­

Health Wanted Show Notes: Ultra-Processed Foods

Today, we’re talking about food processing.

  • It has allowed us to enrich foods to make sure people are getting essential micronutrients.
  • It’s made it so that we can scale up food production and keep food from going bad before it can be eaten.
  • It’s even inspired the dream of creating a superfood so dense in nutrients it’s the only food-like substance you need!
  • As we continue to push the envelope of food technology in search of the most delicious meal, we’re finally starting to ask how much is too much when it comes to processing.

“Processed foods” are simply any foods that are changed from their natural state.

  • Washing, chopping, heating, and cooking are all considered processing.
  • “Ultra-processed foods” are a little more complicated.
  • There’s yet to be an agreed-upon definition of what causes a food to cross the threshold from processed to ultra processed, but ultra-processed foods are generally agreed to be foods that are industrially produced to be more appetizing. That means adding things like colors, flavors, stabilizers, preservatives, salts, or sugars.
  • It includes a huge variety of foods, from frozen pizzas to heat-and-eat meals, to packaged snacks, to many breakfast cereals.
    • So many foods, in fact, that it’s estimated that ultra-processed foods make up around 70% of our food supply.

The impact of ultra-processed foods on our health is starting to cause concern.

  • Afterall, the U.S. has the lowest life expectancy among large, high-income countries.
  • Chronic diseases such as cardiovascular disease, diabetes, and cancer account for half of all deaths in the U.S., and many are increasingly being tied to not only diet, but also to diets high in ultra-processed foods.
  • But correlation doesn’t prove causation. Afterall, there are some foods that are considered ultra-processed that are actually quite good for you.
  • Things like whole-grain breads and cereals would fall under the category of ultra-processed but have known health benefits.
  • So, is it the content of the food, or the system by which it’s made that’s the issue?

Studying the way food impacts health is tricky, because diets are varied along with every other aspect of how people live their day-to-day lives.

  • For example, if you just look at pizza consumption as a risk factor for cardiovascular disease, you need to consider how to separate out people who eat a whole pizza in front of the TV, from people who eat a whole pizza in front of the TV after coming home from the gym, from people who eat a whole pizza by rolling it up into a tube and eating it like a burrito while they run an ultra marathon.
  • It could be the foods themselves, or it could be that the people who are most likely to get the majority of their calories from ultra-processed foods are also more likely to have other environmental or social factors that negatively impact health, like limited time and access to exercise facilities or higher stress levels, all of which have been tied to poor health outcomes.
  • In order to accurately measure the impact that ultra-processed vs. less-processed foods have on the body, you’d need to control the diets of a population with similar baselines of health.

That is exactly what one groundbreaking study did.

  • Researchers at the NIH took study participants and had them stay in a hospital ward for a month.
  • During that time, half of the participants were given a diet of ultra-processed foods and half were given a diet of unprocessed foods. But the meals were designed so that every meal given had the same amounts of things like fats, salts, sugars, and fiber.
  • They could eat as much or as little of the food they were given as they wanted.
  • After two weeks, the groups switched diets.
  • The idea was that, if the problem with ultra-processed food is that it has more sugar or salt or fat, then if you match the amounts of those ingredients in an ultra-processed and unprocessed diet, there shouldn’t really be a difference in health outcomes.
  • But there was a difference! When people were on the ultra-processed diet, they ate, on average, 500 calories a day more than they did on the less processed diet. And they gained an average of 2 pounds on the ultra-processed diet and lost an average of 2 pounds on the less processed diet.
  • The study authors noted that people on the ultra-processed diet tended to eat faster, and therefore consume more.
    • It’s possible that the soft texture of the ultra-processed food makes it easier to chew and swallow quickly, which means more food can get into the body before the signal that you’re full reaches your brain.
  • They also noted that people who were on the unprocessed diet had higher levels of appetite-suppressing hormones and lower levels of hunger hormones, further supporting the theory that processed foods encourage increased consumption.
  • Of course, there are a lot of limitations to this study: it was just 20 people on each diet for 2 weeks. It can give us insights into how ultra-processed foods can contribute to weight gain, but it can’t tell us how it impacts health in the long term.
  • And although weight can be a contributing factor for things like cardiovascular disease and certain subsets of type 2 diabetes, studies have actually found an association between poor health outcomes and diets high in ultra-processed foods, even in people who have what’s considered the “healthy” range for body mass.

Poor health outcomes could have more to do with how ultra-processed foods are made.

  • Extrusion is the process by which many grains are refined down to a starch-rich substance that can then be used in any number of ultra-processed foods to improve mouth feel or make the food shelf stable for longer.
  • A byproduct of this industrial pre-chewing is that our bodies have to do less work to absorb the sugars and other nutrients, because their cell structures are already broken down.
  • This has been seen to cause rapid spikes in blood sugar and insulin.
  • Highly processed foods also have significantly limited fiber concentrations compared to less-processed foods.
  • Fiber has been shown to slow digestion, limit blood sugar spikes, and nourish the microbiome of our colons.
  • Despite this, only 5% of Americans appear to be hitting their fiber goals, impacting their health.

