TIME Research

Your Diet May Be Causing Your Urinary Tract Infections

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A new study reveals that factors related to diet might play a part in urinary tract infections

Tough-to-treat urinary tract infections (UTI) that are resistant to antibiotics are on the rise. Now, in a new study looking at human urine published in the Journal of Biological Chemistry, researchers say they’ve discovered why some people are more prone than others to the infections. Intriguingly, diet may have something to do with it.

Early on in an infection, cells produce a protein called siderocalin that blocks bacterial growth, including the growth of E. coli that often causes UTIs, says Jeffrey P. Henderson, MD, PhD, assistant professor of medicine at Washington University School of Medicine in St. Louis and senior author of the study. (It does this by keeping iron away from the bacteria, which need it to thrive.) The researchers wanted to see how the protein worked differently in various samples of urine at restricting the growth of E. coli, so they analyzed the urine from about 50 men and women.

“We found, kind of to our surprise, that there was a really wide range between individuals and how well this protein worked, just depending on that individual’s urinary composition,” says Henderson.

Two common factors emerged in urine that had a better ability to resist bacterial growth: it had a high pH—one that’s more alkaline, in other words—and higher levels of certain metabolites formed by gut microbes. That metabolite isn’t made from human cells, Henderson says; rather, they come from the diet or are metabolized by bacterial cells from dietary sources. “It looks like this protein that’s part of your immune system is able to use metabolites in the diet as grips to hold onto iron and keep it away from pathogenic bacteria,” Henderson says. In some people, that system is set up really well, he says, but in those who get recurrent UTIs, it doesn’t seem to work as well.

Both urine pH and metabolite production may be able to be changed through diet, and doing so could potentially offer a treatment strategy in the future, he says. “It may be that we have to adjust multiple things at the same time to get the system to work well, but the appealing part is this is not an antibiotic strategy,” he says. It may allow you to keep your normal flora while keeping bacteria out of the urinary tract.”

Physicians already know how to raise urinary pH with things like calcium supplements, and alkalizing agents are already used in the U.K. as over-the-counter UTI treatments, Henderson says. Knowing how to encourage the metabolites is trickier. The molecules come from phenolic, or aromatic, compounds, Henderson says, and robust food sources include those that we more often hear are rich in antioxidants: coffee, tea, colorful berries, red wine and dark chocolate.

And yes: cranberries, too, are known to make urinary aromatics, which may be why cranberry products are so often used as UTI remedies, Henderson says. “One thing this suggests is that maybe the reason it’s not more effective is that people need both cranberries and a higher urine pH, or they need cranberries and appropriate inhabitants of their intestine, or the right microbiome composition in their gut, for the cranberry part to work properly.”

A treatment without antibiotics would be a boon, but it’s likely a several-pronged approach and for now, more research is needed. “We still have a few more details to iron out before we know exactly how to do that.”

TIME Diet/Nutrition

The Strange Link Between Junk Food and Depression

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Elizabeth Renstrom for TIME

Some—but not all—sugars were associated with depressive disorders

Of our many modern diseases, one of the biggest burdens on society is an unexpected one: depression, according to the World Health Organization. And what we eat may be contributing, finds a new study published in the American Journal of Clinical Nutrition.

James E. Gangwisch, PhD, assistant professor at Columbia University in the department of psychiatry, wanted to find out whether foods with a higher glycemic index (GI)—a scale that ranks carbohydrate-containing foods by how much they raise your blood sugar—would be associated with greater odds of depression. “When I was a kid, I was almost like a candy junkie,” Gangwisch says. “I noticed for myself, if I eat a lot of sugar, it makes me feel down the next day.” Gangwisch says he stopped eating added sugar years ago but remained curious about whether a junk food diet could make people depressed.

He and a team of researchers looked at data from food questionnaires and a scale that measures symptoms of depressive disorders from postmenopausal women in the Women’s Health Initiative Observational Study. The data came from roughly 70,000 women, none of whom suffered from depression at the study’s start, who had baseline measurements taken between 1994 and 1998, and then again after a three-year follow-up.

Diets higher on the glycemic index, including those rich in refined grains and added sugar, were associated with greater odds of depression, the researchers found. But some aspects of diet had protective effects against developing depression, including fiber, whole grains, whole fruits, vegetables and lactose, a sugar that comes from dairy products and milk that sits low on the glycemic index.

