I am delighted to have been asked by Alison to provide information for you on the hot topic of Ultra Processed Foods.

I am a Registered Nutritional Therapist, and having qualified in 2009 (BSc in Nutritional Medicine), I have seen an explosive increase in the interest in the nutrition world. There is a plethora of nutritional information available to the public now; which can be seen as a good and bad thing. There are numerous companies, and individuals, offering an array of answers to your health problems; immediate weight loss via signing up to pills and supplements to companies providing ready-made nutritious meals via a one-minute ping in the microwave or a protein powder to add to your meals. It is becoming increasingly difficult to decipher the daily headline/Instagram/advertisements you see … and even harder not to get drawn into the convincing marketing ploys being used; which promise to “change your life”.

Are you increasingly hearing the term ‘Ultra-processed foods’?…

I am passionate about raising awareness of the increasing prevalence of these foods in our diet and I hope to explain to you why they concern me …

I have genuinely always been aware of the easy accessibility of unhealthy, nutrient poor, ultra-processed foods. Fifteen years ago, I presented programmes to school children to raise awareness of how to eat healthily; to educate them and their parents/carers on how to recognise, prepare and eat healthy foods … and here I am today still working on that mission!

My awareness and knowledge in this area has increased further since taking on a voluntary role with an organisation intent on raising awareness of the negative effects of ultra-processed foods on children; Collaboration for Kids https://the-chc.org/cfk; “Our goal is to help children and families turn away from ultra-processed foods, inspiring them to choose real and natural foods, the way nature intended, to improve health and well-being” Having accumulated knowledge, attended seminars, listened to webinars and reviewed research and study papers, I would like to share my observations with you. I have referenced my opinions as much as possible to emphasize the statistics and statements made, but trust this doesn’t become too cumbersome for you!

So, where to begin. It is now recognised that ultra-processed foods comprise 57 percent of the British diet (1). An ultra-processed food is a food that has been processed so much that it has little health value; the main ingredients including additives such as preservatives, emulsifiers, sweeteners, and artificial colours and flavours. These ingredients destroy the integrity of the food itself, and do nothing for its nutritional value (2)

We need to understand what ultra-processed foods are, where they are found and what they are doing to us.

So firstly, how do we recognise an Ultra-processed food? 

Generally speaking, they are foods that are presented NOT in their natural state …

• They can be accessed easily and quickly; they don’t need to be prepared; they come out of a bag or box ready to go right into your mouth, or if heat is required, straight into the microwave/oven.
• You can eat them rapidly and they are absorbed very quickly into the bloodstream.
• These foods typically contain multiple chemicals and synthetic ingredients.
• They are calorically dense, highly flavoured, and nutritionally barren. They typically contain extra corn syrup, sugar, artificial sweeteners, salt, colouring agents, and other potentially disease promoting chemicals.’ (3)

Ultra-processed foods are generally aggressively marketed, with attractive packaging that often include animal and cartoon characters, images, and health related claims (4)

Some examples of these foods would be:

• Breakfast cereals; with their added sugars, artificial flavours and colours
• Fast food; burgers, fries – having gone through extensive processing, they also have a high fat content and contain additives
• Sugary drinks; which are laden with sugar, artificial flavours and often caffeine
• Frozen ready meals; containing preservatives, artificial flavourings and a high sodium content
• Sweets; sugar, artificial colourings, artificial flavours
• Flavoured yoghurts; high sugar content – especially the low-fat variety

The processing and addition of these artificial flavours, sweeteners, colorants, preservatives, thickeners, emulsifiers as listed above (and so many more!) may have detrimental effects on health, both through single exposures and the cocktail effects of several used together (5)

Several studies in animal models and in humans have suggested the health effects for some of the roughly 330 additives currently approved for use in Europe, for instance through gut microbiome dysbiosis, inflammation and DNA damage (5)… a reason why there is increasing concern about ultra-processed food?

