Search results: Ultra processed foods

I don’t like writing about the dietary guidelines process while it is still ongoing because so much can change between now and the time the advisory committee submits its report, and USDA and HHS issue the actual guidelines.

But this Dietary Guidelines Advisory Committee is dealing with the concept of ultra-processed foods and is tied in knots over it.

So I will devote this week to the guidelines.

• Today: Why knots?
• Wednesday: Why isn’t NIH funding more rigorous nutrition research?
• Thursday:  Why all the fuss when guidelines always say the same things?

OK.  Let’s get to it.

Why do I think the Dietary Guidelines Advisory Committee (DGAC) is tied in knots over ultra-processed foods (UPF)?

1. It  is required to make evidence-based recommendations.  This is impossible with observational evidence.
2. It is required to exclude the one existing controlled clinical trial from consideration (because it was too short).

Therefore, it had to conclude: ““Limited evidence suggests that dietary patterns with higher amounts of foods classified as UPF consumed by adults and older adults are associated with greater adiposity (fat mass, waist circumference, BMI) and risk of obesity/overweight. Evidence Grade: Limited.”

The DGAC is in an impossible position, and doing the best it can under the circumstances.

I need to say a word about evidence-based recommendations.  How I wish they could be.   If all you have is observational studies, you need to interpret them carefully.  Interpretation is subject to bias.

When I was a DGAC member (1995 guidelines), the agencies recognized what we were up against.  They instructed us to review the available research and give the best advice we possibly could based on it.

All of this raises a philosophical question: Should government agencies issue advice based on incomplete and inadequately controlled observational research?  Or should they say nothing?

This committee, apparently, is considering saying nothing about ultra-processed foods: “It would be hugely problematic to tell people to avoid 60% of the food supply without having something good to replace it.”

Really?  Plenty of “something good” is available.  It’s called food: fruits, vegetables, grains, meat, fish, dairy, eggs.

These—unprocessed and minimally processred—can be delicious, nutritious, and satisfying, and at reasonable cost.

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Tomorrow: Why don’t we have more rigorous research?

Addition:  The video of the meeting.  The discussion of ultra-processed foods starts at 3:51:45 .

If you are still confused about ultra-processed foods and the current status of this truly important dietary concept, here is a great place to start: The Financial Times of all things: “Deny, denounce, delay”: The battle over the risk of ultra-processed foods.

Why important?  The message is clear: eat less of them.  Hence, the article’s subtitle: “Big Food is trying to dampen fears about the effects of industrially formulated substances.”

This piece is totally worth reading.

It is clear that the public is now much more aware of UPFs, and concerned about them. Two-thirds of Europeans now believe that ultra-processed foods are unhealthy and will cause health problems in later life, according to a February survey of 10,000 people in 17 countries, and 40 percent do not trust that the authorities are regulating them well enough. Research by Mintel in the UK has found that 70 percent of UK adults try to avoid ultra-processed foods.

“I don’t think even Carlos Monteiro in his wildest dreams expected the public discourse to get so attuned,” says Lang at City University. “The public is running with it. The genie is out of the bottle.”

Let’s start the new year with some good news.

I was excited to read in The Lancet that Colombia has enacted a tax on junk foods.

The new tax was included in a wider reform that passed into law in December, 2022, seeking to reduce the
burden of obesity and other diseases on Colombia’s health system, while also bringing in revenue in a country that manages a fiscal deficit.

This is a tax on ultra-processed foods!

The tax is being implemented gradually, beginning at 10%, before rising to 15% in 2024 and 20% in 2025, and targets foods are high in salt and saturated fat, as well as industrially manufactured prepackaged foods.

Colombia already has warning labels.  Here’s who else has them.

The warning label movement!

Now, if we only could get these in the U.S….

But note: not everyone loves the tax.  The Guardian reports charges that it is unfair to the poor.  But so is type 2 diabetes.

The Food and Agriculture Organization of the U.N. released its annual State of Food Security and Nutrition in the World report last week.  Its conclusions are sobering.

Global hunger is still far above pre-pandemic levels. It is estimated that between 690 and 783 million people in the world faced hunger in 2022. This is 122 million more people than before the COVID-19 pandemic. Nonetheless, the increase in global hunger observed in the last two years has stalled and, in 2022, there were about 3.8 million fewer people suffering from hunger than in 2021. The economic recovery from the pandemic has contributed to this, but there is no doubt that the modest progress has been undermined by rising food and energy prices magnified by the war inUkraine. There is no room for complacency, though, as hunger is still on the rise throughout Africa, Western Asia and the Caribbean.