Added sugars—but not total sugars or total carbohydrates—were strongly associated with depression.

Though the authors couldn’t pinpoint a mechanism from this study—it was associative—they note that one possibility is that the overconsumption of sugars and refined starches is a risk factor for inflammation and cardiovascular disease, both of which have been linked to the development of depression.This kind of diet could also lead insulin resistance, which has been linked to cognitive deficits similar to those found in people with major depression.

Further research is needed, Gangwisch says, and it’s not yet known whether the results would translate to a broader group of people, including men and younger women. But even now, diet may be worth discussing with people who suffer from depression, Gangwisch says—even though doing so may be difficult. “It’s hard enough to get the general public to avoid those kinds of foods, but it’s even harder to get someone who suffers from depression to avoid them and give them up,” he says. “You don’t want people to feel guilty either…to say, ‘Your diet’s bad and you should change it,’ would take kind of a soft sell approach.” Still, he believes the effort is worth it. “I think it’s important and I think it has a big effect on your mood and how you feel and your energy level,” he says. “If it’s something that people can change, they really would benefit from it.”

TIME Diet/Nutrition

In Defense of Fiber: How Changing Your Diet Changes Your Gut Bacteria

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Danny Kim for TIME

Finally, the motivation you've been waiting for to gorge yourself on fiber

You no longer live in a world where you can pretend you’re only eating for one; the trillions of bacteria in your gut, we now know, also feed on what you put in your mouth—and they behave very differently depending on what that is.

It’s increasingly clear that the composition of your gut bacteria likely influences your risk for many health problems, from obesity and type-2 diabetes and even certain autoimmune diseases. Scientists are hard at work trying to determine how and why that’s that case, as well as which bacteria are beneficial—and how to protect them. A recent study published in The BMJ adds to the growing evidence that fiber might be a critical gut-nourishing nutrient. (Unfortunately, less than 3% of Americans eat the government-recommended amount daily.)

“You really hold the reins to guiding this community [of bacteria] through the choices you make,” says Justin L. Sonnenburg, PhD, associate professor in the department of microbiology and immunology at Stanford University School of Medicine and author of The Good Gut. Sonnenburg was not involved with this study, but research from his lab also suggests that fiber plays a big role in promoting good bacteria.

The authors of the new study wanted to look at what changes in diet do to one particular gut microbe species: Akkermansia muciniphila—a strain that’s been associated with leanness and better glucose tolerance in mice. They wrangled a group of 49 overweight and obese adults, took stool and blood samples and asked them to follow a six-week calorie-restricted diet (between 1,500-1,800 calories per day) while increasing their fiber intake. The diet was followed by six weeks of eating normally. They kept a food journal throughout, and the researchers biopsied their fat tissue.

The people who had more Akkermansia in their gut from the very start had better clinical measures after they completed the diet, compared to the people with less of the bacterium. Both groups of people lost the same amount of weight, but the high-Akkermansia group had a stronger decrease in visceral fat than the others, says study author Patrice D. Cani, PhD, professor and group leader of the Metabolism and Nutrition Research Group at Université Catholique de Louvain in Belgium. “We discovered that the patients who exhibited higher amounts of Akkermansia were the patients who had a very strong improvement in cholesterol, in glycemia, in waist to hip ratio and also a reduction in different parameters in both cardiovascular disease and risk factors.”

Higher levels of Akkermansia, the findings suggest, seem to have favorable effects on health.

The good news is that your initial Akkermansia levels are not your fate. People who started out with lower stores of Akkermansia had more after they followed the fiber-rich calorie-restricted diet. You can increase these bacterial populations by eating fiber, Cani’s research suggests, which acts as a prebiotic in the gut and has a beneficial effect on some bacteria.

Now, Cani says he is working on an experiment with obese and diabetic patients to administer Akkermansia alone, without any dietary modifications, to see what effect it has on insulin resistance and cardiovascular disease risk factors. “If we can improve these different parameters, that would be something great,” he says.

Here’s why fiber is so important to intestinal flora: gut your microbes feed on it and produce short-chain fatty acids, which get absorbed into the bloodstream and regulate the immune system and attenuate inflammation, Sonnenburg says. “That means if you’re not eating dietary fiber, your immune system may be existing in kind of a simmering pro-inflammatory state,” he says—the very state that predisposes us to different Western diseases. “Our diet and deteriorated microbiota are really a major piece of the puzzle in trying to understand why Western diseases are rising like crazy.”

