The Dangers of 'Ultra-Processed Foods'

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Brian Lehrer: It's The Brian Lehrer Show, on WNYC. Good morning again, everyone. With us now, Chris Van Tulleken, author of a new book, called Ultra-Processed People. One of the things the book does is to explain a relatively new way of classifying foods and reading food labels. Instead of just looking at nutrients to maximize and ingredients to minimize, like salt, sugar, calories, saturated fats, look for how a food seems to stack up on a scale called NOVA, which we'll explain.
The book argues that Americans spend much less of our incomes on food than a century ago, and that that could be a bad thing, because of how food became cheap. It's also a Supersize Me style, first-person book to some degree, as the author experimented on himself by going on and off ultra-processed diets. Some of you know Chris Van Tulleken as the feature doctor on a number of BBC programs. He's an infectious disease specialist by training.
Let's see what he has to say about nutrition and other effects from corporate food dominance, that make so much food ultra-processed. The full title of the book is Ultra-Processed People: The Science Behind Food That Isn't Food. Chris, thanks for joining us. Welcome to WNYC.
Chris Van Tulleken: Thanks so much, Brian. It's a pleasure to be here.
Brian Lehrer: Can you start with this four-point classification system known as NOVA? That's where you get the term ultra-processed foods. Why don't you introduce the concept and maybe even go through this version of the four food groups, as they see them, in brief?
Chris Van Tulleken: I loved your introduction, because you said this is a new classification, and it is. It started in about 2010, but in fact, this is just the scientific formalization of a very ancient bit of thinking that probably both our grandparents would've recognized, an anxiety about food processing. The NOVA classification divides food into four types. Broadly, food can be whole. You can eat it out of the sea, like an oyster, we can pull it off a tree, like an apple. That's whole unprocessed food.
There's almost none of that. Very little that we eat is truly unprocessed. Even that apple, even, in fact, our oysters now, are genetically modified. They're domesticated breeds for increased sweetness, improved flavor, and so on. Then we have processed food. Now, food processing is really, really ancient. Humans, in fact, are the only animals that have to process our food, so we are obligate processivors. We've been processing food for over a million years.
It was mainly invented by female scientists, over the last million and a half years, living in caves, in huts, in shelters. They developed food and they salted, smoked, dried, extracted, ground, milled, all these different natural substances, plants, and animals, in order to create the modern diet. Then, finally, we have ultra-processed food, which is NOVA Group 4. I can't go through the whole NOVA group, but I think it's much simpler to just think in terms of--
There's whole, minimally processed food, and then there's ultra-processed food, which was invented, arguably, in the 19th century, but really got going in the 1950s, in the States, with the TV dinners. There's a very long formal scientific definition that's accepted by UNICEF, the UN Food and Agriculture Organization, lots of governments, my research group at UCL, my colleagues at Cambridge, Harvard, Oxford, colleagues in Canada, Brazil, so it's a very widely accepted definition.
It boils down to-- If it's wrapped in plastic and it contains an ingredient that you don't find in a domestic kitchen, then it's very likely to be ultra-processed. If it's got an emulsifier, a sweetener, a flavoring, a stabilizer, then it's almost certainly an ultra-processed food, or UPF, as we call it.
Brian Lehrer: Are you arguing, in part, that when we read food labels, mostly for individual ingredients to maximize or minimize, salt, sugar, fat, we're missing the forest for the trees?[silence] Do we have Chris? Did we lose Chris's line? I think we've lost Chris Van Tulleken's line for the moment, so listeners, let's open up the phones on this. I'm sure we'll get him back in just a sec.
Who has a question about reading food labels with the NOVA rankings in mind, that scale that he just described, not just individual ingredients? 212-433-WNYC, 212-433-9692. Who has a story about your own food choices, observations about what's on the shelves, or anything else for Chris Van Tulleken, MD and BBC medical presenter, and author now of Ultra-Processed People: The Science Behind Food That Isn't Food, never mind junk food junkie, what would we call it now?
Are you an ultra-processed foods fanatic, or whatever? 212-433-WNYC, 212-433-9692. Do we have him back? Yes, I think you're back, Chris, right?
Chris Van Tulleken: I am back. I'm really sorry. For context, I'm at a house in the country with my family on a short holiday. I'm sorry, it's got a slightly sketchy Wi-Fi, but it was working well. Can you hear me now?