Of course, in addition to how ultra-processed foods are made, the issue might also lie with what we use to make them.

  • There’s been a lot of talk lately about the dangers of certain food ingredients, and ultra-processed foods certainly have a lot of ingredients.
  • Emulsifiers are a common additive used to thicken foods and prevent separation that would otherwise naturally occur. Think of the layer of oil you get on top of “natural” peanut butter compared to big name brands.
  • The evidence is just beginning to emerge, but there’s a chance that these additives might disrupt the natural bacteria of the gut, causing inflammation, though more data is needed.
  • Food colors are also a hot topic in health, and we certainly couldn’t do an episode without mentioning Red 40.
  • The common food color has gotten a bad reputation as an additive that causes attention and behavior issues in children. In reality, the evidence that Red 40 causes these issues isn’t so clear.
  • And that’s for the same reasons that the evidence of ultra processed foods being uniformly bad for you isn't clear: There are a lot of confounding factors when it comes to studying diets.

When it comes to additives, many arguments against them circle back to the idea that they’re banned in Europe.

  • Not all of them are banned in Europe. Take Red 40 for example: It is not banned in Europe. Some European countries have decided to ban it themselves, but others still use it, just under the name of “E129” or “Allura Red AC.”
  • But even in cases where something is banned in Europe but not the U.S., it’s important to remember the different ways that each region approaches food regulation.
  • The U.S. tends to take the approach that something is allowable until proven harmful at the quantities consumed, whereas the EU will ban items if there’s even a theoretical possibility of harm.
  • Is one approach better than the other? That’s hard to say. The approach in the U.S. means that there’s a higher possibility of being exposed to a danger before it’s pulled from the market, and the EU approach could unnecessarily limit people’s access to safe and beneficial ingredients.
  • It’s also worth noting for people who would like to use Europe as the model for health that they have more regulations in general than we do, and that includes things like seriously limiting people’s access to firearms, which are the number one cause of pediatric deaths in the U.S. Which should really be our number one priority for children’s health…but that’s a topic for another show.

This brings us to a larger discussion about how we regulate ultra-processed foods—because the reality is, even if you remove unhealthy foods, it doesn’t magically give people access to healthier foods.

  • You can try to pass all the legislation you want to ban additives, but an estimated 13% of the U.S. population lives in areas with low access to supermarkets or grocery stores.
  • And it’s estimated that 60% of calories in the American diet come from ultra-processed foods.
  • So, for a lot of people (around 40 million), taking away access to processed foods might just mean taking away access to food.
  • Now, does this mean we shouldn’t do anything about the issue? Of course not!

A lot of chronic health issues can be helped with improved diet and exercise, and efforts have been made to pass policies to improve those areas of daily life.

  • For example, Michelle Obama tried to increase access to whole foods and nutritious school lunches for kids. However, these school nutrition standards were rolled back during the first Trump administration.
  • New York banned sugary sodas over 16 ounces in certain places, and some commentators called it “authoritarian.”

Trying to regulate our way to better diets is tricky.

  • Just recently, the committee tasked with updating the Dietary Guidelines for Americans (a process which happens every five years) ruffled some feathers by declining to include guidance on ultra-processed foods, citing a lack of clear evidence.
  • A big part of the struggle to regulate ultra-processed foods goes back to the issue of the lack of a definition. How do you regulate something without a clear definition of what needs to be regulated?
  • Making a sweeping statement to avoid all ultra-processed foods could cut out foods that are actually good for you, like whole-grain breads, yogurts or some dietary supplemental
  • And even once you have a definition, you need a consensus about the risks that the food poses.

The easiest route that the FDA could have for regulation comes through labeling.

  • Because the FDA doesn’t approve foods before they reach the market, the best bet would be to control what can be labeled “healthy” or put warnings on foods about excess sugar or sodium.
  • If there was an ingredient found to be harmful, they might be able to limit or ban its use like they did with trans fats.
  • In 2015, the FDA ruled that partially hydrogenated oils are not generally considered safe. They had previously been the main source of trans fats that were used in processed foods like donuts, potato chips, and packaged cookies and cakes to make them shelf stable for longer, but research demonstrated that trans fats have a direct negative link to cholesterol, which increases the risk of heart attack and stroke.
  • As a result, companies are no longer allowed to add partially hydrogenated oils to foods. Though it doesn’t completely remove trans fats from our diets (some are naturally occurring) it certainly reduces the amount we’re exposed to.
  • But this ban was really only made possible by the fact that we had strong data tying poor health outcomes to this specific food ingredient.
  • Which is why it’s so important we understand exactly what it is about ultra-processed foods that causes harm to health.