What the rise of ultra-processed foods means for our health and society

Published October 2, 2023 at 6:00 AM EDT

Americans now get most of their calories from ultra-processed foods.

“If a food’s wrapped in plastic and it’s got something that you don’t typically find in a domestic kitchen, then it’s almost certainly an ultra-processed food,” infectious disease doctor Dr. Chris van Tulleken says.

We’re talking stabilizers, emulsifiers, thickeners. And often huge amounts of fats, sodium and sugars.

“We know that this stuff is addictive. We know it’s now as harmful as cigarettes in terms of the global effects,” Dr. van Tulleken adds.

But ‘ultra-processed’ can mean many different things. Including canned vegetables. So does ‘ultra-processed’ automatically mean ‘bad for you’?

“That is not a scientific concept. There’s good processing and there’s bad processing. To think that these foods are unhealthy, I just think it’s a bad rap,” Dr. Joanne Slavin, professor in the Department of Food Science and Nutrition at the University of Minnesota, says.

Today, On Point: What the rise of ultra-processed foods means for our health and our society.

Guest

Dr. Chris van Tulleken, infectious diseases doctor in the UK National Health Service. Associate professor at University College London. Author of “Ultra-Processed People: The Science Behind Food that isn’t Food.”

Also Featured

Dr. Joanne Slavin, professor in the Department of Food Science and Nutrition at the University of Minnesota.

Book Excerpt

Transcript

Part I

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TONY THE TIGER: We’ll put a tiger on your team. Kellogg’s Sugar Frosted Flakes. Great big flakes of corn sparkling with a secret sugar frosting. Either with milk or right out of the box, Kellogg’s Sugar Frosted Flakes are packed with energy.

CHILD: They’re good.

TONY THE TIGER: Good? They’re great!

MEGHNA CHAKRABARTI: Tony the Tiger, circa 1959, selling Kellogg’s Frosted Flakes.

Now, don’t get me wrong. Back when I was a kid, much, much later than 1959, mind you, Tony the Tiger was my pal, hawking Frosted Flakes between Bugs Bunny cartoons on Saturday mornings. So seen that way, frosted flakes are like the perfect nexus of stunning mid-century revolutions in American agriculture, capitalism, technology, and marketing.

So stunning that milled corn, malt flavor, a smattering of vitamins, and a whole lot of sugar, more than 30% of each serving, proved to be a highly effective gateway to a life eating ultra-processed foods. Today, food companies sell, and Americans consume, more so called ultra-processed foods than ever.

By some estimates, it could be 70% of the American food system. New Jersey Senator Cory Booker raised the issue at a Senate hearing on nutrition back in 2021.

SEN. CORY BOOKER: These food companies carefully formulate and market nutrient poor, addictive, ultra-processed foods, which now comprise two thirds of the calories in children and teens.

CHAKRABARTI: Awareness of the impact of ultra-processed foods on American’s health is growing. These days, we here at On Point can’t do a single show about health in this country without somebody mentioning ultra-processed foods. Here’s an example. Just last month, we explored why cancer rates in young people are rising.

And Dr. Kimmie Ng at Boston’s Dana Farber Cancer Institute told us that the rise is especially sharp when it comes to gastrointestinal cancers.

DR. KIMMIE NG: Many of these cancers are associated with obesity, and as we know, in recent decades, the rates of obesity have skyrocketed dramatically. So highly processed means, they’re not natural.

They have these substances that preserve them for a long time, and we don’t yet know how those things may lead to an increased risk of cancer, but we highly suspect that perhaps they’re shaping our microbiomes. And our microbiome, we know, has a lot to do with many different chronic diseases, and it may actually be contributing to why these cancers are rising in younger people.

CHAKRABARTI: But that too isn’t the whole story. Processed foods are also feeding the nation. Over the decades, they’ve brought down food costs. And not all ultra-processed foods are the same. So today, we want to understand as deeply as possible: What are ultra-processed foods? How are they made? Why does the food system rely so heavily on them?

And can we really, as a modern, mechanized, interdependent society, can we really live without them?

Dr. Chris van Tulleken sought the answers to those same questions in his new book. He’s an infectious diseases doctor in the United Kingdom’s National Health Service. He’s also an associate professor at the University College London.