Brian Lehrer: Yes, we can hear you just fine. Of course, that's one of the charms of going on a vacation in the country, is that maybe you're not as tethered to Wi-Fi as you usually are. Right? The question I was asking was, are you arguing, in part, that when we read food labels, mostly for individual ingredients like salt, sugar, fat, looking for what to minimize, we're missing the forest for the trees?
Chris Van Tulleken: I think that's a good way of putting it, but it's also impossible to do that. Humans are the only animals that seem to think they can read numbers on packets and synthesize that information. In fact, I would say, as a scientist, a clinician, and someone who now does research in this area, I would find it impossible to keep track of my salt content across the multiple things I eat in a day.
Add it all up, know my total salt intake, and work out how to integrate that, then, with my saturated fat, my fiber requirements, all the other vitamin requirements, it can't really be done practically, but the thing that we all worry about is energy intake, that's what-- The book is actually about lots of [unintelligible 00:07:13] diseases.
Brian Lehrer: When you say energy intake, that's calories, right?
Chris Van Tulleken: Yes. We worry about calories, so we've been putting labels on packets with calories for a long time, and the world crisis of particularly childhood obesity is going up because you know what? Kids don't read those labels and total up the calories, and very few of us know how many calories our kid should eat in a day. What we know is that when people eat real food, the body has very well-evolved mechanisms inside it that say, "You're full now. You can stop eating."
In fact, in clinical trials done in the states, with the NIH, on ultra-processed foods, when the participants were just given real food, they not only ate fewer calories per day, they ate 500 calories fewer per day, and most of them lost weight, even though they had access to unlimited calories, and they rated the unprocessed calories as delicious as the ultra-processed calories. This is food that subverts our body's ability to say, "I am full. You can stop eating."
Brian Lehrer: Maybe this is a good place to bring in your experiment on yourself. It's reminding a lot of people, like people reviewing your book and people who I just happen to tell, off the air, that I'm interviewing you and what you did, reminds them of Supersize Me. The documentary from 20 years ago, by Morgan Spurlock, in which he only ate McDonald's for a month and measured the effects on himself. What did you do with ultra-processed foods?
Chris Van Tulleken: It was a great documentary. I wonder if it subconsciously inspired this. I was the first participant in a much larger study that my research group is now running at University College in London. We did it in a much more formal way, and there was a crucial difference. I went on a diet for one month, where I ate 80% of my calories from ultra-processed food. I wasn't force-feeding myself. One of the bargains in Supersize Me is, he had to go with the supersized deal, which meant he was deliberately overeating.
I wasn't doing that. I was just eating to appetite, and my diet isn't a very extreme diet. I was eating the normal diet of a British or American teenager. It's not quite the average diet, but it would be a very, very typical diet for particularly a low-income or disadvantaged family, to get 80% of their calories from ultra-processed food, and we did it very formally, to generate pilot data. I like to think we did it a little more rigorously than Morgan, but he made an important contribution, and I did it in a very open-minded way.
I was not persuaded that ultra-processed food was legitimate or important when I started doing the experiment.
Brian Lehrer: What did you learn, based on your own body's reactions to whatever you ate?
Chris Van Tulleken: Three things happened, and they all back up what we now know from much, much larger studies. The first thing was that I gained weight. In fact, I gained so much weight that I would have doubled my body weight in a year, if I'd kept going on the diet. The second thing that happened was, my hormonal response to a meal changed. At the beginning of the diet and at the end of the diet, I ate a standard meal, we measured the hunger and satiety hormones.
At the end of the diet, my hunger hormone remained sky-high at the end of a big meal. This is food that is modifying our body's ability to stay full and to regulate its nutritional intake. The third thing, and really the most alarming thing, was the MRI scans that we did, where we saw an enormous increase in connectivity between the habit-forming parts at the back of the brain in the cerebellum, and the reptilian addiction reward parts, right in the middle of the brain.
This is concerning, because when I did the experiment, I was 42, and I have the resources and knowledge to be able to stop eating ultra-processed food, but if-- Many children in the States and the UK start their lives on a diet of 100% UPF, and they will continue eating that all the way to adulthood, having 60 to 90% of their calories from UPF. We don't really know what it's doing to those children's brains, but there's very, very good evidence now that, for many people, many of these products are addictive.
Brian Lehrer: What was the heart of your UPF ultra-processed food diet? You mentioned TV dinners. I don't even know if they exist anymore, but that was supposed to be like a whole little packaged meal, you get some turkey and gravy, some mashed potatoes, and a little vegetables thing, maybe. I don't know [crosstalk] if there was a dessert thing. What was your typical ultra-processed dinner, if I can ask?