Ultra-processed foods are a critical part of this story.  The word “processed” comes up 264 times in this report; “highly processed” comes up 99 times .  Some examples:

• Healthy diets are essential for achieving food security goals and improving nutritional outcomes. A healthy diet…is based on a wide range of unprocessed or minimally processed foods, balanced across food groups, while it restricts the consumption of highly processed foods and drink products…Eating a healthy diet throughout the life cycle is critical for preventing all forms of malnutrition, including child stunting and wasting, micronutrient deficiencies and overweight or obesity. It also helps reduce the risk of non-communicable diseases (NCDs) such as cardiovascular diseases, diabetes and certain types of cancer.
• The unfinished agendas to reduce stunting, wasting and micronutrient deficiency, along with rising overweight and obesity, represent the current challenge to address multiple forms of malnutrition. Malnutrition in all its forms is related to poor diets, the rise of low-cost
  nutrient-poor foods and the increasing availability of highly processed foods in rural areas.
• Supply-side factors, including globalized technology in food production, transportation and marketing, coupled with an increase in demand for readily available foods, have contributed to a substantial expansion of supermarkets, hypermarkets, food deliveries and other convenience retailers. However, these are also associated with increased supply and spread of energy-dense and highly processed foods.
• However, urbanization has also contributed to the spread and consumption of processed and highly processed foods, which are increasingly cheap, readily available and marketed, with private sector small and medium enterprises (SMEs) and larger companies often setting the nutrition landscape. Cost comparisons of individual food items and/or food groups from existing studies indicate that the cost of nutritious foods – such as fruits, vegetables and animal source foods – is typically higher than the cost of energy-dense foods high in fats, sugars and/or salt, and of staple foods, oils and sugars.
• The dynamics of supply and demand for processed foods, however, are complex. There has been a surge on the supply side, with small and medium enterprises and large private companies alike making massive aggregate investments in all types of processed foods (from minimally to highly processed) in response to demand. At the same time, aggressive marketing and relatively low pricing – and even interference in policies to curb consumption of highly processed foods and sugar-sweetened beverages – are driving up consumption.

The report emphasizes the importance of food processing in contributing to poor diets and health.

What is to be done?  From the Brief summary:

Leveraging connectivity across the rural–urban continuum will require adequate governance mechanisms and institutions to coordinate coherent investment beyond sectoral and administrative boundaries. To this end, subnational governments can play a key role in designing and implementing policies beyond the traditional top-down approach. Approaches to agrifood systems governance should ensure policy coherence among local, regional and national settings through the engagement of relevant agrifood systems stakeholders at all levels.

I read this as saying what’s need is community-based, bottom up approaches at the local level.  That’s a great place to start.  Go for it.

Resources

• The online report
• The  pdf
• The digital report
• The Brief 
• And see Access to food in 2022: filling data gaps. Results of twenty national surveys using the Food Insecurity Experience Scale (FIES)

I am devoting this week to the pushback against advice to reduce consumption of ultra-processed foods.  It is coming from the food industry, of course, government agencies with ties to the food industry, and nutritionists who focus on  the benefits of nutrients, without contextualizing the foods and diets they come from (“nutritionism”).

For the record, ultra-processed foods are :

• Industrially produced
• Bear little resemblance to the foods they were derived from
• Typically contain additives for color, flavor, and texture
• Cannot be made in home kitchens,
• Are formulated to be irresistable,
• Are associated with excessive calorie intake and poor health
• Are extremely profitable to their makers
• Cannot be made in home kitchens (a brief operating definition)

Ultra-processed food pushback #1: A study from the USDA and authors with conflicted interests

The USDA’s Agricultural Research Service is so proud of this study that it sent out a press release.

Scientists at the USDA Agricultural Research Service’s (ARS) Grand Forks Human Nutrition Research Center led a study that demonstrates it is possible to build a healthy diet with 91 percent of the calories coming from ultra-processed foods (as classified using the NOVA scale) while still following the recommendations from the 2020-2025 Dietary Guidelines for Americans (DGA). The study highlights the versatility of using DGA recommendations in constructing healthy menus.

The Study: Dietary Guidelines Meet NOVA: Developing a Menu for A Healthy Dietary Pattern Using Ultra-Processed Foods.  Julie M. Hess, Madeline E. Comeau, Shanon Casperson, Joanne L. Slavin, Guy H. Johnson, Mark Messina, Susan Raatz, Angela J. Scheett, Anne Bodensteiner, Daniel G. Palmer.  The Journal of Nutrition, 2023.  https://doi.org/10.1016/j.tjnut.2023.06.028.