Sonnenburg says that when researchers try on mice what many of us do on a regular basis—eat food depleted of dietary fiber—their gut microbes behave erratically. “They turn and start eating the mucus lining of the intestine,” says Sonnenburg, “because that’s also a carbohydrate source and it’s kind of a fallback food for them.” In mice on a low-fiber diet, the mucus lining thins to about half of its normal width, he says. It’s so far unclear whether the same thing happens in humans, but Sonnenburg thinks it might. “We start to see these correlates that we think over the course of decades in a human could lead to something problematic,” he says.

Loading up on fiber-fortified processed foods isn’t likely a good way to increase the kind of fiber that benefits the gut. Studies done on single fibers—those, like inulin, which are added to foods—haven’t shown to have the same effects as fiber that occur naturally in whole foods. “All of the vegetables we’re encouraged to eat by our mothers and by the government guidelines, these are all filled with fiber, and filled with a diversity of fiber, and probably the best route for encouraging a diverse microbiota,” Sonnenburg says.

Nuts, seeds, whole grains, legumes and even dark chocolate are high in fiber—as are vegetables. “You can eat massive amounts of plant material and it can be incredibly good for you, you can feel really satisfied and full,” Sonnenburg says. “I find that a really nice way to eat—just kind of gorging myself on plant material.”

TIME Diet/Nutrition

Should I Eat Sushi?

You now have the blessing of five health experts to eat sushi—but there are some things you should know before ordering.

“Sushi is a nice and healthy meal if you make the right choices,” says Sunniva Hoel, a PhD candidate at Sør-Trøndelag University College in Norway. It comes with all the health benefits you’d expect from fish, like omega-3 fatty acids and lean protein, but the problem is often what it’s wrapped in. “Maki and nigiri sushi mainly consist of rice, which is just fast carbohydrates,” she says. Eating sashimi, slices of raw fish accessorized with vegetables, is the better way to order.

It should be noted, too, that sushi is raw, so people with immune deficiency, like the elderly or chronically ill, and pregnant women should take care when eating foods that haven’t been heat-treated, she says. “Raw fish can transmit infectious diseases,” adds Dr. David Katz, director of the Yale University Prevention Research Center, “so you need to choose a very well-run establishment.”

Store-bought sushi might face even more of a quality challenge than the kind you eat at a restaurant, since its longer shelf life gives bacteria more of an opportunity to flourish, Hoel says. A study by Hoel and her colleagues found that almost half of the 58 samples of supermarket sushi they sampled had unsatisfactory levels of bacteria. “The main concern is to maintain an unbroken cold chain during production, distribution, and display in stores and all the way to the consumer’s tables,” she says.

Needless to say, rolls that are deep-fried and smothered with mayo are less healthy choices, says Kristin Kirkpatrick, RD, manager of wellness nutrition services at Cleveland Clinic Wellness Institute. She tells her patients to focus on lean sources of fresh fatty fish, get plenty of sea vegetables and wrap it in brown rice, or no wrap at all. “If that’s how you approach a night at the sushi bar, then a portioned controlled thumbs up to you,” she says.

Mercury is still a concern with sushi, says Roxanne Karimi, PhD, 
School of Marine and Atmospheric Sciences at Stony Brook University
. Her research on mercury found that blood mercury levels were positively associated with eating a weekly tuna steak or sushi. But small-bodied fish lower on the food chain have less of it, she says.

Those lesser-known fish lower on the food chain are often the best ones to pick for sustainability, too, says Tim Fitzgerald, director of impact in the oceans program at the Environmental Defense Fund. “The sushi market in general is much more opaque than the larger seafood market,” he says. Unfortunately, three of the most popular items—tuna, salmon and shrimp—aren’t often fished or farmed sustainably, he says.

Opt instead for things with two shells, like scallops, clams and oysters. Roe—fish eggs—are a good choice too and have some of the highest omega-3 levels of any food per volume, Fitzgerald says. Other sustainable options are mackerel and arctic char, which is produced in a much more sustainable way than farmed salmon sushi, he says. (For more on the best fish to order, check out the Environmental Defense Fund Seafood Selector—complete with a sushi guide.)