Chris Van Tulleken: I'd have almost any breakfast cereal for breakfast. They're all ultra-processed, or almost, universally. Even the Mueslis have emulsifiers. For lunch, I'd have our standard British lunch of a packet sandwich, a pack of crunchy things, popcorn, baked chips, crisps, whatever, and then a fizzy pop. Then for dinner, I could have takeaway. I could have a frozen pizza, a ready meal, oven chips. I could order in fast food. It's very easy to eat a very normal diet that's extremely ultra-processed.
Then I had little snacks throughout the day. A really good rule of thumb is, if there is a health claim on the packet, something is almost certainly ultra-processed. A lot of the food that I ate, I didn't want to hurt myself, so I wasn't trying to prove a point. We were trying to get data, in an open-minded way. I started drinking diet sodas. I started having the healthy, high-fiber, high-protein snack bars. I would order the low-fat ready meals, the microwaveable complete meals that you can put in the oven or the microwave, lasagnas.
I'd even get packet salads. I wasn't deliberately eating the worst stuff. I think that's a misconception. Ultra-processed food is not all obvious junk, and it's also worth saying that you can eat pizza that is not ultra-processed. There's a brilliant restaurant near my house, in London, that makes beautiful sourdough pizza. It's possible to eat a burger from a really good patty, and have a fresh bun, or fresh bread, and it won't be ultra-processed. You can have junky feeling food that's actually probably extremely healthy for you.
Brian Lehrer: That's very counterintuitive. What about-- To take one of your examples of eating cereal flakes, I think you call them their flakes, which are boxed and obviously, therefore, processed, but they're really made out of whole grains. People might be thinking, "Well, what about those? Should I not be eating those?"
Chris Van Tulleken: One of the things to consider is, if you look at the box of cereal and it really is just grains, then it's not ultra-processed. If you just buy porridge oats that's not ultra-processed, they'll have been pressed and rolled. They're processed, but they're processed using an ancient technique. It's when those oats are combined with whey protein flavorings, chocolate chips, emulsifiers, stabilizers, added wheat, glutens, glucose syrup. There's a long, long list of them, I could keep going.
Brian Lehrer: Got you. That makes them [crosstalk] more processed, ultra-processed.
Chris Van Tulleken: That's when it becomes ultra-processed. The thing to understand is the food these-- Your box of cereal-- You and I can have been eating the same cereal for the last three, four decades, but every year, the cereal ingredients are tweaked and adjusted. They're tweaked and adjusted, not with an eye on public health, they're put through focus groups. In the book, I speak to a huge number of people in the food industry who confirm this.
This is not an anti-food industry book. One of the things that the companies measure is how much of the box of cereal do people eat. Do they eat more of box A, or do they eat more of the new formulation box B? If they eat more of box B, that's the one that goes on the shelf, and this happens every year. All sorts of parameters are adjusted, so that now, five, six decades into our ultra-processed food diet, the foods have become extremely hard to stop eating.
Lots of listeners will recognize this dissonance where they're eating a thing and they know they're full, and they've stopped enjoying it, they've stopped liking it, and yet, they can't stop themselves eating it.
Brian Lehrer: Well, that was a very interesting paradox to me, in your book, describing yourself, that you were wanting to eat more, but you were enjoying your food less, so that's the paradox you're laying. Let me go to a caller, Matt, in Brooklyn, you're on WNYC. Hi, Matt.
Matt: Hi. I would like to have the doctor's response to the cost of eating a healthy diet. I think I eat a healthy diet. I eat a lot of fish. It's quite expensive. Yes, you can buy chicken without antibiotics, and so forth, that's much less expensive. [unintelligible 00:16:14] turkey, we eat a lot. That's less expensive. Can people eat a healthy diet, and can we teach about a healthy diet in schools, as we did anti-smoking, teach about good food in schools?
Brian Lehrer: Matt, thank you very much. I'd like you to focus on the monetary aspect of that call, and we don't have that much more time. One of the other really interesting things to me, about your book, was the stat, tell me if I'm getting this right, in 1900, food accounted for more than 40% of the typical American's budget, today, it's less than 10%, and then you relate that to ultra-processing.
Chris Van Tulleken: Matt's exactly right. One of the things I don't do in the book is give out any advice, because at the moment, in the US and in the UK, there's a cost of living crisis. The advice would be almost impossible for many people to follow, particularly disadvantaged communities, people of color, minority groups, indigenous people. Real food is almost unaffordably expensive for a huge number of people. My book really asks for structural change.
