Based on the preponderance of scientific evidence spanning many decades, the National Health Association recommends that we consume a whole food, plant-based diet. This diet is comprised of foods that, by and large, we can grow in our gardens and find at the local farmers market. They would be recognizable by our grandmothers, and we can prepare them in our own kitchens with commonplace ingredients. These are the types of foods that we have been living on, and thriving on, for as long as humans have been on the planet. But in the last 50 years or so, there has been a major change in our dietary pattern. Instead of healthy, locally grown produce, more and more of us are consuming “food-like substances” that have been greatly altered and sometimes even completely created in a lab. These substances, known as ultra-processed foods (or UPFs for short) are drastically changing our diet, our bodies, and our societies. And as we will delve into, UPFs are in large part responsible for a population suffering from increased rates of chronic illness and early death.
First, a little more on definitions
Whole and minimally processed foods include fruits and vegetables, legumes (which are beans, lentils, chickpeas, and split peas), whole grains like brown rice and quinoa, nuts and seeds, herbs and spices, and mushrooms. Cooking beans, blending whole apples into applesauce or smashing oat groats into rolled-oats are all examples of minimally processed foods. We’ve been doing this sort of processing for a very long time. But the more processing that is done to these foods, the more they tend to have healthy components removed and unhealthy components added back in. Brazilian physician and researcher Carlos Monteiro first published the concept of UPF in 2009. He and his team define it as, “industrial formulations manufactured from substances derived from foods with little, if any, whole food and typically with added flavors, colors, and other additives” (reference Monteiro). See the NOVA classification box for more info. In straight-forward terms, UPF is something made from one or more ingredients that are not found in a home kitchen, typically with lots of added salt, fat, and sugar, and usually comes in a plastic package. Many UPFs are made from the cheapest plant ingredients, such as refined by-products of corn, soy, rice, and wheat, but they can also be animal based, such as processed meats like bacon, pastrami, and Spam.
How did this happen?
How, in such a short amount of time have we gone from a population that ate the majority of our diet from whole and minimally processed food, to one that now gets close to 60% of our daily calories from UPF? (reference Steele). Let’s look at three important contributors to the rise of UPFs in our diet.
Innovations in food processing and distribution
Processing isn’t new to the human diet. Human ancestors were likely cooking food over a million years ago, and we’ve been grinding, salting, curing, baking and fermenting for many thousands of years (reference Scientific American). But during the 1970s, new innovations in food processing and mechanization allowed for massively increased production and the ability to get these foods to more people. New methods and more food preservatives were developed to increase shelf life. Techniques were developed to more efficiently refine whole foods into their component parts of sugars, starches, proteins, and fats. Vacuum sealing and deep freezing allowed companies to distribute these foods widely. Unsurprisingly, families started switching from time and labor intensive “made-from-scratch” meals to convenient frozen TV dinners that could be unwrapped, reheated, and enjoyed in a fraction of the time. With ready-made meals filling our stores and fast-food restaurants, access to affordable processed foods has skyrocketed. And now, with the power of modern technology, apps on our phones can have UPF showing up at our doorstep even quicker.
Government support
Government subsidies also contributed to the rise of UPF. The US government uses billions of dollars from our taxes to artificially lower the price of certain crops. Corn and soy are now particularly cheap to produce. They are used mostly as feed for factory farmed animals and to be made into highly processed substances like high-fructose corn syrup and soybean oil. Now with the advances in food technology mentioned above, along with subsidized ingredients, UPFs like corn chips and soda are very inexpensive to make and can be sold for a huge profit. And the best way to get them sold is through consumer marketing.
Marketing
Most fruits and vegetables have a very slim profit margin and are therefore not marketed (how many times did you see a commercial for rutabagas during the last Super Bowl?). UPFs, on the other hand, make companies a lot of money. Mega-corporations invest heavily on marketing. McDonald’s, for example, spent 1.9 billion dollars in 2022 on advertising in the US alone (reference statista). With this type of investment, these companies have a variety of means at their disposal to efficiently sell their goods. They spend money for the best shelf space at supermarkets (reference Stanton “food retailers and obesity”). They sell UPFs at non-food retailers such as gas stations, hardware stores, and even schools and hospitals – places where we should be offering the best that nutrition has to offer. There is a disproportionate amount of marketing towards people of color (reference Nguyen). Marketing also frequently focuses on children. Sugary breakfast cereals are often located physically closer to the ground, right at eye level for little consumers. With input from child psychologists, young consumers are reached by TV commercials, print media, social media, and video games. In fact, TV alone exposes children to tens of thousands of junk food commercials per year (reference Lapierre). Supermodels, soccer stars, and music superstars are all paid to encourage us to consume more UPF. As publicly traded companies, UPF corporations have a fiscal duty to constantly increase sales (reference Cohen). They don’t have a duty to improve our health – though they may seem like they are trying (e.g., breakfast cereals with front-of-the-box advertising of added vitamins and minerals to subtly convince parents that eating them must be good for their children). (Reference Stanton “changing eating patterns”). These powerful companies have the budgets and the influence to pay scientists to publish papers minimizing the harms caused by UPF (reference Schillinger). They have lead public health campaigns that focus on exercise, thus distracting us from the ill-effects of eating UPF (Sorodio reference). If this discussion on shady marketing practices makes you think of the tobacco industry, it’s for good reason. In the 1980s, the two biggest tobacco companies (Philip Morris International which owns Marlboro brand, and R.J. Reynolds Tobacco, which owns Camels) bought the world’s largest food companies: Nabisco, General Foods, and Kraft.