And he’s author of “Ultra-Processed People: The Science Behind Food that isn’t Food.” Chris, welcome to On Point.

CHRIS VAN TULLEKEN: It’s such a pleasure to be here.

CHAKRABARTI: Okay. I want to start by putting myself on the chopping block, as it were. And describing to you what I had for breakfast, and seeing how much I subjected my own body to ultra-processed food, if that’s okay.

VAN TULLEKEN: Go for it.

CHAKRABARTI: Okay. This morning, I had a pretty typical breakfast. I had, my husband makes me coffee every morning. So that’s just coffee beans ground up. I hope. Along with half and half. I’ll admit. I like cream in my coffee. Then I had, admittedly —

VAN TULLEKEN: Half and half we don’t have in the UK.

CHAKRABARTI: Oh, what do you call it?

VAN TULLEKEN: It’s just 50%.

CHAKRABARTI: 50% cream. Yeah.

VAN TULLEKEN: It’s not quite cream and not quite milk.

CHAKRABARTI: Yeah, exactly. It’s like somewhere in between. Okay. Mostly because, I don’t know, I just think milk is too thin for regular coffee. But okay.

VAN TULLEKEN: (LAUGHS)

CHAKRABARTI: And then I had an almond currant scone, homemade by my husband, but along with butter.

Oh my God, all the nutritionists out there are just groaning. And then I also had, high fiber cereal with milk from Trader Joe’s, which now that I say all that out loud, it makes me sound like the perfect satire of a public radio host. I’d just be wearing like home processed wool as well, but I’m not.

VAN TULLEKEN: Literally, your yak wool jumper that you’re sitting in.

CHAKRABARTI: (LAUGHS) Exactly. Exactly. Exactly. And I’m wearing my like, all vegan shoes, which is actually not true at all. My shoes have leather on them. But so how is, how did my sort of like average, for me, breakfast pan out in terms of the amount of processing that might’ve gone into it?

VAN TULLEKEN: So you ate a processed breakfast that is not ultra-processed. And it was really interesting listening to the introduction to this show. There was another expert who wasn’t named, but they said, “Ultra-processed foods include tinned fruit.” I think was their example.

CHAKRABARTI: We’re going to hear more from her later, by the way.

But go ahead.

VAN TULLEKEN: What’s really important to say is ultra-processed food is not an informal definition. It’s a formal scientific category. It’s recognized by the United Nations Food and Agriculture Organization, by the World Health Organization by UNICEF, who I work with, and I’m an expert advisor to WHO as well.

There are research groups at Harvard, Yale, Oxford, Cambridge, my group at University College London, all over the world that use the formal definition. And so what’s really important is not to conflate food processing with ultra-processing. So food processing is ancient and human beings have to process our food.

We are the only obligate processivores. We must process our food. If you compare a human to any other animal of a similar size, what you’ll see is that our teeth are tiny, our jaws are tiny, and our guts are very short. And that’s because we’ve extended our digestive tracts out into our kitchens. So cutting food, cooking food, salting, steaming, all these things are processing our food. And processing was invented mainly by female scientists working in caves and then huts and kitchens. And they developed this huge array of modern foods and that all traditional diets are associated with good health. So we must not associate processed food from ultra-processed food.

It’s an entirely different thing.

CHAKRABARTI: So first of all that scientist that you heard, that you mentioned in the open, we’re going to, we have some more tape from her in her defense of food processing.

VAN TULLEKEN: But also which I would agree with. Food processing, super important.

CHAKRABARTI: So we’re going to, we’re going to hear from about that later.

But so let’s bear down a little bit on the definition of ultra-processed because okay, just sticking with my Trader Joe’s high fiber cereal. It has a lot of stuff added to it that wasn’t in the initial, fibrous, whatever they used it to make it. So I’m looking at the ingredients.

VAN TULLEKEN:Is it cool —

Oh, you’ve got the ingredients.

CHAKRABARTI: I’ve got them right here.

VAN TULLEKEN: Do you mind? Do you mind doing it?

CHAKRABARTI: Yeah. No, not at all I’ll tell you the ingredients. And then I’ll tell you the things that were added in terms of vitamins. So the ingredients list are wheat bran, corn flour, corn bran, dehydrated cane juice crystals, whole wheat flour, whey, salt, caramel color, and then some vitamins.