It's a violation of people's rights that we are missold food that isn't really food, that has very strong evidence of health harms now, and real food is inaccessible. There is an experiment at the heart of my book, which is-- The reader is invited not to quit this food, but to eat the food as they go along, because what a lot of people find is, as they try and eat the food while they engage with it, they're put off it, in exactly the same way that there's a very famous book that put people off smoking.
I do that with unease, because some people will learn to find this food disgusting, but find it very hard to change, so it's a really important point.
Brian Lehrer: Well, what's the class and income disparity piece of this then, or solution to this? Has this become a forced choice, based on income, for some of us more than others? As the caller says, fresh foods are actually more expensive.
Chris Van Tulleken: They're more expensive in every way. They're more expensive to buy. You take time to prepare them. They spoil quicker. What we need is the same approach we brought to smoking, and I was pleased Matt raised that. There's a few simple steps we need to prevent the very close financial links between policy-makers in the UK and the US and the food industry, the people that profit from diet-related disease. We need to limit the marketing of this food.
We should not be selling food to children with cartoon characters, and none of this is anti-capitalist, by the way. I'm not anti-capitalist. I'm not anti-food company. You can regulate companies and they can still have enormous financial growth, employ people, and everything will be fine. It happened with pharma. We've done it with lots of other industries. Even tobacco barely suffered. We limit the marketing, we change institutional food.
Teaching kids is really important, but at the moment, that's low down my list of asks, of either of our governments, because if you teach kids in an environment where they're still saturated in ultra-processed food marketing, and real food is unaffordable, you're doing something really quite stressful for them. The final part of the triangle, and the hardest bit, is to make real food affordable. That is a political choice we can make. We have food subsidies.
We can reduce income inequality, we can improve social justice. These are all achievable things. If there was only one thing we did, it would simply be to implement policies that reduce poverty. If you get rid of poverty, the modeling shows you'll reduce the problem by about 60%. The problem of diet-related disease and obesity.
Brian Lehrer: Isn't capitalism part of the problem? Isn't the food industry doing this to us on purpose, and that lives in the capitalist system that we have?
Chris Van Tulleken: I asked very senior investment bankers about this. My academic research is now largely economic. I study commercial determinants of health, and how capitalism affects health. What it was explained to me by asset managers is that the food companies aren't in control of their business model. They can try and sell healthy food. Danone famously tried to do this. They turned themselves into a social enterprise.
The board and the CEO were immediately fired by activist investors who hold our pension funds. Yes, there is a loop of capitalist money flow that constraints the companies. That's why the argument in the book is for government intervention. We can either have unelected corporations the size of medium-sized countries controlling our diet, or we can have our elected governments controlling our diet. Either way, someone's going to control what we eat.
Yes, I make a case, I think, for well-regulated capitalism. It's worked brilliantly well within the pharmaceutical industry, works well in aviation. It's worked reasonably well with tobacco. Fewer people do now smoke. Although the tobacco industry have been extremely clever marketing other products, and we're seeing the rise of vapes. It hasn't yet worked as well as I'd like it to with alcohol. There is a way that government can protect us from predatory industries, and I'm not making an argument for the downfall of capitalism.
Brian Lehrer: One more call. Ethan, on Cape Cod. You're on WNYC. Ethan, we have about 30 seconds for you. Hi.
Ethan: Hey, Brian. Hey, doctor, thank you for the fascinating topic. Just curious, someone who eats vegan diet, like me, I'm eating a lot of stuff that's super processed to create these delicious fake meats, but obviously, by definition, they're ultra-processed. Is it a net gain healthwise? I know ethically and ecologically it is, but how about healthwise?
Brian Lehrer: We have 30 seconds for a last response, Dr. Tulleken.
Chris Van Tulleken: I'd say no, it's not a net gain, healthwise. If it's at all possible, switch to making your own vegan food ethically. There is a question, as well, that many of these products are made by the same corporations that are essentially the meat industry. You could consider as well that you are contributing to the problem. Broadly, I applaud vegans. You are doing a huge amount more for the planet than those of us who eat a huge amount of meat, which does include me.
Brian Lehrer: Well, I think that implies a whole other segment to be done on lab meats, but we leave it there today, with Chris Van Tulleken, who some of you know from the BBC, he is now the author of Ultra-Processed People: The Science Behind Food That Isn't Food. Thank you so much for sharing this with us. We really appreciate the content.
Chris Van Tulleken: Brian, thanks so much.
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