Some restaurants, too, are raising the bar: Fitzgerald points to Bamboo Sushi in Portland, OR, Miya’s Sushi in New Haven, CT, and Tataki in San Francisco, CA as pioneers in sushi sustainability.

“You don’t have to give up sushi,” Fitzgerald reiterates. “It’s still good for you: just have a cheat sheet when you go in.”

Read next: Should I Eat Tilapia?

TIME Diet/Nutrition

Should I Eat Butter?

2.5/5 experts say yes*.

Americans eat almost 23 sticks of butter a year, so let’s be clear that none of us is suffering from acute butter deficiency. While few health experts would encourage that you eat more of it, the question of whether butter really is back—as many magazines, including this one, has said—has many experts disagreeing.

There was a time when butter would have been a clear-cut no. After all, it’s a block of fat made of churned milk (and sometimes salt), and most of it is saturated. Just one tablespoon of salted butter, which isn’t even enough to grease a grilled cheese, has 102 calories and 36% of the daily limit for saturated fat, if you are going by the Food and Drug Administration’s recommendations. For many years, official U.S. dietary guidelines vilified fat—especially saturated fat—as a key contributor to excess weight cardiovascular disease.

But recent research suggests that butter—or, rather, the saturated fat it contains—might be more benign than previously thought, says investigative journalist Nina Teicholz, author of the 2014 book The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet. “For saturated fat causing heart disease, the science has never been very strong,” she says. “That basically means you should let those foods that people have been avoiding for so long out of jail.” Saturated fat increases levels of LDL cholesterol, which are associated with higher rates of heart disease—but saturated fat also seems to raise HDL cholesterol, which might help ease those effects.

It’s safe in moderation and is a natural source of added fat, agrees Julia Zumpano, a dietitian at Cleveland Clinic’s Heart & Vascular Institute. She adds that it’s a much better choice than buttery spreads that contain hydrogenated or partially hydrogenated oils.

But Dr. David Katz, director of the Yale University Prevention Research Center, avoids butter—opting instead for olive oil, which is high in monounsaturated fats and proven to improve health. The recent research indicates that, “at best, some saturated fat is ‘not harmful’—there is no evidence indicating it is beneficial,” Katz says.

When thinking about butter’s place in a diet, Dr. Walter Willett imagines a spectrum ranging from super healthy (blueberries) to toxic (like a 20-oz Coke, he says). “I would put butter close to the middle, maybe a little closer to the Coke,” says Willett, chair of the department of nutrition at the Harvard School of Public Health.

“Thumb neutral,” concurs Dr. Dariush Mozaffarian, dean of the School of Nutrition Science and Policy at Tufts University (this represents the half-thumb* mentioned above). “No evidence it’s good for you, little evidence for major harm.”

Illustration by Lon Tweeten for TIME
TIME public health

This Is the Only Sunscreen Article You Need to Read

Only 43% of people know the definition of SPF

How proficient are you in sunscreen-ese? According to a new survey in JAMA Dermatology, most people don’t understand much of what’s written on a lotion label.

Researchers at Northwestern University Feinberg School of Medicine wanted to test people’s knowledge of sunscreen, so they surveyed 114 people who came to the dermatology clinic during the summer of 2014. Even though 93% of them had purchased a bottle in the last year, most people showed important gaps in their sunscreen smarts.

1. UVB rays

“People think that SPF equals everything,” says Dr. Roopal Kundu, one of the study’s authors and a dermatologist at Northwestern University Feinberg School of Medicine. And it does count for a lot: the sun protection factor measures a sunscreen’s ability to filter UVB rays, which are related to sunburn and skin cancer. But SPF only measures UVB rays; it doesn’t tell you anything about protection from UVA rays, Kundu says.

MORE: Top Sunscreens Are Put To The Test

2. UVA rays

The most misunderstood part of sunscreen is UVA, Kundu says. “UVA is around every day; it can penetrate through window glass,” she says. Like UVB, it’s also related to an increased risk of skin cancer, but unlike UVB, it’s not filtered by the ozone at all, Kundu says. UVA doesn’t cause sunburn, but “it really leads to darkening and aging, because it penetrates deeper into the skin and has more influence in the collagen.”