Purpose: “The purpose of this proof-of-concept study was to determine the feasibility of building a menu that aligns with recommendations for a healthy dietary pattern from the 2020 DGA and includes ≥80% kcal from UPF as defined by NOVA.”

Method: “we first developed a list of foods that fit NOVA criteria for UPF, fit within dietary patterns in the 2020 DGA, and are commonly consumed by Americans. We then used these foods to develop a 7-d, 2000 kcal menu modeled on MyPyramid sample menus and assessed this menu for nutrient content as well as for diet quality using the Healthy Eating Index-2015 (HEI-2015).”

Results: “In the ultra-processed DGA menu that was created, 91% of kcal were from UPF, or NOVA category 4. The HEI-2015 score was 86 out of a possible 100 points.”

Conclusions: “Healthy dietary patterns can include most of their energy from UPF, still receive a high diet quality score, and contain adequate amounts of most macro- and micronutrients.”

 Conflicts of Interest: “MM serves as the Director of Nutrition Science and Research for the Soy Nutrition Institute (SNI) Global. The SNI Global receives funding from soybean farmers via the soybean national checkoff program and via membership dues from companies involved in manufacturing and/or selling soy ingredients and/or soyfoods. GHJ serves as Senior Advisor to the McCormick Science Institute. JLS serves on advisory/consultant boards for Simply Good Foods, Quality Carbohydrates Coalition, and the Sustainable Nutrition Scientific Board and has received funding from the National Institutes of Health, Taiyo, Barilla Foods, and the USDA in the past 12 mo. The other authors report no conflicts of interest.”

Funding: This work was supported by USDA Agricultural Research Service project grant #3062-51000-057-00D.

Comment:  I can think of only one reason for doing a study like this: to cast doubt on the concept of ultra-processed foods (UPF) and all the research showing that UPF diets induce people to eat more calories (see the study by Kevin Hall et al) and are strongly associated in hundreds of studies with poor health, evidence that by this time is overwhelming and incontrovertible.  Why now?  Because the 2025-2030 Dietary Guidelines Advisory Committee has been charged with examining the relationship of UPF to heart disease risk.

The first rule of the ‘Playbook” is to cast doubt on the research, which is what we are seeing here.  The message to reduce consumption of ultra-processed foods makes good sense for health reasons.  But such advice is very bad for the profits of food companies making junk foods.

The USDA’s Agricultural Research Service is a marketing arm of the food industry,.  It is heavily conflicted.

For one thing, the Healthy Eating Index is not useful for this purpose; it is strictly nutrient-based, which is not the issue here.  And the Dietary Guidelines are careful to leave plenty of room for eating junk foods and to say not one word about UPF.

I think the UPF concept is so solidly backed up by evidence that it is here to stay.  But it is so threatening to food companies making UPF products, and the USDA is so captured by the food industry (checkoff programs, anyone?) that it is understandable why they are so eager to cast doubt.

Thanks to the half dozen or so readers who sent this one to me, to Ted Kyle for calling it “oxymoronic healthy eating,” and  Kevin Hall for pointing out that the healthfulness of this diet is assumed, not tested:

Ultra-processed foods—defined operationally as industrially produced foods formulated to be irresistably delicious that can’t be made in home kitchens (because you don’t have the machinery or the ingredients—are by now well established to be associated with weight gain and weight-related chronic diseases.

Evidence now suggests the association is causal.  Ultra-processed diets induce people to eat more calories without realizing it.

Alas for food companies.  Ultra-processed products are among their most profitable.

The British Nutrition Foundation to the rescue!

• It has issued a position statement on ultra-processed foods.   It complains that:
• The classification system omits foods the Foundation considers healthy.
• It implies that expensive artisanal products are superior for health (advice to reduce UPF raises questions of equity).
• The research is largely observational.
• The food environment is a key driver of poor health.
• Making products that are not ultra-processed may have unintended consequences.
• Demonizing ultra-processed foods could foster feelings of guilt and stigma.
• Messages to avoid UPF might discourage industry from reformulation.
• Food processing plays a releant role in food system sustainability and food security.

When I read things like this, I have the usual question: Who paid for this?

The British Nutrition Foundation says:

BNF’s funding comes from: membership subscriptions; donations and project grants from food producers and manufacturers, retailers and food service companies; contracts with government departments; conferences, publications and training; overseas projects; funding from grant providing bodies, trusts and other charities.

If it lists its corporate sponsors, I can’t find it.

But PowerBase says:

The British Nutrition Foundation (BNF) is the key food industry front group in the UK. The BNF promotes itself as a source of impartial information, but it does not always make its links with industry clear.