And the vitamins are things like ascorbic acid for vitamin C, thiamine for B1, riboflavin for B2, niacin for B3. Pyridoxin for B6, folic acid for B9, a ton of iron and calcium. A lot of that, for example, the dehydrated cane juice crystals, that seems to have needed a lot of processing. Does that count as an ultra-processed ingredient?

VAN TULLEKEN: Dehydrated cane juice crystals is, I believe, sugar. It’s not an ingredient that I’ve come across before, but I think it is sugar.

CHAKRABARTI: It says natural milled sugar. That’s what they’re calling it.

VAN TULLEKEN: Yeah. It’s sugar. So no, that’s a normal ingredient. The whey, whey is a traditional food that people have eaten for a long time.

This is in the sort of liminal space, but I would say this is broadly a minimally processed meal. Food we can think of as being broadly three groups. There’s unprocessed whole food, which is like an oyster, an apple, a BlackBerry, there’s not much of it. Almost all food is processed to some extent.

And processed food is a really big category that includes things like kitchen ingredients, like vinegar, sugar, salt, pasta, rice. Yogurt. And so we can think of a whole food, like milk, we can process it into cheese, butter, and yogurt. We’ve been doing that for thousands of years. It extends shelf life.

It often brings nutritional benefits, but ultra-processing is this third category. It’s actually called Nova group four. And the category that is recognized by say, the United Nations food and agriculture organization, which is the research definition, extends to about 12 paragraphs, but it boils down to this.

If it’s wrapped in plastic and it contains an ingredient that you don’t typically find in a domestic kitchen, then it is almost certainly ultra-processed. And the definition wasn’t invented out of the blue. It was an attempt to describe the diet that suddenly started causing so much harm and disease, mainly in Central and South America.

So in Mexico and Brazil, Columbia, Chile, in about a decade, particularly obesity went from being pretty much unheard of to being the dominant public health problem. And so some research team in Brazil led by a guy called Carlos Monteiro looked at the products that were causing harm, these new industrially produced products, and tried to create a definition that would wrap up all the harmful products.

And so it is a description really of an industrialized, and I hate to say this on an American program, it is an American diet.

CHAKRABARTI: You can say that. You can.

VAN TULLEKEN: I hate to say that. Because America’s brought so many wonderful things into the world. I don’t want to, I’m not anti-American. And the food system comes with a lot of benefits, but it is the American diet, that when it is exported everywhere, we see that is the food that immediately starts causing, certainly weight gain, but now we have very good evidence about it.

So we, the definition, the team came up with it in 2009, 2010. And now we have 13, 14 years of really good research on this category of food. And so we’ve done epidemiological research, we’ve done the laboratory research, and we’ve done clinical trials. And we have now very good robust data that this is the source of a huge number of negative health outcomes.

In fact, we’d say what happened between 2010, 2019 is poor diet overtook tobacco as the leading cause of early death on planet earth. And so what we’re now pretty sure of is that when we say poor diet, what we mean is a diet high in industrially processed or ultra-processed foods. And the formal definition is that it doesn’t matter how you describe it, you could describe these as typical American foods, or you could say it’s anything wrapped in plastic with a health claim on it. That would also be UPF.

Part II

CHAKRABARTI: Sometimes we put out the word of a future show to listeners and ask for their comment, and we really touch a nerve on sometimes and this ultra processed food was one of them. Because we got a ton of early feedback from listeners. So here’s a couple of things.

This is Thomas who lives in Vermont, and he tells us he does everything he can to try to avoid, I’ll call them food UPFs from now on, because he’s concerned about what goes into his body. So he looks at all the ingredients on the foods that he buys at the grocery store.

THOMAS: It’s chemicals, additives, gums, all kinds of stuff that our body doesn’t know what to do with it.

I personally follow the advice when I go to the grocery store and I look at packaging and ingredients, which everybody should do. I always say if it’s not in your kitchen, if you can’t pronounce it, don’t pick it up. It’s not good for you.

CHAKRABARTI: So that’s Thomas in Vermont. And here is a really good question from Ted in Rhode Island.

TED: I’m a 62-year-old guy status post bariatric surgery gastric bypass. And I’ve been seeing. A lot of non-scientific, non medical articles in the press. My interest is, what are the short- and long-term impacts of ultra processed foods? What are they, and how do you determine what’s ultra processed and processed on the food shelves?