There’s only one way to tell whether your sunscreen offers UVA coverage: the words “broad spectrum.” Only 34% of people in the study named “broad spectrum” labeling as an influence in their choice to buy a sunscreen, but they’re the two most crucial words to look for on a sunscreen label, Kundu says, because there’s no other metric on the bottle for UV-A coverage. Without the words “broad spectrum” your sunscreen likely doesn’t offer coverage from UVA, Kundu says.

Most active ingredients in sunscreen shield against UVB, but far fewer have UVA coverage, and only a handful offer both.

Personally, Kundu uses an SPF 30 sunscreen with the active ingredient zinc oxide, a natural sunscreen ingredient that physically—instead of chemically—blocks rays. Zinc oxide protects against both UVA and UVB rays.

MORE: 80% Of Sunscreens Don’t Really Work Or Have ‘Worrisome’ Ingredients: Report

3. SPF numbers

So why does a dermatologist only use an SPF of 30? People in the study rated a high SPF number as the number-one reason they bought one sunscreen over another, but only 43% of people in the study knew what SPF actually meant. Here’s the real definition: an SPF of 30 means that technically, you could be out in the sun 30 times longer before you get sunburned than you would be able to if you went out without sunscreen, as long as you keep reapplying it appropriately, Kundu says.

And an SPF of 15 is not half as effective as an SPF 30, contrary to what 39% of the people in the study thought. According to Kundu, SPF 15 filters about 93% of UV-B rays; SPF 30 filters about 97% of UV-B rays; and SPF 50 filters about 98% of UV-B rays. The difference between SPF 30 and SPF 50 is only a 1% filtering improvement, she says, and since SPF 30 is readily available at many different price points, that’s the one many dermatologists recommend.

4. How much you need

For a sunscreen to work as advertised, you have to use a shotglass worth for unexposed areas, Kundu says. (About half of people in the study got this wrong.)

Bottom line: Typical adults should buy a water-resistant, broad-spectrum SPF 30 sunscreen, reapply every two hours and use the right amount, Kundu says. “If we can help reduce or spot skin cancer sooner, or be more aware of it, these are the mechanisms by which we can do it.”

TIME Diet/Nutrition

If You Want to Lose Weight, Don’t Pick Your Own Diet

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Danny Kim for TIME

The freedom to choose how to diet may mean less impressive weight loss results, a new study finds

The best diet is the one you’ll stick to, but a new study suggests that might not be the one you’d pick for yourself.

In the experiment published in the Annals of Internal Medicine, a group of 207 veterans, mostly men, followed a diet for 48 weeks. About half were given a choice between two diets—low-carb or low-fat—while others were randomly assigned to one diet or the other.

Of those who got to choose, 58% picked the low-carb diet, and 42% chose the low-fat diet. Everyone in the study got group and phone counseling over the course of the study, and the researchers measured weight loss, adherence, attendance and weight-related quality of life.

“We figured that if people chose the diet on their own or with assistance that they would be more invested in the diet,” says lead author Dr. William Yancy, a research scientist at the Durham VA Medical Center. “We also thought that if they chose the diet based on what foods they preferred that that would help them stick to the diet better, but that’s not what we found.” Contrary to what the researchers expected to find, choosing a diet didn’t improve weight loss or make people any more likely to stick to their diet. In fact, people in this group actually lost less weight (an average of 12.5 pounds) than those assigned a diet (an average of 14.7 pounds). Statistically, however, there was no difference between the groups in any of the measures.

That might be because people are more likely to overeat when following a diet that emphasizes the foods they like—which would likely be the diet they’d select, Yancy says. The weight loss disparity could also be due to something the researchers call a “personal trainer” effect: you adhere to a workout program better if you’re told which exercises to do. “We all know we can go and exercise on our own,” Yancy explains. “But a lot of people still prefer to have a trainer or go to a setting when someone is overseeing what they’re doing.”

Future research is needed, he says, but especially in the little-explored areas of prescribing diets for individuals. There may be promise in future weight loss interventions that focus on pairing a person with a diet through personality questionnaires, metabolic profiles like cholesterol tests or insulin tests, or even a person’s genetic profile, Yancy says.

TIME Diet/Nutrition

Should I Eat French Fries?

7/9 experts say no.