The BNF is hard at work on behalf of food companies who wish the entire UPF concept would just disappear.  See, for example, “How do we differentiate not demonise –Is there a role for healthier processed foods in an age of food insecurity? Proceedings of a roundtable event” published in the Nutrition Bulletin.  The themes that emerged from the conference:

• problems with the use of definitions for UPF,
• the lack of causal evidence and defined mechanisms linking processing per se with poor health outcomes,
• advice that may result in consumer confusion.
• misalignment of UPF foods with dietary guidelines
• unintended consequences for vulnerable groups

Comment: 

OK, the food industry is fighting back.  I think it’s a losing battle.  The UPF concept has so much evidence backing up its usefulness.  But I will say one thing about the point about unintended consequences.   It’s OK for rich people to avoid UPF but OK for poor people to eat them?  I think the food industry is in trouble on this one.  It has gotten away with pushing junk food for way too long.  The British Nutrition Foundation would be much more crredible if it put public health first.

Jim Krieger of Healthy Food America sent me this Food Navigator article titled “Can ultra-processed packaged food play a role in healthy, sustainable diets of the future.”

Uh oh.  Another attack on the concept of ultra-processed foods.  These, you will recall, are strongly associated in observational studies with poor health outcome, and one clinical trial demonstrates them to cause people to eat more calories.

The makers of highly processed foods are understandably worried that the word will get out and people will stop eating them.

Clif Bar to the rescue.

It sponsored a small session to establish guidelines for making highly processed foods healthier: “Making Healthy, Sustainable Diets Accessible and Achievable: A New Framework for Assessing the Nutrition, Environmental, and Equity Impacts of Packaged Foods”

The publication emphasizes flaws in the concept of “ultra-processed,” an approach it says

lacks the nuance needed to holistically evaluate packaged foods within recommended dietary patterns. Additionally, there is considerable diversity of opinion within the literature on these topics, especially on how best to improve nutrition security in populations most at risk of diet-related chronic disease. In support of addressing these challenges, 8 sustainability and nutrition experts were convened by Clif Bar & Company for a facilitated discussion on the urgent need to drive adoption of healthy, sustainable diets; the crucial role that certain packaged foods can play in helping make such diets achievable and accessible; and the need for actionable guidance around how to recommend and choose packaged foods that consider human, societal, and planetary health.

Acknowledgments: “Staff at Clif Bar & Company developed the meeting agenda, synthesized all prework inputs, participated as observers in the workshop, and assisted in the gathering of the materials used to prepare this manuscript.”

Here is an ingredient list for an oatmeal raisin walnut Clif Bar:

ORGANIC ROLLED OATS, ORGANIC BROWN RICE SYRUP, SOY RICE CRISPS (SOY PROTEIN ISOLATE, RICE FLOUR, BARLEY MALT EXTRACT), ORGANIC ROASTED SOYBEANS, ORGANIC TAPIOCA SYRUP, ORGANIC CANE SYRUP, ORGANIC RAISINS, CHICORY FIBER, ORGANIC SOY FLOUR, WALNUTS, SUNFLOWER AND/OR SOYBEAN OIL, NATURAL FLAVORS, SALT, ORGANIC CINNAMON, MIXED TOCOPHEROLS (ANTIOXIDANT).

My definition of ultra-processed is that you can’t make it in your home kitchen because the ingredients are industrially produced and not available in supermarkets.  By this definition, the soy rice crisps are ultra-processed and maybe chicory fiber, but that’s about it.

The Clif people must be worried that they will be viewed in the same category as seriously ultra-processed snack foods.

Let’s give them and their parent company, Mondelez, credit for full disclosure.

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The commentary: Perspective: Soy-Based Meat and Dairy Alternatives, Despite Classification as Ultra-Processed Foods, Deliver High-Quality Nutrition on Par With Unprocessed or Minimally Processed Animal-Based Counterparts.  By Mark Messina, John L Sievenpiper, Patricia Williamson, Jessica Kiel, John W Erdman, Jr.  Advances in Nutrition, nmac026, https://doi.org/10.1093/advances/nmac026

Purpose: “This perspective argues that none of the criticisms of UPFs [ultra-processed foods] apply to soy-based meat and dairy alternatives when compared with their animal-based counterparts, beef and cow milk, which are classified as unprocessed or minimally processed foods (group 1). Classifying soy-based meat and dairy alternatives as UPFs may hinder their public acceptance, which could detrimentally affect personal and planetary health. In conclusion, the NOVA classification system is simplistic and does not adequately evaluate the nutritional attributes of meat and dairy alternatives based on soy.

Conflicts of interest: the statement is so long that I will save it for the end.

