Ultra-processed foods are understood to be detrimental to human health across several parameters, including macronutrient and micronutrient composition, fibre, effects of food additives, toxins, heat exposure, and packaging.[1]
They are only cheap (as promoted by various MPs) when the costs of their negative metabolic effects are externalised to personal health care and public health budgets.
The cost of the metabolically related and rapidly increasing obesity crisis and just one of the consequences – that of the cost of type 2 diabetes – is being borne by every person in the country.
The failure to understand or wilfully ignore the relationship between big food manufacturing practices and the cost to productivity and human health is reflected in government inaction as set out in Henry Dimblebys’ recent book ‘Ravenous’. Plus it is covered in more detail in the 2023 Lancets; Commercial Determinants of Health series.[2]
The cost of diabetes
In the UK, the organisation Diabetes UK says that the number of people with diagnosed diabetes in 2023 has now breached 5 million. It also recognises that many others will have the condition but are yet to be diagnosed. The great majority are type 2, a disease driven by environment and lifestyle rather than type 1 which is related to genetics, infection or an autoimmune trigger.
The conservative estimate for the NHS is, that it spends around 10% of its annual budget (around £16 billion) on direct care for people with diabetes. This alone is 2% of the gross tax raised by the UK in 2022 or approximately 1/3 of the annual defence budget. The estimated global direct health expenditure on diabetes in 2019 was USD 760 billion and is expected to grow to a projected USD 825 billion by 2030 and USD 845 billion by 2045.[3] These are unsustainable and mostly preventable costs.
Common Misunderstandings
A dominant misconception is that the cause of chronic disease is the quantity of food consumed according to the metric of “calories.” Rather, it is the quality of the food consumed that contributes to insulin resistance and ultimately type 2 diabetes. The Western Diet or the Processed-Food Diet, replete with ultra-processed foods, acts as endocrine disruptors that drive adiposity and adversely alter mitochondrial ATP production.
The recent advent, validation, and utilisation of the NOVA classification (a name, not an acronym) food classification system is based on the nature, extent and purpose of industrial food processing and demonstrates that Group 4,[4] i.e., the ultra-processed food category, portends the greatest risks of morbidity and mortality. Numerous culturally diverse studies illustrate that ultra-processed food consumption is correlated with many chronic diseases. These include obesity[5], diabetes[6], heart disease[7], cancer[8], dementia[9], and other mental health disorders.[10] In short, obesity and chronic disease are not the same, in the same way that different sources of calories are not the same.[11]
Consequences
The data has clearly demonstrated that ultra-processed foods are detrimental to human health due to numerous excesses, including trans-fats, sugar, branched-chain amino acids, omega-6 fatty acids, emulsifiers, additives, salt, antibiotics, and nitrates.[12] In addition, ultra-processed foods are creating havoc with the biochemistry of the brain.
Children are especially vulnerable to specific nutritional insufficiencies, including inadequate omega-3 essential fatty acids, a lack of gut-beneficial prebiotic dietary fibre leading to limited serotonin production, and a lack of key nutrients vital for neurotransmitter function, cognition, mood, sleep, and optimal neurodevelopmental outcomes.[13]
Prof. Robert Lustig
Dr Lustig is Emeritus Prof. of Paediatrics, Endocrinology, at UCSF, and among the top 10 most eminent obesity specialists in North America. Author of New York Times best seller “Fat Chance,” he has raised the notion that it is imperative that food manufacturers recognise their role in creating the foods that predispose to disease generation and develop solutions.
Whilst everyone will agree that eating natural minimally processed foods should be the first choice, the reality is that the commercial pressures brought to bear on individuals means that ultra-processed foods are still going to be consumed. His co-founded company BioLumen has engineered an ingredient that combines natural complex polysaccharides to capture sugars and fats in the stomach. These sugar and fat ‘micro-jelly-balls’ then pass through the small intestine avoiding normal absorption routes to arrive in the large colon.
Here some of the contents are released to feed the microbiome, generating short-chain fatty acids, with the rest being excreted – a type of ‘caloric elimination’.
An article in the Journal Frontiers, called the Metabolic Matrix explores the mechanisms and possibilities of companies utilising these components to minimise the harms linked to ultra-processed food consumption.[14]
Comment
The pervasive, detrimental and progressive adverse effects of the consumption of ultra-processed foods and the powerful use of marketing to drive the highly problematic commercial determinants of health ever further into society means that there has to be multiple and varied attempts to mitigate the damage.
Relying on the state, or individual willpower, has to date shown only limited success. Modifying behaviour to change people’s understanding of their food decisions does show promise but many remain unaware of the costs of their lifestyle choices or choose to ignore them.
