Tag Archive for: ultra-processed food

A Closer Look at Ultra-Processed Food Risk

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I think the results of the UK Biobank ultra-processed food (UPF) study were interesting, as I relayed on Tuesday, but the researchers went further. They estimated how substituting non-UPF plant-sourced foods for any of the other three sources of food resulted in a reduction of cardiovascular disease (CVD) morbidity and mortality. Further, and what got the headlines, substituting UPF plant-sourced foods for any of the other three increased the risk of CVD morbidity and mortality.

That led some experts to speculate about how processing destroyed fiber and phytonutrients and may even increase the amounts of negative chemicals that have been associated with disease in UPF plant-sourced foods. The problem is that there are no randomized-controlled trials to prove that. Here are a few things that stood out to me.

Theoretically…

The most important issue was this: The determination made about UPF increasing or decreasing the risk of CVD was theoretical and based on calculations. They used a 10% substitution for the non-UPF or UPF plant-sourced foods to calculate the expected raising or lowering of risk. What they could have done was divide the subjects into actual groups based on percentage of nutrients they actually ate instead of running theoretical statistical formulae. My impression is that so few people were diagnosed or died from CVD during the nine-year observational period that they wouldn’t have enough subjects for each group.

So few subjects were diagnosed or died? In the entire subject population—over 118,000 subjects followed for nine years—there were only 7,806 people diagnosed with CVD and only 529 deaths from CVD. Only? Most of the subjects were between 40 and 70, prime time for being diagnosed with some form of CVD.

When looking at the percentage of UPF-plant-sourced foods, the highest percentages were from industrialized packaged breads (9.9%),

pastries, buns, and cakes (6.9%) and biscuits (the kind called cookies in the U.S.) at 3.9%. That’s over half the amount of UPF-plant based foods on the list provided in the research paper. While wheat and other grains were certainly stripped of nutrients in the ultra-processing, that’s nothing new—that’s been happening to flour for over 100 years. What was missing were any fruits or vegetables processed in that manner.

The Bottom Line

Should you take the corn chips and vegan burgers out of your cart? Don’t get the impression that I think UPF plant-based foods should be eaten in mass quantities. I don’t. But I don’t think this study provided much direction in a reasonable response to the issue. On top of that, the analysis of the data may be just plain wrong. We’re not done yet, but we’ll get to that after the 4th of July. One more holiday challenge coming up on Tuesday.

What are you prepared to do today?

        Dr. Chet

Reference: DOI:
https://doi.org/10.1016/j.lanepe.2024.100948


Is Ultra-Processed Food Worthless?

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Ultra-processed food (UPF) has been in the news again: researchers have found a relationship between plant-based UPF and cardiovascular disease (CVD) and mortality. Health news writers were brimming with opinions on what the study meant. The comment that got my attention was that UPF manufacturing destroyed good nutrients found in plant foods to the point that there was no benefit to eating them. For example, store-bought cereals and cookies are worthless no matter how much fruit or nuts are added.

Is that true?

Let’s begin by looking at the study. Researchers used data from the UK Biobank database. They selected only the participants who completed at least two 24-hour dietary recalls—118,397 subjects. All participants were part of the healthcare system in the UK, so the researchers were able to collect diagnostic and mortality data from electronic medical records.

Researchers divided the dietary data into four groups:

  • Non-UPF plant-sourced foods (fresh grapes or canned corn)
  • UPF plant-sourced foods (corn chips or vegan burgers)
  • Non-UPF animal-sourced foods (ground beef or canned tuna)
  • UPF animal-sourced foods (chicken nuggets or ice cream)

The two main findings were that the more UPF plant-sourced foods were eaten, the higher the risk of CVD and CVD mortality; second, the increase of non-UPF plant-sourced foods reduced the risk of CVD and mortality. I think those results were to be expected. In Saturday’s Memo, we’ll take a closer look at whether the expert diatribes about negating the benefits of UPF-plant-sourced foods were warranted.

Don’t forget that the Men’s Health Webinar is this Wednesday evening. If you want to participate, respond by tonight to get the login information. The live webinar is free.

What are you prepared to do today?

        Dr. Chet

Reference: DOI:
https://doi.org/10.1016/j.lanepe.2024.100948

Where’s the Proof?

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A series of articles and studies published recently have called into question the use of statistics in examining large health databases. It’s especially pertinent to nutrition research because placebo-controlled trials are virtually impossible.

See if this sounds familiar: eating meat is associated with an increased risk of colorectal cancer. The “association” is calculated by considering variables that may impact the development of cancer and estimating the hazard of eating various quantities of meat. Recent articles have called into question whether enough variables are being considered, because only a few people decide what else could impact the development of cancer other than meat. Then the analysis is run and the results reported.

