies. I mean I’ve covered the drug industry for a long time. They’ve dealt with a lot of pressure over their pricing practices. It works for a little, little while. They’ll always find ways to raise prices again if they’re allowed to. Yeah. I mean, so that’s the question is regulation versus pressure. I asked Doctor Hall how optimistic he was that research like this would change anything about the way companies approach the food they make, because they want to sell more food. Of course they want to make it more delicious. They want you to eat more of it. And he was saying, well, you know, a soda company doesn’t care whether it’s selling you regular soda or diet soda. They don’t care how many calories they’re selling you because they can price side the same way. And so he sort of use that as analogy of maybe we can change these things. And, and also through behaviors, if you give people information maybe they can use that to, you know, make buying choices that influence what companies do.

I mean, you know, one area that policy often goes, as you well know better than anybody is pricing. And the idea that some products would cost more than others, could, could be something that happens. And personally and I, I’m not an expert, but I think that’s a dangerous slope because when you start to think about things like syntaxes, you know, I’m going to charge a tax for something that we now think is sinful in some way. I don’t know, I feel like you’re punishing people to buy calories.

Nicotine. I put in a different, different category because it really has no redeeming qualities. But food is food. And, you know, you’d rather people eat good, healthy, not super energy dense, calorie dense food. But again, you could feed your family for a five for 25 bucks, that’s a pretty good deal. Are you going to put a tax on that and in a sense punish people for that?

Right. That would disproportionately hurt the people who already find food difficult to afford. So there is a huge issue with doing that. And I think that’s part of a lot of pushback around all this focus on ultra processed foods. But that probably doesn’t mean we shouldn’t understand what processed foods do. It’s just what do you do with that information? I think there is evidence to suggest with cigarettes, which of course are very different from food. You don’t need them to live.

Exactly.

But they have found that taxing those is one of the most effective ways to discourage people from using cigarettes. With food, it’s a different question, and I think some places are trying this. And, you know, of course, in New York City, Michael Bloomberg tried to put a tax on soda and it failed.

I you know, I so I interviewed Michael Bloomberg as well about this. And it was it’s actually one of the funniest interviews. First of all, he starts off even before we started rolling, he said, I just want to tell you, Sanjay, I love Cheetos. I know I never get that. And I’m like, oh, that’s very interesting, Mr. Mayor. Like, you love Cheetos. Things like, why leave the interview with me?

It was a skeleton in his closet. That he needed to put out there.

I just want to get this out of the way. I’m a Cheeto lover. But he had this thing. Obviously, part of it was pricing. But the other part was that if you went to a movie theater, you could no longer buy a 16 ounce sofda, you could buy an eight ounce. And if you wanted, you could buy two, eight ounce sodas. So then you could have your 16oz, but you couldn’t buy a 16 ounce in one glass. And I said tell me about that. And he was making this point that I’m adding these micro blocks. This is part policy. But part of this is just psychology. I’m just saying I’m going to make it. Even if it’s not more expensive. It’s just slightly more difficult for people. And there might be enough people out there who say, hey, eight ounce is enough. I’ll just, you know, take that as a micro block.

Yeah. And then something with soda. I mean, that’s not necessarily in the same category as a meal. So worrying about the, the tax on on folks who are for…

Yeah. So are, you know, in terms of takeaways for people like I, you know, I’ve often been told read the ingredients. If you can’t pronounce some of the ingredients, probably not a good thing to buy. Is that kind of how you just simply approach things when you go grocery shopping?

Yes. But after learning more about this and talking more with Kevin Hall, I. I suspect it’s more nuanced than that. And I also, I’m giving myself a little bit of a break as a parent of young kids who love goldfish crackers.

They have a lot of ingredients you can’t pronounce in the goldfish cracker.

Cracker, including, I think smiles are, an ingredient in goldfish crackers listed in the ingredients list. I definitely I mean, I guess I can make those in my own kitchen, so there we go.

Do they really have that listed in the ingredients?