Any Benefits?
For many people living in poverty, UPFs are often what is available and affordable. Not everyone can afford a refrigerator and a freezer. And trips involving bus rides to the nearest grocery store are arduous, especially when working one or multiple jobs. So having access to food that can be stored at room temperature for a long time is very important for many folks. Similarly, not every household has a stove and oven. Having microwave ready meals can be important to these families. And even when there is access to a full kitchen, some folks don’t have basic cooking skills, or may not have the cooking equipment necessary to prep a meal from scratch.
The Harms
Unfortunately, and not surprisingly, the harms of UPF far outweigh the benefits. We know from the landmark 2017 Global Burden of Disease study that eating a poor diet is the greatest risk factor for dying (reference GBD). Kevin Hall’s important randomized controlled trial from 2019 proved that UPF causes increased weight gain (reference Hall). Reviews of many studies specifically focused on UPFs have found that they were associated with many conditions, including obesity, several cancers, type 2 diabetes and diabetes of pregnancy, cardiovascular disease, intestinal disorders such as irritable bowel syndrome (IBS) and Crohn’s disease, fatty liver, anxiety, depression, dementia, and death (References, both Elizabeth and Dicken). And importantly, these associations stayed strong even when adjusting for differences in education, socioeconomic level, salt and sugar intake, general dietary pattern and others.
Why are they so bad for us?
This is a complex question. Let’s focus on four areas.
Taking out the healthy ingredients
During the many processes that isolate a plant’s proteins, carbohydrates, and fats, thousands of other components are removed or destroyed. For one, UPFs have had most or all of their fiber removed. Fiber is a critical component of a healthy digestive system, helping to prevent constipation, inflammation and colon cancer, but also improving health in general due to the diverse ways the gut microbiome orchestrates our health. Additional components lost are the antioxidants. We need antioxidants like vitamin A, vitamin C, polyphenols, and beta-carotene to reduce oxidative stress, the wear and tear on our bodies due to metabolic processes over time. Another critical component removed is water, which is taken out to prolong shelf life. Therefore UPFs are often dry (though food additives may give the perception of moisture), and without the water to dilute the calories, are therefore more calorically dense. We can eat much more before the stretch receptors in our stomach tell us to put the breaks on. Compare cookies with strawberries. The fruit is less energy dense, in part, because it is diluted with zero calorie water.
Adding back unhealthy ingredients
When food is altered in a laboratory and many healthful components are removed, there is a need for adding back other substances to make it palatable. The goal, of course, is not just to make the food taste “OK”, but to go way beyond that. Food scientists use salt, refined sugar, unhealthy fats, emulsifiers, flavor enhancers, coloring agents, and many other substances to make the foods extremely appealing. They have a large arsenal to choose from; there are roughly 10,000 additives in our food stream. The exact number is not known since the FDA does not keep a full list. Amazingly, many of these additives have never been presented to the FDA and have entered our food supply without any government oversight (Reference Tulleken).
Tendency to overeat
If we just had some UPF once or twice a year, we wouldn’t experience all the problems associated with them. But not only do we eat them regularly, we tend to overeat them when we do. There are multiple reasons why we overeat UPFs. Marketing, as mentioned above, is clearly one reason. Another reason is how they are designed. UPFs are engineered by scientists. Many hours and dollars are spent creating the perfect balance of salt, sweet and fat. The mouth feel is deliberate and tends to be soft. This allows us to eat faster, and therefore more calories per minute, since we aren’t wasting all that time chewing (reference Hall). Even crunchy snacks like potato chips dissolve after the first crunch or two. Perhaps the most unsettling reason we tend to over eat them is that UPFs can truly be addicting. Globally we see UPF addiction rates similar to addictions to tobacco and alcohol (Reference LaFata). In large part, the addictive potential is likely due to the fact that UPFs are processed to hit our blood stream quickly (much like coca leaves have a mild effect on humans until they are processed into cocaine). Similarly to those addicted to drugs like heroin, people with a UPF addiction may exhibit an inability to stop consuming them, even though the substance is known to be causing harm. Additionally, people may experience intense cravings for UPF (few of us wake up in the middle of the night to have one more serving of cabbage). Their slogans say it all: Lay’s brand potato chips promises “Betcha can’t eat just one”, and Pringles brand tells us “Once you pop, you can’t stop”.