However, we need to appreciate that a large percentage of the food we consume has been “processed” in some way; washed, cleaned, packaged, frozen, ground, churned, pasteurised and when we slice, roast, fry, steam or boil our food, this can also be classed as processing (5). It is the extent of processing that is key.

To help us understand the difference in this scale, there is a grading system which groups foods according to the extent and purpose of industrial processing. This is called the NOVA system.   It considers all physical, biological and chemical methods used during the food manufacturing process, including the use of additives (6). The NOVA system has been used worldwide in nutrition and public health research, policy, and guidance as a tool for understanding the health implications of different food products (7). Researchers at the University of Sao Paulo, Brazil, proposed this system in 2009.

Coincidentally, also in 2009, Public Health Nutrition wrote a paper entitled Nutrition and Health; The issue is not food, nor nutrients, so much as processing (8)  … an indication that the industrial processing of foods was already being seen as detrimental to health?

The Nova system classifies food into four groups (9):

In summary, according to the NOVA Food Classification System, an ultra-processed food is an industrial formulation mostly comprised of substances that are extracted from foods (e.g., oils, fats, and sugar), derived from food components (e.g., hydrogenated fats), or synthesized in laboratories (e.g., food additives). Soft drinks, sweets, packaged bakery items, pre-prepared pasta dishes and pizzas, fish nuggets and hot dogs are just a few examples of ultra-processed foods (10)

Unhelpfully, there are some foods that may fall into both the processed and ultra-processed categories depending on the brand you buy, which can be confusing.

Foods such as plain oats, cornflakes and shredded wheat become ultra-processed when the manufacturer adds sugar, flavourings or colourings. Plain yoghurt is minimally processed, but when sweeteners, preservatives, stabilisers or colourings are added, it becomes ultra-processed (11)

A further study explains how out of two brands of Kellogg’s cornflakes, one was classed as a group1 food (unprocessed or minimally processed) and another a group 4 (ultra-processed) due to the addition of salt, sugar and malt extract to the second one. The same can be said for two Jordans products; moved from category 1 (Jordans Special Muesli 30% fruit and nuts) to category 4 (Jordans Super Berry Granola) with the addition of a flavouring ingredient (11).

This is an example of where we need clear information on what has been added to a product to make it become ultra-processed? What is being added to a natural ingredient? The concept of the NOVA system does not yet appear on any packaging for guidance purposes.

A practical way to identify an ultra-processed product is to check to see if its list of ingredients contains at least one item characteristic of the NOVA ultra-processed food group 4, which is to say, either food substances never or rarely used in kitchens (such as high-fructose corn syrup, hydrogenated or interesterified oils, and hydrolysed proteins), or classes of additives designed to make the final product palatable or more appealing (such as flavours, flavour enhancers, colours, emulsifiers, emulsifying salts, sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling and glazing agents) (12)

Educating ourselves to understand and recognise names of ingredients on food labels, and being aware of what those ingredients actually are, will contribute to our decision making and help us to select healthy foods when we are shopping.

So why is there such concern around ultra-processed foods? …

There has been an increase in general awareness of the implication that ultra-processed foods are having a detrimental effect on health, as already implied.

The main focus of so many of these studies can be summarised as concentrating on three main health concerns, in relation to the effects of ultra-processed foods.  These being; inflammation, brain health and weight gain/obesity (11)

One research paper highlighted “Ultra-Processed Food linked to 32 Harmful Effects” (14). This umbrella review reports a higher risk of adverse health outcomes associated with ultra-processed food exposure. The strongest available evidence pertained to direct associations between greater exposure to ultra- processed foods and higher risks of all-cause mortality, cardiovascular disease related mortality, common mental disorder outcomes, overweight and obesity, and type 2 diabetes.