Good for them.

So I haven’t totally changed the way, but I do, I do think about it more for sure.

But this whole thing about not being able to pronounce and we’re going to look at some of these products here in a second. But if you can’t buy it yourself, the ingredient in the food that you’re about to eat. From what I’ve seen, from what you’ve reported in the past, that that’s a red flag.

Yeah. If you’re trying to avoid ultra processed foods, it’s a red flag.

And people should avoid ultra processed foods. I guess we’re coming right back to the beginning of this discussion again. So should I, based on everything you know, it sounds like a good idea to avoid ultra processed foods. They might be too hyper palatable. They might make me eat too much, even unknowingly. And they have all these ingredients that some of. We don’t know what they do, but just in terms of precautionary principle might be a good thing to avoid.

Yeah, if you can. I think it’s a good I mean, I’m not a doctor. You are. You can say that, but.

Well, again, some of this, to be to be fair to, is we don’t have a lot of data to show whether or not some of these ingredients are necessarily bad for people. But if you’re if you’re trying to apply this precautionary principle and anyone who’s listening should maybe think about this a little bit and maybe even look it up and think about how you want to live your life in terms of precautionary principle, there’s a lot of things that we do in our lives to avoid something. It’s not that it’s necessarily going to be a harm to us, but hey, I’d rather not take the chance. But when it comes to some of these ingredients, I don’t know. I’m just listening to you. And I don’t know that it makes a difference. And I’m a doctor because again, we don’t have data on a lot of these things. But I think precautionary principle is pretty sound when it comes to some ingredients that I can’t pronounce.

Yeah. The way I think about it is like, if I’m in the grocery store and I’ve got two loaves of bread in front of me and I can look at the ingredients, I’m going to choose the one with the ingredients I recognize all else being equal. If that cost twice as much. Maybe I’ll think about it a little more.

This I mean, this this fundamentally is probably what’s going to drive the policy discussion, because I think you’re absolutely right. If it cost twice as much. People may choose with their with their wallet more so than their precautionary principle. You know, and that’ll be a really interesting discussion to have going forward. Maybe we can talk about that in a future podcast.

Yeah. We’ll see what happens.

Just what’s the timetable on any of this? So the studies are ongoing. How long will they take to complete and have real results? And then what? What happens next?

‘Yeah. So Kevin Hall’s current study, he expects to be done by the middle of 2025. And to have results, he hopes, at least in a pre-print — so not peer reviewed, published in a journal necessarily — but to have the results out there in the world by the end of 2025 or early 2026. So these things take a long time. This is slow. And there’s not a lot of it going on, and there’s a lot of demand for change even before we get these data sets. And already, you know, the USDA Dietary Guidelines Committee is meeting to talk about what’s going to go in 2025 to 2030s dietary guidelines. And these won’t necessarily change huge amounts of things, but they are important. And they’re not they’re not considering ultra processed foods. Really. Because they think there’s not enough evidence to to help them make decisions about it for this upcoming set. So we’re talking about 2030 for that. But whether there could be actions that take place sooner than that. And how much science they’re based on and, you know, we’re going to have to see and I think industry will push back based on what they say is a lack of evidence.

Yeah. And I mean, I think this idea of what, what level of evidence is necessary in order to implement policy change is a question that comes up, not just in health care, but I think in many aspects of our society a lot. And and how cautious we want to be. It’ll be interesting to see how it all plays out. I’m fascinated by it. But, you know, I’m a doctor. I think that, 70% roughly of chronic disease in this country is preventable. This is according to studies that I’ve read and reporting I’ve done over 20 years. And I think a lot of that is in some way, shape or form based on how we nourish ourselves. Food is the only signal that we consciously give from our outside world to our inside world on a daily basis. We’re informing our inside world with with our food. You know, I just think we should be really thoughtful about it based on the best evidence. But as you said at the beginning of this podcast, that evidence is really hard to collect. These aren’t the 10,000, you know, huge clinically controlled trials that people would like. And I think what regulators probably need to understand is we may never have that kind of data. So how do you act in the meantime? That’s going to be a really good question. So you have a bag of…

Yes, I brought you treats! Okay. So I asked Ben Tinker, the head of health, and Sanjay, longtime producer. What Sanjay’s favorite treat is. Do you know what it is?