Bio-Fortification through the ingestion of metabolically supporting nutrients derived from healthy foods and supplements is increasingly understood to be a necessary strategy by scientists to help the liver, gut and brain, but is poorly understood by politicians and exploited by commercial food manufacturers. Yet nutritional deficiency not only affects the population’s health but also causes an impact on economic prosperity. The micronutrient and macronutrient deficiency economic cost annually is estimated at ∼2 trillion US dollars.[15]
A review published in the journal Molecules sought to analyse the role of food ingredients and dietary supplements in managing chronic health conditions including metabolic syndrome and non-alcoholic fatty liver disease (NAFLD) in human clinical trials. The review found that food supplements and foods including omega-3s, polyphenols, and vitamin D, plus fruits and vegetables, can be effective in reducing pro-inflammatory cytokines found in metabolic syndrome, cardiovascular risks, and obesity, and may also improve the body’s lipid profile.[16]
The key takeaway is that the appropriate application of food supplements represents a compelling, simple and cheap way to reduce the risk of metabolic dysfunction and is amplified when combined with other healthy lifestyle changes. Modified ultra-processed foods as per BioLumen’s technology may also play a part in this approach.
References
[1] Srour B, Kordahi MC, Bonazzi E, Deschasaux-Tanguy M, Touvier M, Chassaing B. Ultra-processed foods and human health: from epidemiological evidence to mechanistic insights. Lancet Gastroenterol Hepatol. 2022 Dec;7(12):1128-1140.
[2] Commercial Determinants of Health March 23rd 2023 The Lancet
[3] Global and regional estimates and projections of diabetes-related health expenditure: Results from the International Diabetes Federation Diabetes Atlas, 9th edition
[4] Moubarac, JC, Parra, DC, Cannon, G, and Monteiro, CA. Food classification systems based on food processing: significance and implications for policies and actions: a systematic literature review and assessment. Curr Obes Rep. (2014) 3:256–72.
[5] De Vogli R, Kouvonen A, Gimeno D. The influence of market deregulation on fast food consumption and body mass index: a cross-national time series analysis. Bull World Health Organ. 2014 Feb 1;92(2):99-107, 107A.
[6] Srour B, Fezeu LK, Kesse-Guyot E, Allès B, Debras C, Druesne-Pecollo N, Chazelas E, Deschasaux M, Hercberg S, Galan P, Monteiro CA, Julia C, Touvier M. Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort. JAMA Intern Med. 2020 Feb 1;180(2):283-291
[7] Srour B, Fezeu LK, Kesse-Guyot E, Allès B, Méjean C, Andrianasolo RM, Chazelas E, Deschasaux M, Hercberg S, Galan P, Monteiro CA, Julia C, Touvier M. Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé). BMJ. 2019 May 29;365:l1451.
[8] Fiolet T, Srour B, Sellem L, Kesse-Guyot E, Allès B, Méjean C, Deschasaux M, Fassier P, Latino-Martel P, Beslay M, Hercberg S, Lavalette C, Monteiro CA, Julia C, Touvier M. Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort. BMJ. 2018 Feb 14;360:k322.
[9] Li H, Li S, Yang H, Zhang Y, Zhang S, Ma Y, Hou Y, Zhang X, Niu K, Borné Y, Wang Y. Association of Ultraprocessed Food Consumption With Risk of Dementia: A Prospective Cohort Study. Neurology. 2022 Sep 6;99(10):e1056-e1066.
[10] Hecht EM, Rabil A, Martinez Steele E, Abrams GA, Ware D, Landy DC, Hennekens CH. Cross-sectional examination of ultra-processed food consumption and adverse mental health symptoms. Public Health Nutr. 2022 Nov;25(11):3225-3234
[11] Schutte S, Esser D, Siebelink E, Michielsen CJR, Daanje M, Matualatupauw JC, Boshuizen HC, Mensink M, Afman LA; Wageningen Belly Fat Study team. Diverging metabolic effects of 2 energy-restricted diets differing in nutrient quality: a 12-week randomized controlled trial in subjects with abdominal obesity. Am J Clin Nutr. 2022 Jul 6;116(1):132-150.
[12] Lustig RH. Processed Food-An Experiment That Failed. JAMA Pediatr. 2017 Mar 1;171(3):212-214.
[13] Gow RV, Hibbeln JR. Omega-3 fatty acid and nutrient deficits in adverse neurodevelopment and childhood behaviors. Child Adolesc Psychiatr Clin N Am. 2014 Jul;23(3):555-90.
[14] Harlan TS, Gow RV, Kornstädt A, Alderson PW, Lustig RH. The Metabolic Matrix: Re-engineering ultraprocessed foods to feed the gut, protect the liver, and support the brain. Front Nutr. 2023 Mar 30;10:1098453.
[15] Ofori KF, Antoniello S, English MM, Aryee ANA. Improving nutrition through biofortification-A systematic review. Front Nutr. 2022 Dec 9;9:1043655
[16] Figueiredo PS et al. “An overview of novel dietary supplements and food ingredients in patients with metabolic syndrome and non-alcoholic fatty liver disease.” Molecules. Published online April 11, 2018.