CHAKRABARTI: Okay, Ted. So we’re going to actually take the second part of your question first here, and then we’ll talk about the impacts. Dr. van Tulleken, you described that, broadly speaking, we can define ultra processed foods as anything that’s wrapped in plastic and has ingredients in it that are not found in a domestic kitchen.

Name some of those ingredients.

VAN TULLEKEN: There are, in the United States, around 10,000 different food additives, and even naming the individual categories would take us well over the rest of the next hour. So there are humectants, there are foaming agents, there are anti foaming agents, there are bulking agents, emulsifiers, stabilizers, non-nutritive sweeteners, modified starches, the gums, guar gums, xantham gum, all of these additives serve slightly different functions.

The emulsifiers are a nearly universal category. You’ll find them in almost everything. And emulsifiers are found in nature. Your body is full of natural emulsifiers. They’re simply molecules that bind fat and water. So egg yolk, when we make a mayonnaise, binds the fat to the vinegar and makes it creamy.

Milk is an emulsion. Cream is an emulsion. It’s the synthetic or modified emulsifiers that we find in ultra processed food that seem to have quite a wide range of effects. So the first thing is they are a proxy for ultra processing, which is a whole suite of different processes that food is put through.

So if something has an emulsifier in it, it will also have lots of other things done to it that may cause you harm. But the emulsifiers are part of the category of foods and the expert from Dana Faber that you quoted spoke to this. They seem to affect the microbiome. So they act as detergents.

Detergents, of course, are emulsifiers. They bind fat to water, and that’s how you wash your dishes. And they scrub out the friendly bugs from the gut and thin the mucus layer protecting the gut. And so we think that doesn’t just affect your immune system, it also causes the gut to start leaking. Nonnutritive sweeteners, modified starches, maltodextrin, all do the same thing.

They all start to promote the growth of bugs that shouldn’t be there, reduce the populations of healthy bugs, and generally promote gut inflammation. And one of the things we’re seeing that’s really remarkable and striking is these rising gastrointestinal cancers. And it may be to do with lack of immune regulation in the gut.

It may be to do with fecal leakage into the bloodstream, drains to the liver. And so we think this may be causing the increased rates of liver and gastrointestinal cancers. So going through that long list of additives is, would be exhausting, but the sort of two things to know are the additives, some of them we know are harmful, but the main thing is they are signifiers of food that has been developed in a very particular way.

So this is food made by a very small number of transnational food corporations. For my book, I spoke to huge numbers of people in the food industry, and everyone confirmed the same thing. When the food is made, it’s put through focus groups.

So the project is you have formulation A of your high fiber cereal you were talking about earlier, and formulation B. The box that people eat quicker in the focus group. That is the box that goes to market. So if you like, there are loads of dials on all these boxes of food. All of which can be tweaked, whether it’s the salt, sugar, fat ratio, the emulsification content, the different stabilizers, and all of them are dialed up to 11 to make us unable to stop eating the food.

So what results from the system of production is an addictive product.

CHAKRABARTI: Okay. But there’s also some things that those ingredients do that seemed to me beneficial. For example, you talk about how there’s slime in ice cream but that some of the added, first of all, I’ll get you to explain what that is. But then, but that some of the additives that go into ice cream make it more tolerant for transportation, right?

So maybe the refrigeration trucks don’t have to be as cold, now that saves a little energy, it saves a lot of money, makes the ice cream cheaper. Those actually don’t seem like entirely terrible things. Plus, ice cream is great.

VAN TULLEKEN: Well, that’s only true if you’re running an ice cream company. And one of the, most of my research now, so I’m an infectious diseases physician, and that made me interested in how companies affect people with low incomes.

And now most of my research focuses on economics. And what we see is our food system is extremely financialized. So all the companies are owned by institutional investors and every decision that’s made in the food system, the incentives are all to do with money and finance. And we can show this very easily, using economic indicators.

And so what we end up with, from the perspective of people within the food companies, is they need to hammer down the cost of production and you can’t really modify energy. It’s hard to change some ingredients, but the thing you can do is replace real ingredients with synthetic ingredients. If you have dairy fat, you’ve got to feed a cow, milk a cow, process it, get the butter out.