What if they didn’t pick the correct variables or enough variables that could impact cancer? What if they didn’t use the correct statistical methods to analyze the data? That could be why one study shows fish oil lowers the risk of cardiovascular mortality and another says it does not. Let’s look at an example.

“Ultra-Processed Food is Bad”

Eric Schlosser is an author and filmmaker who wrote Fast Food Nation and made the movie Food, Inc.; Food, Inc. 2 has come out recently. As a guest on Real Time with Bill Maher, he commented that ultra-processed food (UPF) is the leading cause of obesity and other diseases, but he offered no evidence to support that position. He suggested that it was the artificial ingredients found in UPF that make us crave them and eat them without restraint. Again, no evidence.

Several epidemiological studies have suggested that UPF is related to obesity. The question that remains is how? If it’s the artificial ingredients, how do they do that? By stimulating appetite? Or turning off satiety signals? Or some other mechanism?

That data isn’t collected in most large studies. When the researchers select variables that could impact the results, are they considering the correct ones? It makes a difference because at the end of these large observational studies, that’s the question that remains: How?

The Bottom Line

There is no conclusion at this point. That’s not usually my style, but this is complicated. There are too many observational studies and meta-analyses that are being used as the foundation of medical care and health and nutrition education, because as I see it the data are incomplete. For now, there are some changes we know will work and can prove: Eat less. Eat better. Move more.

What are you prepared to do today?

        Dr. Chet

The Final Question on Ultra-Processed Food

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Here’s what we found out so far: When we eat ultra-processed food (UPF), we tend to eat way too much of them, upwards of 500 more calories per meal. We absorb more of those calories; the absorption starts sooner in the small intestine because of the simple carbohydrates in the UPF. Finally, we found out that we do not lose as many calories in our stool as we would if we had more fiber and more resistant starch in our foods.

But we need to answer one more question.

Is a Calorie Just a Calorie?

Despite the research that’s been done, all the clinical trials on UPF are on small groups of subjects. I’d like to see one more study similar to the one comparing the microbiome-beneficial diet with the Western diet high in processed foods. If researchers could do the same study on a group of overweight people and put them on one of two calorie-restricted diets—one following the microbiome-beneficial diet while the other used an ultra-processed food diet—we could see if there were differences in weight loss and other health markers between the two groups. Then we’d know whether there were any real differences between the types of calories we put into our bodies.

When thinking about weight loss, I always go back to the Minnesota Starvation Experiment. The subjects, all conscientious objectors, were given only the foods that would be available after WWII in war-ravaged Europe: bread, potatoes, and other root vegetables, little to no protein, and little fat. Normal-weight men lost weight and continued to do so for the entire six months of the study. If it’s just about the calories, then substituting UPF for the starvation diet and adjusting it on a weekly basis would get the same results today. But I don’t see that study happening any time soon.

Are UPFs Healthy?

Not in my opinion because of what they don’t have. No fiber. No resistant starch. No phytonutrients. Then add artificial flavors and colors and throw in sodium and umami flavoring to make us want to eat more of them. No, I don’t think they’re healthy. But if they’re a part of a total diet and consumption is controlled, then, while the research is not in yet, a calorie could be just a calorie.

The Bottom Line

It’s easy to be a demagogue and condemn UPFs as so many others have, but remember that protein powder is a highly processed food, whether from animal or plant sources. So is stevia, the “natural” sweetener. How about almond milk? Have you ever seen an almond teat? Neither have I.

What we need for good health today, not in 1900, 1930, 1950, or even 1970, is a balanced approach to nutritional intake. It’s as simple as eat better, but not perfect. Eat less, but don’t starve yourself on foods you don’t enjoy. And move more. It’s as simple as that.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1038/s41467-023-38778-x

Ultra-Processed Foods: Losing Calories

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In our examination of the research on ultra-processed food (UPF), we’ve found out that we consume more calories and that we absorb more calories if we eat UPF. The final question is probably going to seem a little unusual. Do we actually lose more calories if we eat less UPF? In other words, do we actually eliminate calories if we eat a diet favorable to our microbiome? This is really interesting: we may actually not absorb every calorie we consume! I must admit that this one surprised me; I didn’t realize that we lost calories in our stool under healthy conditions.

Researchers wanted to test whether diet could influence the number of calories lost in feces among a variety of other variables. The researchers recruited 17 healthy, normal-weight to overweight men and women with an average age of 31. They designed a diet that could enhance the microbiome by feeding the healthy microbes that reside in the colon. They matched the diet for percentages of calories and macronutrients with a Westernized diet. The major difference was the fiber content and level of resistant starch; the Western diet included more highly processed foods.