Chris van Tulleken, author of the book “Ultra processed people – why do we all eat stuff that isn’t food … and why can’t we stop, sites studies and research papers emphasising how an increase in ultra-processed foods has been strongly associated with an increased risk of;

• All-cause mortality (death)
• Cardiovascular disease (strokes and heart-attacks)
• Cancers (especially breast cancer)
• Type II diabetes
• High blood pressure
• Fatty liver disease
• Inflammatory bowel disease
• Depression
• Worsened blood lipid profile
• Frailty
• Irritable bowel syndrome and indigestion
• Dementia (15)

A further paper explains how greater exposure to ultra-processed food was associated with a higher risk of adverse health outcomes, especially cardiometabolic, common mental disorder and mortality outcomes (16).

A study of middle-aged adults in France noted that a 10% increase in the proportion of ultra-processed food consumption was statistically significantly associated with a 14% higher risk of all-cause mortality (17)

There are plenty of studies looking at the link between ultra-processed foods and obesity. One study looked at how ultra-processed foods can affect gut-brain signalling, stating ultra-processed foods may facilitate overeating and the development of obesity because they are typically high in calories, salt, sugar, and fat and have been suggested to be engineered to have supernormal appetitive properties that may result in pathological eating behaviour. Furthermore, a disruption to gut- brain signalling may influence food reinforcement and overall intake, via mechanisms distinct from the palatability or energy density of the food (3). Ie. the more of these modified foods we eat, the more we want!

The World Health Organisation acknowledge that the current pandemic of obesity and related chronic diseases has, as one of its important causes, increased consumption of convenience pre-prepared foods (18) Thus, the consumption of ultra-processed foods not only deprives individuals of essential nutrients but also introduces potentially harmful substances into their diets, contributing to various health concerns (19)

I really want to keep your attention so will limit the amount of research papers I refer to … but be assured there are plenty of them to highlight the growing awareness of the harmful effects on our health of consuming ultra-processed foods.

So, with increasing awareness of these potential detrimental effects on our health, why is consumption of ultra-processed foods so high; over 50% of our diet??

Could it be price? This research paper discusses how modern and sophisticated food marketing strategies are concentrated on ultra-processed products such as soft drinks, burgers and biscuits, not on minimally processed foods like traditional staples of grains and legumes, or even on oil and sugar. They state the reason is well-known. Ultra-processed foods and drinks are very profitable. Their ingredients may cost the manufacturer a mere 5–10 % of the product’s retail price, and in the case of ‘premium’ products, even less (20)

A further paper concurred; Ultra-processed foods are not ‘real food’. They are formulations of food substances often modified by chemical processes and then assembled into ready-to-consume hyper-palatable food and drink products using flavours, colours, emulsifiers and a myriad of other cosmetic additives. Most are made and promoted by transnational and other giant corporations. Their ultra-processing makes them highly profitable, intensely appealing and intrinsically unhealthy (21)

There are no signs that leading food manufacturers are prepared to withdraw many of their leading ultra-processed products from sale, even those now aggressively marketed at children, and they may say that their duty to their shareholders prevents them from any such action (22)

What can we do?

There is so much we can do to firstly identify the ultra-processed foods in our diet and secondly learn how to reduce them.

By increasing awareness of ultra-processed foods and reducing them, we will naturally resort to natural foods which are better for the body; ie. protein, carbohydrates, healthy fats, vegetables, fruits, nuts, seeds, pulses that provide an abundance of vitamins and minerals that the body needs to function optimally.

I have reviewed many papers, studies, books and seminars in my quest to understand the complexities of ultra-processes foods and in preparation for this article and I really appreciate a quote highlighted in the book Ravenous by Henry Dimbleby.

“If we don’t put in the right fuel, our cells struggle to function properly. This can manifest itself in a number of diseases; not just diabetes and coronary heart disease, but strokes, cancer, depression, and arthritis” (23).