Comment: This commentary is a critique of the NOVA classification system, which puts foods in four categories by level of processing:

• Group 1: Unprocessed/minimally processed (fruit, vegetables, nuts, grains, meat, milk with no complicated additives)
• Group 2: Processed culinary ingredients (oils, fats, butter, vinegars, sugar, and salt eaten with added to Group 1)
• Group 3: Processed (mix of groups 1 and 2, chiefly for preservation)
• Group 4: Ultra-processed (industrially produced, cannot be made in home kitchens, chemical additives)

By this time, literally hundreds of studies have linked frequent consumption of ultra-processed (“junk”) foods to weight gain and its associated chronic diseases—type 2 diabetes, heart disease, etc—as well as high risk for poor outcome from COVID-19.  One carefully controlled clinical trial has shown that ultra-processed diets induce people to unwittingly take in more calories (“you can’t eat just one.”).

Artificial meats and dairy products made with plant proteins clearly meet the definition of ultra-processed.   Are soy products in a different category from those made with pea protein, for example?  Should plant-based meats in general be exempt from being considered ultra-processed?

I don’t think we know yet whether these products are better for health and the environment.  The issues are complicated and we don’t yet have the research or experience.

These authors report conflicted ties—many such ties—to companies making soy products and other products that might be considered ultra-processed:

Author disclosures: MM is employed by the Soy Nutrition Institute Global, an organization that receives funding from the United Soybean Board and industry members who are involved in the manufacture and/or sale of soyfoods and/or soybean components. JLS has received research support from the Canadian Foundation for Innovation, Ontario Research Fund, Province of Ontario Ministry of Research and Innovation and Science, Canadian Institutes of health Research (CIHR), Diabetes Canada, PSI Foundation, Banting and Best Diabetes Centre (BBDC), American Society for Nutrition (ASN), INC International Nut and Dried Fruit Council Foundation, National Dried Fruit Trade Association, National Honey Board (the USDA honey “Checkoff” program), International Life Sciences Institute (ILSI), Pulse Canada, Quaker Oats Center of Excellence, The United Soybean Board (the USDA soy “Checkoff” program), The Tate and Lyle Nutritional Research Fund at the University of Toronto, The Glycemic Control and Cardiovascular Disease in Type 2 Diabetes Fund at the University of Toronto (a fund established by the Alberta Pulse Growers), and The Nutrition Trialists Fund at the University of Toronto (a fund established by an inaugural donation from the Calorie Control Council). He has received food donations to support randomized controlled trials from the Almond Board of California, California Walnut Commission, Peanut Institute, Barilla, Unilever/Upfield, Unico/Primo, Loblaw Companies, Quaker, Kellogg Canada, WhiteWave Foods/Danone, Nutrartis, and Dairy Farmers of Canada. He has received travel support, speaker fees, and/or honoraria from Diabetes Canada, Dairy Farmers of Canada, FoodMinds LLC, International Sweeteners Association, Nestlé, Pulse Canada, Canadian Society for Endocrinology and Metabolism (CSEM), GI Foundation, Abbott, General Mills, Biofortis, ASN, Northern Ontario School of Medicine, INC Nutrition Research and Education Foundation, European Food Safety Authority (EFSA), Comité Européen des Fabricants de Sucre (CEFS), Nutrition Communications, International Food Information Council (IFIC), Calorie Control Council, International Glutamate Technical Committee, and Physicians Committee for Responsible Medicine. He has or has had ad hoc consulting arrangements with Perkins Coie LLP, Tate & Lyle, Wirtschaftliche Vereinigung Zucker eV, Danone, and Inquis Clinical Research. He is a member of the European Fruit Juice Association Scientific Expert Panel and former member of the Soy Nutrition Institute (SNI) Scientific Advisory Committee. He is on the Clinical Practice Guidelines Expert Committees of Diabetes Canada, European Association for the study of Diabetes (EASD), Canadian Cardiovascular Society (CCS), and Obesity Canada/Canadian Association of Bariatric Physicians and Surgeons. He serves or has served as an unpaid scientific advisor for the Food, Nutrition, and Safety Program (FNSP) and the Technical Committee on Carbohydrates of ILSI North America. He is a member of the International Carbohydrate Quality Consortium (ICQC), Executive Board Member of the Diabetes and Nutrition Study Group (DNSG) of the EASD, and Director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation. His wife is an employee of AB InBev. PW is employed by Cargill, Inc, a global food company headquartered in Wayzata, MN. Cargill produces soy-based food and industrial products. JK is employed by Medifast Inc., a nutrition and weight-management company based in Baltimore, Maryland, that uses soy protein in many of its products. JWE is a scientific advisory to the Soy Nutrition Institute Global.