“How Bad Are Ultra-Processed Foods?”
At present, the United States has the lowest life expectancyof the top dozen richest countries in the world.We also have the greatest shareof our diet composed of ultra-processed foods.In fact, most of our diet.Most of what goes into our mouthisn’t considered real food.Could there be a connection?Ultra-processed foods are said to be troublesomefor a wide variety of reasons,like all the packaging, etc.,but I’m just going to discuss the health aspects.Based on studies encompassing nearly ten million participants,greater exposure to ultra-processed foodwas associated with a higher riskof a variety of adverse health outcomes,including all-cause mortality,meaning living a significantly shorter life.As a reminder, ultra-processed foods are,”Industrial formulations of processed food substancesthat contain little or no whole foodsand typically include flavorings, colorings,emulsifiers, and other cosmetic additives.”Think Twinkies.So, nutritionally vacuous that you could go blindfrom nutrient deficiencies if that’s all you ate,like this 14-year-old boywho apparently lived on French fries,Pringles, white bread, ham, and sausage.Some of the health outcomes make sense,like higher ultra-processed food consumptionbeing associated with more dental cavities in kids.That makes sense since a lot of them are packed with sugar.Higher ultra-processed food consumptionis also associated with an increased riskof high blood pressure.That makes sense as a lot of them are packed with salt.And with high blood pressures, you can seehow there can be a higher rate of cardiovascular eventslike heart attacks and strokes.And since cardiovascular diseasesare our leading killers,you can see how that could lead to increased overall mortality.Obesity is also a no-brainer.A lot of ultra-processed productsare packed with calories,and furthermore intentionally engineeredwith hyperpalatable combinations of fat, sugar, salt, and flavorsso you can’t just eat one, promoting weight gainthrough so-called hedonic eating,meaning eating for pleasureeven if you aren’t really hungry.I can see all that,but why would there also be a higher overall cancer riskassociated with ultra-processed food consumption?Or a higher risk of dementia?Or a higher risk of inflammatory bowel disease?Or a higher risk of irritable bowel syndrome?And a higher risk of developing chronic kidney disease, too?Overall, direct associations have been foundbetween exposure to ultra-processed foodsand 70% of the health issuesthat were investigated.A higher risk of dying from all causes put together,a higher risk of getting cancer, not sleeping well,suffering from anxiety, depression,and other common mental disorders,wheezing, cardiovascular disease,Crohn’s disease, abdominal obesity,obesity in general, fatty liver disease,type 2 diabetes.So, increased risk of a varietyof chronic diseases and mental health disorders.And apparently not a single studyreported an association between ultra-processed food intakeand beneficial health outcomes.There was never a,”Take two Twinkies and call me in the morning.”Given the large body of evidenceimplicating ultra-processed foods in human diseases,and their ever-increasing consumption around the world,there is a pressing need to recognize their contributionto the global burden of disease.All right, but wait. These are associations.Just because A is correlated with Bdoesn’t mean that A causes B.Maybe B causes A.For example, snapshot-in-time studies showthat intake of higher ultra-processed foodsis associated with increased oddsof depression or anxiety symptoms,but individuals might turn to ultra-processed foodsin an attempt to mitigate stress-related anxiety.They don’t call it comfort food for nothin’.Now there are longitudinal studiesshowing that greater intake of ultra-processed foodspreceded depression,but maybe the food was just used to fend off bad feelingsfor years before any official diagnosis.But reverse causation, B causing A,seems less plausible when it comesto non-mental health outcomes.For example, it’s harder to paint a pictureof how a heart attack would cause people to then go onto eat more junk food instead of vice versa.The other big issue when trying to establish cause-and-effectfrom observational, correlational datais confounding.Maybe the reason A is associated with Bis that some third confounding factor, C,is linked to both.For example, if people who eat more junktend to smoke more,no wonder junk eaters would be dying more,but it would have more to do with the cigarettesthey put in their mouth rather than the food.And indeed, people consuming unhealthy dietsare also likely to smoke, drink, and not exercise,but we have ways to control for these factors.Indeed, the majority of studieswere adjusted for these confounders.The most obvious confounding factor, though,is that highly processed foodsjust tend to be more likely to be junky crap.The reason cakes, crullers, candy, and cola are bad for usmay have less to do with how much they’re processedand more to do with the factthat they are cakes, crullers, candy, and cola,packed with sugar and calories,with very few nutrients.Diets high in ultra-processed foodsare diets high in added sugars, saturated fat,sodium, and calories,displacing more nutritious foods,such as fruits, vegetables, legumes, nuts, and seeds.So, maybe ultra-processed foodsare just markers of poor diet quality.And indeed, the more ultra-processed foods people eatthe more refined carbs they’re eating,the more sugar, saturated fat, sodium, energy, cholesterol,and the less fiber in their diets.So, where’s the mystery?People who eat more bad foods get more diseases.We already knew that.What does processing per se have to do with it?Because ultra-processed category foodsare more likely to be crappy foods,we could use it as a kind of heuristicthat they probably won’t be good for us.For example, if you made up some rulethat you’re going to avoid breakfast cerealswith cartoon characters on them, you’d probably end up healthier,but not because the graven image of Tony the Tigermagically hastens you to the grave,but rather because they’re proxies for high sugar content.But for the developers of the ultra-processed concept,”ultra-processed” was no proxy.They claimed that the harmful effectsof ultra-processed foods are not fully capturedby their nutrient profile, and even go as far to saywe should avoid ultra-processed foods,irrespective of their nutrient profiles.Whether ultra-processed diets are detrimental to healthsimply because they are of a poor nutritional quality,or whether the nature and extent of processing itselfhas health consequences has been an ongoing debate.How might we settle it?Well, if it were the casethat the association between ultra-processed foodsand poor health was solely becauseof the excess saturated fat, sugar, and salt,or just from a less healthful dietary pattern in general,then, if we were to adjust for dietary quality,the association between ultra-processed foodsand disease should disappear.In other words, if it was all about the nutrients,then people eating crappy dietshigh in saturated fat, salt, and sugarshould have high disease rates regardless of whether they eatmore ultra-processed foods or less of them.And people who eat really healthy dietsshould have low rates of disease regardlessof how many ultra-processed foods they consume.But that’s not the case.The majority of the associations between ultra-processed foodsand obesity and health problems remain significant and unchangedin magnitude after adjustment for diet quality or pattern.Meaning, even if you balance out dietary quality,those eating more ultra-processedtend to do worse.This suggests that at least some of the adverse consequencesof ultra-processed foodsare independent of dietary quality,so it’s not as thoughthe ultra-processed food companiescan just reformulate their productsto be lower in salt or sugar and be done with it.There appears to be something about this class of foodsbeyond the standard nutrient profilethat contributes to their deleterious effects.And that’s just what I’ll be discussingin this extended video series on ultra-processed foods.