It would be lazy to complete this article without throwing in a few of the comments I came across disputing the dangers of ultra-processed foods …

On the use of the NOVA system a Registered Dietitian Policy & Public Affairs Manager at World Cancer Research Fund International was quoted in an article stating that most people who care about their health have the same question about processed foods: Are they killing me? And right now—despite their looming possible inclusion in dietary guidelines—no one really knows the answer. There’s limited cause-and-effect research on how processed foods affect health, and scientists and policymakers have yet to come up with a good way to “meaningfully delineate between nutrient-dense foods and nutrient-poor options” (24)

Scrutinising the system further, a recently published paper concluded that discussing the NOVA concept, it remains unclear whether the processing of foods leads to increased health risks or if ultra-processed food consumption is only a measure for poor diet quality (25).

I feel we have a long way to go before food manufacturers will make positive changes to the way they manufacture, produce and market their foods.

​References

1 European consumption of ultra-processed food by country; Monteiro, C et al. (2018) Household Availability of Ultra-processed Foods and Obesity in Nineteen European Countries. Public Health Nutrition. Ravenous – Henry Dimbleby

2 https://hansard.parliament.uk/Commons/2023-06-21/debates/E86A4BD8-C101-4C7E-B893-8AB8FB248270/Ultra-ProcessedFood Sir Greg Knight, (East Yorkshire) (Con)

3 https://www.cell.com/cell-metabolism/fulltext/S1550-4131(19)30248-7

4 https://www.cambridge.org/core/journals/public-health-nutrition/article/un-decade-of-nutrition-the-nova-food- classification-and-the-trouble-with-ultraprocessing/2A9776922A28F8F757BDA32C3266AC2A

5 https://www.cambridge.org/core/journals/public-health-nutrition/article/un-decade-of-nutrition-the-nova-food-classification-and-the-trouble-with- ultraprocessing/2A9776922A28F8F757BDA32C3266AC2A

6 Monteiro CA, Cannon G, Moubarac J-C et al. (2018) The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr 21, 5–17. [PMC free article] [PubMed]

7 https://world.openfoodfacts.org/novaa

8 https://pubmed.ncbi.nlm.nih.gov/19366466/

9 https://www.researchgate.net/figure/Spect rum-of-processing-of-foods-based-on- the-NOVA-classification-The-figure- provides_fig1_355481122

10 Ref Gibney MJ. Ultra-processed foods: definitions and policy issues. Curr Dev Nutr. 2018;3(2):nzy077. doi:1093/cdn/nzy077

11 https://hansard.parliament.uk/Commons/2023-06-21/debates/E86A4BD8-C101-4C7E-B893-8AB8FB248270/Ultra-ProcessedFood

12 British Association of Nutrition and Lifestyle Medicine (BANT). Ultra-processed Foods, the Science, the Perception and the Debate, David Titman (RNutr) Raising Nutrition. Webinar March 24.

13 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10260459/

14 Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses (bmj.com) https://www.bmj.com/content/bmj/384/bmj-2023-077310.full.pdf

15 Chris van Tulleken “Ultra processed people – why do we all eat stuff that isn’t food … and why can’t we stop.

16 Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses BMJ 2024; 384 doi: https://doi.org/10.1136/bmj-2023-077310 (Published 28 February 2024)Cite this as: BMJ 2024;384:e077310

17 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450295/

18 World Health Organization (2003) Diet, Nutrition and the Prevention of Chronic Diseases. Report of a Joint WHO/FAO Expert Consultation. WHO Technical Report Series no. 916. Geneva: WHO.Google Scholar 2

19 Levy RB, Barata MF, Leite MA, Andrade GC. How and why ultra-processed foods harm human health. Proc Nutr Soc. 2024 Feb;83(1):1-8.

20 https://pubmed.ncbi.nlm.nih.gov/19366466/

21 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10260459/

22 https://pubmed.ncbi.nlm.nih.gov/19366466/

23 Expert disagreements on nutrition; Spector, t (2022) Food for life; the new science of eating well. Jonathan Cape Ravenous – How to get ourselves and our planet into shape – Henry Dimbleby, 2023.

24 https://time.com/7007857/ultra-processed-foods-advocate/ Kendra Chow

25 https://pubmed.ncbi.nlm.nih.gov/38363072/