French fries may seem the least of all evils when perusing a bar food menu. Potatoes are a health food, and what’s a French fry but a potato heated with a little oil? A record number of experts weighed in on this one—we didn’t want to take no for an answer—but regretfully, 7 out of the total 9 give French fries a big thumbs down.

For starters, fries are nutritionally unrecognizable from a spud, says Jonathan Bonnet, MD, a family medicine resident physician at Duke University. “They involve frying, salting, and removing one of the healthiest parts of the potato: the skin, where many of the nutrients and fiber are found,” he says. “The fry you eat is much different than the potato from which it came”—a scary thought, considering that by 15-18 months of age, French fries are the number-one vegetable consumed by toddlers.

Many of those come from a drive-thru. A medium order of fries has 365 calories along with 17 grams of fat, a full 26% of your daily value. Sodium clocks in at 246 mg, or 10% of the upper limit you should eat in a day. Sugar and trans fat may even make appearances in small quantities. “Here we have an extremely starchy vegetable dipped in a fryer that then loads on the unhealthy fat, and what you have left is a food that has no nutritional redeeming value in it at all,” says Kristin Kirkpatrick, RD, manager of wellness nutrition services at Cleveland Clinic Wellness Institute.

What’s more, French fries are often the super-fatty side dish to a burger—and both are often used as vehicles for things like sugar-laced ketchup and fatty mayo, says David Katz, MD, director of the Yale University Prevention Research Center. Things escalate quickly from there. “Let’s face it: it is very hard to stop eating these things,” says Katz. Foods high in fat and refined carbohydrates are likely to be addictive, found one study.

On a much stranger note, French fries may mess with your…eyes? Chung-Jung Chiu, PhD, a scientist at the USDA Human Nutrition Research Center on Aging at Tufts University found a link between popular Western-diet foods—including French fries—and age-related macular degeneration. “When people are older, they become even more vulnerable to these dietary insults,” he says.

All of which makes a compelling case for fries as a selective treat, says Alice Lichtenstein, director of the Cardiovascular Nutrition Laboratory at Tufts University.

Nearly half of the experts we talked to warned about the carcinogen acrylamide, a chemical that forms in some foods when they’re cooked at high temperatures by frying, roasting or baking. To make acrylamide, a food needs sugars, an amino acid called asparagine and hot temperatures—all of which are involved in the making of the fry. Along with potato chips, it’s the most often-cited source of dietary acrylamide.

It’s not yet definitive what acrylamide means for human health, but the European Food Safety Authority (EFSA) just released its scientific two cents, saying that acrylamide “potentially increases the risk of developing cancer for consumers in all age groups.” The Joint Food and Agriculture Organization/World Health Organization Expert Committee on Food Additives has named acrylamide a human health concern in the past and called for more studies. “At very low concentrations, it will accumulate during the years of childhood and adolescence and will contribute to serious diseases, including cancer,” says Allal Ouhtit, professor at Sultan Qaboos University in Oman and author of a recent review on acrylamide. You should limit your intake of French fries, says Eric Morrissette, spokesperson for Health Canada, but eating them occasionally isn’t likely to be a health concern.

One way to cut down on the toxin is to cook fries for less time. “When the product is overdone—beyond the ‘golden yellow’—the amount of acrylamide in French fries increase exponentially,” says Vincenzo Fogliano, chair of food quality and design group at Wageningen University in the Netherlands. People who eat a diet high in acrylamide may have a slightly increased risk of cancer, he says, but if fries are prepped in good oil that hasn’t been reheated, cooked for not-too-long and naked of mayo and ketchup, they’re a-ok. “French fries per se are not that bad as people think,” he says.

So agrees Steve Elmore, PhD, senior research fellow in the department of food & nutritional sciences at the University of Reading in the UK. “They are delicious, natural and like most foods, harmless in moderation,” Elmore says. He’s researched acrylamide since 2002, but doesn’t think there’s enough evidence to prove that it causes cancer in humans. He does have a French fry preference, however: thick-cut over thin-cut, which yields a lower fry-to-oil ratio.

For those of us with a French fry fetish, it’s tough news to hear. But on the plus side, any food this bad for you must taste oh-so-good—a fact you’ll savor when you sparingly treat yourself to a small order of fries.

Illustration by Lon Tweeten for TIME

Read next: Should I Eat Corn?

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