If you can grow, if you can cut down some rainforest and grow oil palm monoculture, that fat is, depending on the market commodity price, three to six times cheaper. So it’s about, if you have eggs carry risks of salmonella, you need to clean them. You need to sterilize them. If you can replace them with a synthetic emulsifier in your ice cream, then that’s what you should do.

So there is a purpose to all these ingredients, but it is always about reducing the cost of production of the food. And some of that cost is definitely passed on to the consumer.

CHAKRABARTI: So I want to just actually stick with ice cream for another second here. Since I mentioned slime, you want to clarify that?

VAN TULLEKEN: Xanthan gum is the thing that lots of people are going to be familiar with. And xanthan gum is in loads of things. Because the way I would understand, it’s a bacterial exudate. So bacteria need to cling to things. And so they secrete slimes in order to cling to surfaces. So if you’re ever cleaning out your dishwasher and you get that filter out from the bottom, it’s covered in a sort of coating of goo.

That’s a bacterial biofilm slime. And xanthan gum is something like that. So, it’s used to replace gluten in bread. It’s used to thicken ice cream. And we don’t think, we haven’t studied it enough to know if it is directly harmful. There is early research that it does modify the friendly bugs in the gut.

So I use it in the book, when I’m writing the book, because actually in the book, I don’t say to stop eating this food. I give no advice in the book whatsoever, mainly because for many people listening right now, they will be unable to stop eating.

CHAKRABARTI: That’s right.

VAN TULLEKEN: Because this is the only affordable available food for people.

So when I talk about xanthan gum as a bacterial slime, I’m using a bit of artifice. Because what I want to do is discussed my reader. So there is a project running throughout the book. I’ve written it in the same way as that book called “The easy way to quit smoking,” which the project I invite the reader to participate in is to keep eating this food while you read, keep learning about it.

And by the end of the book, you’ll probably stop being able to eat it. But I never tell anyone how to eat because firstly, it’s none of my business. I think people should eat what they want. No one has an obligation to be healthy.

But secondly, the food system is such that for particularly in the United States, people living with disadvantage, which is broadly people of color, indigenous, people without addresses, migrant populations, immigrant populations, they are people who are essentially forced to eat food that we are very sure is driving pandemics of cancer, metabolic disease, inflammatory disease.

CHAKRABARTI: So I have to cut in here because I’ve got, you just said something that I think maybe we should have a full show on later about. No one has the obligation to be healthy. I would say that’s quite a morally debatable point. Because of the economic and social costs of the exact kinds of increases in the diseases that you’re talking about.

Maybe we do, if not have an individual obligation to be healthy, we have a societal one to, societal obligation to help people be healthier. I’m going to set that aside for a moment here, because I do want to talk about the fact that you made an experiment of yourself in terms of what may happen when people eat high amounts of ultra processed food.

So can you tell us a little bit about what the experiment was and why you undertook it? And then I want to navigate through your experiences. (LAUGHS)

VAN TULLEKEN: Through my, you may not want to, by the time we’ve discussed all the health effects, but I don’t know what time this is going out. So I did this, actually, it wasn’t just Supersize Me. I did this as a pilot study. I was the first patient in a pilot study to gather data for a much larger study that I’m now conducting at the hospital I now work with colleagues. So I went on a typical diet for a UK teenager. I ate 80% of my calories from ultra processed food for a month.

And that’s the diet that one in five people in the UK and approximately one in five people in the U. S. This is a normal American diet.

CHAKRABARTI: 80% ultra processed for one month, you said.

VAN TULLEKEN: And I wasn’t force feeding myself. I was just eating what I felt like when I wanted, which is what I normally do.

And several things happened.

CHAKRABARTI: So what did you eat? Give me some examples.

VAN TULLEKEN: Very normal food. So for breakfast, I would have, we heard the ad for Kellogg’s Frosties. I would frequently have a breakfast cereal like that, pressed cornflakes, puffed rice flavored with chocolate covered in sugar, maltodextrin, emulsified and added malt flavor.

So that would be a normal breakfast, or I’d have emulsified bread. So almost all of the bread that you buy in the supermarket is ultra processed. It all contains an emulsifier called datum, which is diacetyl tartaric acid ester of mono- and diglycerides of fatty acids. And that’s partly why our supermarket bread in the States and in the UK is, it’s a foam, really, it’s an emulsified foam and it’s creamy and it melts in your mouth and it’s extremely soft compared to anyone who’s, you probably have a lot of sourdough aficionados being in NPR, but people eating rye bread, there’s a much more robust bread. So that’d be. For lunch, I had a very typical British lunch of a sandwich.

