Of course we always say “shop the perimeter” of your grocery store, and skip buying anything with industrial ingredients you wouldn’t normally find in your kitchen. Avoid added sugars, colors, preservatives, synthetic vitamins like folic acid… and avoid additives like MSG and carrageenan. Even if these are labeled organic and especially if they are not. Here’s why:
A recent peer-reviewed journal article, published February 2024 in the prestigious British Medical Journal, hasn’t just stirred the pot with its comprehensive umbrella review on ultra-processed foods, it created front-page waves in major news outlets. But should these waves be even bigger? Tsunami size, even? We think the evidence speaks for itself:
In the study findings, which totaled nearly 10 million participants (!), the researchers reported that the evidence is now convincing and highly suggestive that greater ultra-processed food exposure is linked to increased risk for early death and increased risk of developing the diseases of aging, namely cardiometabolic diseases (obesity, dysregulated cholesterol and triglyceride levels, high blood pressure, insulin resistance, and diabetes).
One perhaps surprising addition to the convincing/highly suggestive connections was mental health. In functional medicine, we know that dietary and lifestyle factors play a large role in psychological conditions, but to establish such a direct connection to ultra-processed foods sets a new precedent.
In total, the study authors found connections between higher ultra-processed food intake and 32 different health indices, although the additional connections don’t (yet?) carry the same weight of evidence as those mentioned above. Nevertheless, they constituted over 70% of the conditions evaluated and the data limitations don’t rule out the establishment of convincing links in the future.
Data have shown more than 50% of our collective calorie intake in the United States comes from ultra-processed foods. Other countries such as the United Kingdom and Canada show similar consumption patterns. Countries such as France, Spain, Mexico, Malaysia, Japan, Australia, and New Zealand consume between 25-50% of calories from ultra-processed foods. Out of the countries where data is available, only Italy and Colombia stand out for keeping ultra-processed food intake at less than 20%.
The problem is significant. And change has to start with an understanding of what kinds of foods we’re talking about.
What are ultra-processed foods?
Ultra-processed foods, as defined by the NOVA food classification system, include a wide array of ready-to-eat products that are primarily characterized by their industrial formulations. They often include predominantly made up of chemically modified substances extracted from foods, alongside additives aimed at enhancing taste, texture, appearance, and durability. They are notable for having minimal to no inclusion of whole foods.
Take a look in your kitchen pantry and the chances are you’ve got some ultra-processed foods in there. They are so ubiquitous it’s hard for even the most health-conscious among us to avoid them. When we eat out we can be even more likely to consume ultra-processed foods as we relinquish more control over the ingredient supply chain. Here are the indicators that let you know a food is likely ultra-processed:
- Industrially-formulated foods
- Foods made from extracts and derivatives, or synthesized in laboratories
- High calorie, high salt, and/or high refined carbohydrates/added sugar foods
- Foods low in fiber, vitamins and minerals
- Foods high in ingredients you wouldn’t normally cook with – flavor enhancers, colors, stabilizers, and other additives that make the food more palatable or shelf stable
These characteristics may contribute to chronic inflammatory diseases through mechanisms like changes to the gut microbiome and increased inflammation. Not least, they are inappropriately and harmfully addictive, and displace essential foods and nutrients in the diet that are necessary for health.
Examples of ultra-processed foods include:
- Sweet, savory, or salty packaged snacks
- Cookies and other packaged baked goods
- Ice creams and other frozen desserts
- Candy and chocolate (although some dark chocolate is not ultra-processed)
- Energy/sports drinks
- “Instant” meals such as soups, noodles, and sauces
- Sweetened and flavored yogurts including fruit yogurts
- Sweetened juice
- Margarines and spreads
- Preprepared foods including pizza, hot dogs, sausages, cold cuts
- Breakfast cereals and bars
Should ultra-processed foods come with a health warning like tobacco? Should ultra-processed food advertising be banned?
These may seem far-fetched ideas, but the similarities are hard to dismiss between the journey to realizing the damaging effects of tobacco exposure during the early/mid-1900s, and where we are with ultra-processed foods. Only this time, it may be even harder to reign in industry and consumption patterns – after all, consuming food is essential for survival in a way that tobacco is not, and there are very real structural hurdles for some populations to be able to access unprocessed and less processed foods. These include cost and availability – you can read more about the relevance of food apartheid here.
The battle to addressing the public health crisis over tobacco took decades. The first US Surgeon General’s warning was issued in 1929, not long after the rapid rise in smoking during the early twentieth century. But it took until 1964 when the Surgeon General’s report on Smoking and Health was published to finally open the door for the US congress to require health warnings on cigarette packaging and to ban cigarette advertising. The report was based on more than 7,000 scientific articles that had been amassed relating smoking to disease, and concluded that smoking caused lung and laryngeal cancer, as well as chronic bronchitis.
But those efforts paid off. It is estimated that around 8 million premature deaths were prevented due to tobacco control and education between 1964 and 2012, and this is widely considered to be a huge success.
How many premature deaths could be prevented from reducing ultra-processed food consumption? How many healthcare dollars could be saved and repurposed for other much-needed purposes?
Scientists in Brazil have taken a stab at answering this question: across a total of 541,160 premature deaths occurring in 2019 (in individuals aged 30-69 years), the researchers attributed 57,000, or 10.5%, of those to the consumption of ultra-processed foods. They estimated that reducing the contribution of ultra-processed foods by 10-50% could prevent up to premature 29,300 deaths per year.*
In the United States, there are an estimated 12.1 million premature deaths per year (i.e., occurring in those aged 30 – 69 years). If we apply the same percentages the Brazilian scientists used to this number, then reducing ultra-processed food consumption by up to 50% could save over 6 million lives per year and around 296 million lives over the same amount of time it took for tobacco control policies to save 8 million.
Even if those numbers are only estimates – even if they have a margin of error – the weight of the potential benefit to society seems extraordinarily compelling.
How does the Younger You program handle ultra-processed foods?
Ultra-processed (or highly-processed as they are referred to in the Younger You book, page 116) are “foods to avoid” in the Younger You program. The cascade of damaging biochemical events that occur body-wide after we consume an ultra-processed food is known to include raising pro-oxidant reactive-oxygen species, C-reactive protein (a measure of the body’s inflammatory response), and nuclear factor kappa-B (NF-κB) (a potent inflammation-signaling molecule). Studies have shown that these effects can last over three hours, meaning that if we regularly consume ultra-processed foods we are bathing our bodies in these harmful compounds. Excess inflammation is linked to almost all chronic diseases, as well as aging and premature death.
Where do you land?
We want to hear from you – let us know in the comments below your thoughts about this latest research and what it means to you. How hard is it for you to avoid ultra-processed foods?
Should ultra-processed foods even be allowed to be called foods? Could we imagine a world where you have to be over 21 to purchase ultra-processed foods?