At different points in the study, on both types of diets, they measured the exact calories consumed, calories used in exercise, rest, and sleep, and collected all urine and stool for 24 hours. The most interesting result was that the microbiome-friendly diet increased the calories lost in the stool by an average of 116 calories per day. The bacteria were using the fiber and resistant starch to manufacture more metabolizable calories, but they were lost in feces. They weren’t absorbed, so those calories do not apply.

What does it all mean? More than that, what is the question that hasn’t been answered by any study on ultra-processed food? I’ll cover that on Saturday.

And here’s one more reason to limit UPF, according to an article in the Washington Post: “…eating more pro-inflammatory foods, such as processed meats or sugary sodas, was associated with a higher risk of fecal incontinence. The authors hypothesized that pro-inflammatory foods could have negative interactions with the gut microbiome and diminish the function of the muscles and nerves of the pelvic floor.”

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1038/s41467-023-38778-x

Will Ultra-Processed Food Harm You?

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Use of ultra-processed food (UPF) has risen over the past 20 years; that’s clear from a recent study that examined eating trends. Using data from nine cycles of the NHANES (National Health and Nutrition Examination Survey) study, there has been a steady rise in the percentage intake of UPF from 53% to 57%. Over the same period, there has been a decline in minimally processed meat, chicken, and dairy products with an increase in UPF meats.

As you saw if you looked at the NOVA categories (first reference below), the largest component of the UPF are breads and sodas of all types, together with confectionary products such as cakes and pies. The first question: what has this rise in UPF done to our health?

UPF and Mortality

Researchers tracked adult participants in the 1988–1994 NHANES study. Over a median follow-up of 19 years, individuals in the highest 25% of servings of UPF per day had a 31% increase of mortality from all causes. Curiously, the increase in mortality was not from CVD—but dead is still dead, so it doesn’t really matter what caused it.

Recently published research associated UPF with type 2 diabetes, Alzheimer’s disease, and maybe most important, changes in the microbiome. That’s where the immune system begins, so the low fiber in UPF may actually be the root cause of the rise in mortality. Finally, as the servings of UPF went up, so did the caloric intake compared with the lower quartiles—an additional 600 calories per day.

One Nagging Question

I’ve talked about the sweet spot before: How many vegetables and fruits can we eat to offset some of the poor food choices we make? The data showed that minimally processed vegetable intake stayed constant at less than one serving per day and fruit and fruit juices declined over the nine NHANES survey periods. The researchers in both studies could have analyzed the data by intake of healthier food to see if that had any impact. Not that I believe we should increase our UPF intake, but for those who do, what can we do to offset some of negative impacts?

The Bottom Line

As 2023 continues, rather than tell you to reduce your UPF intake—which is a good idea—I’m going to propose that you add one vegetable or fruit serving to your daily diet every month, and do it early in the day. You might naturally reduce your UPF intake as a result. Because the recommendation never changes in our trio: eat less, EAT BETTER, and move more.

What are you prepared to do today?

        Dr. Chet

References:
1. https://educhange.com/wp-content/uploads/2018/09/NOVA-Classification-Reference-Sheet.pdf
2. Am J Clin Nutr 2022;115:211–221
3. Public Health Nutr. 2019. 22(10):1777–1785. doi:10.1017/S1368980018003890

What Are Ultra-Processed Foods?

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Several studies have been published recently that demonstrate the hazard of eating too much processed food: digestive issues, type 2 diabetes, cardiovascular disease, early mortality, and even premature Alzheimer’s disease. Today I’ll focus on some definitions and look at the research on Saturday.

Many of the studies that have examined ultra-processed food have used the NOVA four categories of processed foods developed at the University of Sao Paulo’s School of Public Health in Brazil:

“Ultra-processed foods are industrial formulations made entirely or mostly from substances extracted from foods (oils, fats, sugar, starch, and proteins), derived from food constituents (hydrogenated fats and modified starch), or synthesized in laboratories from food substrates or other organic sources (flavor enhancers, colors, and several food additives used to make the product hyper-palatable). Manufacturing techniques include extrusion, moulding, and preprocessing by frying. Beverages may be ultra-processed.”

Doesn’t that sound appealing? Actually, hot dogs, mac and cheese from a box, and just about every dessert bought in a typical grocery store fits that bill. For the complete list, check out the link in the Reference below.

Now that we know what we’re talking about, I’ll talk about what the research says about ultra-processed foods and assess our risk in the real world. In the meantime, try choosing more foods from the first group for the next few days; that’s healthy eating.

What are you prepared to do today?

        Dr. Chet

Reference:https://educhange.com/wp-content/uploads/2018/09/NOVA-Classification-Reference-Sheet.pdf