Any sandwich you buy in the shop is made with that emulsified bread. It will have mayonnaise with emulsifiers, maltodextrin, and it will have flavorings and other condiments, a pack of crunchy stuff always flavored full of stabilizers and probably flavor enhancers that give things that umami taste.

And then a can of fizzy pop, often a kind of diet fizzy pop actually, because I wasn’t trying to make myself sick.

CHAKRABARTI: What about the meats in the sandwich?

VAN TULLEKEN: Meat of course is not necessarily ultra processed. Even cheap meat is just actually whole food that you cook.

CHAKRABARTI: Okay.

VAN TULLEKEN: Even processed food. So if you buy traditional ham that’s just a processed food.

And there’s lots of, humans have been eating ham for centuries. Most of the meat in the sandwiches is ultra processed in the sense that it’s covered in a coating or has flavorings on it. Flavoring enhancers. It’s often colored, any kind of ultra processed meat, lots of the sliced sausages will be ultra processed.

CHAKRABARTI: What about the people often are concerned about the nitrates and preservatives in meats?

VAN TULLEKEN: So there are known health outcomes of those, some of the nitrates and nitrites, although you could say they have been used in food traditionally for quite a long time. They don’t necessarily meet the definition of ultra processed food, but broadly processed meats are typically ultra processed.

They’ll have dextrose in them. They’ll have flavor enhancers. They’ll often have flavoring. So that will make them ultra processed. And then dinner would be, I’d have a frozen meal or some fish fingers, oven chips or oven fries. I guess you’d call them a microwave lasagna. Pretty normal stuff.

So it was, I wasn’t having to eat as often. What was nice is as a man, I was doing this in my early forties. And as a physician with young kids, I had started to eat quite healthily. And so what I was looking forward to on this diet was really going back to the kind of naughty foods of my youth, fried chicken takeouts and lots more burgers.

And so I was really looking forward to this diet. I said, “I’m sorry, Dee, I have to order in tonight.”

CHAKRABARTI: But your 40-year-old body is not the same as your 20-year-old body.

VAN TULLEKEN: It really isn’t. So there were three main effects physically, which was that I put on an enormous amount of weight.

I put on six kilos in a month. So if I’d continued the diet for a year, I would have doubled my body weight, and I wasn’t trying to eat to excess. Then we did brain scans, and whilst I’m only one patient, I did this with colleagues at our National Hospital for Neurology and Neurosurgery. We were doing these very robustly, and we saw enormous changes in my brain, in the connectivity between the habit centers at the back of the brain and the addiction reward centers in the middle.

So it was definitely having significant effects. The final change that was in a way the most alarming is that my hormonal response to a standard meal was dramatically altered. So at the end of the diet, my hunger hormones remain sky high at the end of a big meal. So this is food that’s interfering with our body’s ability to say, “I’m done.”

And we’ve all evolved. We do have a system inside us that controls all kinds of things, our oxygen intake, the way we get rid of carbon dioxide, our salt and water levels. We have a way of managing our intake and expenditure of everything. And this is food that’s hacking our ability to detect the energy coming in.

But the biggest effect was just before the end of the diet, I was organizing some research with a colleague in Brazil, and we were talking about this food, and I kept calling it food. And she kept saying, “It’s not food, Chris, it’s an industrially produced edible substance.” It’s like a tick.

She just kept saying this. The end of the phone call, I ordered fried chicken takeout. I could barely finish it. And we know that with addictions, and I am someone who I would say I have lived with an addiction to these products for a long time. With addictions, you can flick from addiction to disgust very quickly.

They’re very closely related in the brain. And lots of listeners will know this with, you often have it in human relationships. You go from being quite maybe obsessed is a strong word, but you’re deeply committed to an individual and quite quickly, they can become someone you really don’t want to see.

And we see it with cigarettes, drugs of abuse. And this is what happened with me with the food so that the book is really an invitation to people to engage with the food in the hope that I can pass on some of that disgust to them.

This article was originally published on WBUR.org.