A word on environmental effects
While the majority of this article has delved into the direct harms these substances have on our bodies, there is a toll on the environment as well. Through its effects on ecosystems, the modern industrial food system that supplies the building blocks of UPFs is the leading cause of loss of animal habitat and biodiversity. Pristine rainforest is being chopped down, and wild animal species are becoming endangered and extinct, in order for us to have fast food and snacks that make us chronically sick. This same system is a leading source of greenhouse gas emissions. Additionally, UPFs almost always come in plastic packaging, the majority of which does not get recycled. In fact, Coca-Cola company, along with PepsiCo, Nestlé, Unilever and other UPF companies are the world’s largest plastic polluters (reference “break free from plastic”). These plastics frequently end up in our oceans, killing birds, fish, and sea turtles, and eventually make their way into our food supply in the form of endocrine-disrupting micro-plastics. In order for us to be truly healthy as a population, our environment must be healthy as well.
How do we take back control
For people struggling to quit eating UPFs – you are not alone, and it’s not your fault. Remember, it is best to think of UPFs as a drug, and one that was designed to get us and keep us hooked. Don’t think of your habit as a personal weakness, or a lack of willpower. Realize UPFs for the dangerous substances that they are, created by companies focused on making money, not on keeping us healthy, regardless of what the front of the box may say. While it usually isn’t easy to give them up, it’ll be worth it. After some weeks to months you may find that some stubborn chronic conditions are finally improving. Consider some of these tactics to kick the habit.
Keep them out of the house
Our friend Chef AJ likes to say, “If it’s in your house, it’s in your mouth”. The first step is to leave UPFs at the grocery store. The majority of the items in a supermarket are UPFs. Focus on the produce section and the bulk aisle. Sometimes keeping them out of the house can be trickier than it may seem. While some UPFs are obvious, such as sodas and Twinkies, some foods may have just one or two ingredients that sneak in that you hadn’t noticed. If you are trying to get as many UPFs out of your diet as possible, I’d recommend using a fine-toothed comb approach on the foods already in your house to make sure they aren’t flying under the radar.
Fill your body with whole plant foods
Shoot for a diet made up of mostly or completely healthy, delicious whole and minimally processed foods. Some substitutions are straight forward. Replace breakfast cereals with homemade oatmeal. Skip the chips, and instead use fresh crunchy veggies as a vehicle for your hummus and guacamole. Ditch the soft drinks, diet drinks, and energy drinks and make water your drink of choice, with some tea and coffee for their antioxidant benefits (hint, you can receive the health benefits of coffee from decaf and skip the caffeine, if you prefer). Some things take a little more time and dedication. Invest in some books, videos, or a live class to learn how to make sourdough or 100% whole grain breads. Learn from folks like Brittany Jaroudi, Chef AJ, and Cathy Fisher, and become a wiz in kitchen with healthy desserts. As you start to make amazing black bean brownies, you won’t think twice about leaving the boxed brownie mix at the store. As Dr. Greger puts it, “think outside the box” (Reference Nutritionfacts).
Try these additional tips to help you walk away from UPFs. Aim for 7-9 hours of quality sleep so you don’t crave UPFs the next day. Manage your chronic stress so you aren’t as driven to binge on less healthy options. Surround yourself with really healthy eaters, and you’ll likely start to eat healthier, too. Lace up your jogging shoes, as once people start a regular exercise routine, they may see their diet improve subconsciously.
Get active
You vote with your dollar every time you leave the UPFs at the supermarket. But also consider asking your local and state representatives to take UPFs out of our school cafeterias. Push them to create a rating system that puts warning labels on foods high in salt, sugar, and saturated fat. Petition your local hospital to take cancer-promoting processed meats like bacon and sausage off of their hospital menus. Changing the current state of affairs won’t be easy, but every effort counts.
We have evolved over millennia to prosper from the natural foods that grow abundantly around us. In an amazingly brief amount of time, our food supply has been flooded with substances that are bad for our health and pushed on us by powerful companies that profit off of our addictions. The good news is that we have the power to leave them on the shelves and keep them out of our diet. We must do this, for our health, our children’s health, and for the planet.
Article originally published in Health Science Magazine : https://www.healthscience.org/health-science/
About the Author
Jeffrey Pierce, MD is a Plantrician Provider specializing in weight management, diabetes, cardiovascular disease, hypertension, cholesterol management, fatty liver disease, cancer prevention, hormonal health and healthy pregnancies, plant-based nutrition, autoimmune disorders, depression and anxiety, digestive health, and dementia prevention. He practices telemedicine at Love.Life Telehealth and speaks Spanish.
Dr. Pierce believes that with the right information and motivation, people can get to the root cause of their illnesses and heal themselves.
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