Raisin Bran crunch.

Oh, no. Actually, I think we have that in the kitchen, but no. Well, he said…

Oh, gosh.

Ice cream. Where’d you get this?

So I don’t know, what’s your favorite? What’s your favorite flavor? I don’t know what your favorite flavor is.

You know, I got a few.

I got the darkest chocolate and chocolate chip cookie dough. Give these a look see.

All right. Do you have reading glasses? I can’t even I can’t even read this anymore.

Okay, so, here are the ingredients. Okay. Cream, skim milk, liquid sugar, which is sugar and water. Water. Wheat flour. It’s probably the cookie dough we’re talking about here.

Yeah.

Sugar. Brown sugar, egg yolks. Butter, which is cream and salt. Expeller pressed soybean oil. Eggs. Coconut oil. Chocolate liqueur. Cocoa, processed with alkali. Cocoa, molasses, guar gum, salt, vanilla extract, natural flavor, cocoa butter, invert sugar, carrageenan, milk fat, tapioca flour, soy lecithin, annatto extract for color, turmeric extract for color, and milk.

You know, I got to tell you, in some ways I. That’s a lot. But I thought I was going to be worse. I thought there’s gonna be a lot of things in there that we’re going to be these multi, multi syllabic words that I couldn’t possibly pronounce. What do you think when you read that list?

That’s a lot of ingredients. I mean probably to explain the chocolate chip cookie dough. Maybe I should have gotten just vanilla so we could compare. But something like carrageenan.

Yeah. What is?

I don’t know. I think it’s some kind of maybe gum. I’m not really sure what that is. Or. And I certainly have never used it in my own kitchen.

Yeah.

‘Okay, so this is I had to really scour the shelves, which is why I was a little bit late coming in here this morning to try to find an ice cream that was not ultra processed. Let’s see, where is the ingredient list? It’s so small, I can’t find it. Okay. Ingredients. Milk. Cane. Sugar. Cream. Cocoa powder. Processed with alkali. I don’t know what that is. Tapioca syrup. Nonfat milk. That was the closest thing I could find to non-ultra processed. I don’t know what the alkali thing is, so maybe that’s still ultra processed. Here’s the thing about these two, though. Does that make this one more healthy than that one?

Right.

Kevin Hall doesn’t think so. His hypothesis is that you’re going to this is so hyper palatable. This is so energy dense. Even if it’s minimally processed, it is going to drive you to eat to the same degree that the ultra processed ice cream is going to drive you to overeat. That’s what his study is trying to figure out.

That’s really interesting. I think I think that’s a it’s a it’s a great point to sort of leave things on that at the same time that, we may have these preconceived notions of just how, how problematic ultra processed foods are. Maybe there are other foods that may not be as processed that still have that, that really high energy density, that hyper palatability, that are still going to really make you eat. And kind of knowing yourself in this regard probably is maybe the most important thing. But a pleasure always, I always enjoyed, enjoy talking to you.

Thank you. Appreciate it. Chasing life is a production of CNN audio. Our podcast is produced by Eryn Mathewson, Jennifer Lai, Grace Walker, Lori Galaretta, Jesse Remedios, Sofia Sanchez, and Kyra Dahring. Andrea Kane is our medical writer. Our senior producer is Dan Bloom. Amanda Selay is our showrunner, Dan Dzula is our technical director. And the executive producer of CNN Audio is Steve Lickteig, with support from James Andrest, John Dionora, Haley Thomas, Alex Manasseri, Robert Mathers, Leni Steinhardt, Nicole Pesaru, and Lisa Namerow. Special thanks to Ben Tinker and Nadia Canning of CNN Health and Katie Hinman.