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The Prediabetes Nutritionist

Ultra-processed Foods: Do They Belong in Your Diet?

“Ultra-processed foods 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” – Monteiro et al., 2019

Some health professionals, notably registered nutritionists and dietitians, have begun tip-toeing around the subject of ultra-processed foods, commonly known as ‘junk foods’, to supposedly help people improve their relationship with food. 

These registered nutritionists and dietitians avoid advising people to eat less ultra-processed foods and more whole foods because it allegedly promotes ‘diet culture’ and encourages people to view food as ‘good’ or ‘bad’. 

While I appreciate that poor relationships with food can propagate restrictive diets, eating disorders and even weight gain, sugar-coating the truth about ultra-processed foods is also problematic. 

Let me explain. 

Obesity and type 2 diabetes are spiralling out of control worldwide, and plenty of evidence shows that lifestyle, particularly diet and inactivity are major contributing factors (Zimmet, 2017; Fruh, 2017; Kyrou et al., 2020). Evidence also shows that improving diet quality and increasing exercise promotes weight loss, prevents type 2 diabetes and its complications, and improves glucose control in people with and without type 2 diabetes (Sami et al., 2017).

Ultra-processed foods – foods that undergo many physical, biological, or chemical processes, including hydrogenation, pre-frying, moulding and extruding­– are being eaten increasingly worldwide and even comprise 56.8% and 57.9% of total energy intake in the United Kingdom and the United States, respectively (Monteiro et al., 2019; Steele et al., 2015; Rauber et al., 2019).  

In middle-income countries such as Brazil, Mexico and Chile, ultra-processed foods account for between one-fifth and one-third of total energy intake (Louzada et al., 2018; Marron-Ponce et al., 2018; Cediel et al., 2010).

However, a recent study suggests that ultra-processed food intake in some countries may be inaccurate because some of the tools used to estimate ultra-processed food intake are not validated (Marino et al., 2021). This observation is significant because using non-validated tools may cause misinterpretation of studies investigating the links between ultra-processed food intake and health markers. 

Which foods do we classify as ultra-processed? 

Ultra-processed foods include carbonated soft drinks, sweet or savoury packaged snacks, chocolate, candies, ice cream, mass-produced packaged breads and buns, margarines and other spreads, cookies (biscuits), pastries, cakes and cake mixes, breakfast cereals, pre-prepared pies, pasta and pizza dishes, poultry and fish nuggets, sausages, burgers, hot dogs and other reconstituted meat products, powdered and packaged ‘instant’ soups, noodles and desserts and many other products (Monteiro et al., 2019). 

Due to the processing these foods undergo, some contain compounds with no nutritional value and others, potentially metabolic-disrupting substances such as emulsifiers, thickening agents, colourants, sweeteners, and preservatives.

Preservatives lengthen the shelf-life of these foods, and because they remain in their packaging for long periods, harmful compounds such as bisphenol A can migrate from the packaging into food. 

Notably, exposure to bisphenol A is associated with a higher risk of type 2 diabetes (Hwang et al., 2018). 

It is obvious that the manufacturing methods and ingredients in ultra-processed foods are potentially harmful. But is there evidence that eating large amounts of these foods raises the risk of obesity and type 2 diabetes? 

Yes, lots of evidence exist (Matos, Adams and Sabate, 2021; Llavero-Valero, et al., 2021). But I will illustrate this point using recent data from the NutriNet-Santè study.

The NutriNet-Sante Study

The NutriNet-Santè study is an ongoing web-based cohort launched in 2009 in France, aiming to study the links between nutrition and health. 

It recruits and follows adults aged at least 18 using a dedicated web interface. Once they enrol, participants provide fasting blood samples. They also complete surveys about age, sex, education level, smoking status, height, weight, physical activity, health status and medication use. 

Participants complete a series of three validated web-based 24-hour dietary records on enrolment and every six months. Their food intake is categorised into one of the four NOVA food categories: unprocessed or minimally processed, culinary ingredients, processed foods, ultra-processed foods.  And the proportion of ultra-processed food in the total diet is calculated for each participant. 

What the NutriNet-Santè study found about ultra-processed foods and type 2 diabetes

A total of 104 707 adults (20.8% men) were included in the study (Srour et al., 2020). 

The mean age of the participants was 42 years, and the majority (76.47%) completed high school education at least. A total of 50.16% had never smoked, and 65.1% exercised at moderate or high intensity. Most of the participants (69.1%) had a body mass index of less than 25. 

The average contribution of ultra-processed food to the diet was 17.3%. Still, ultra-processed foods accounted for a larger proportion of diets of younger participants, individuals with obesity, low physical activity, and current smokers. 

Participants who ate ultra-processed foods frequently had higher intakes of energy, saturated fat, sodium, and sugar, with lower intakes of fibre and alcohol. Generally, they had a poor diet quality with high intakes of sugary drinks and processed meats and low intakes of whole grains, yoghurt, nuts, fruits, and vegetables. 

After a median follow-up of six years, 821 people developed type 2 diabetes. The overall incidence rate for type 2 diabetes in the cohort was 132 per 100,000. However, the incidence of type 2 diabetes among the highest consumers of ultra-processed foods was 46.9% higher than the lowest consumers, 166 vs. 113 per 100 000, respectively. 

While more studies are needed to confirm their findings, the results clearly show a higher risk of type 2 diabetes in people with high ultra-processed food intakes.

The researchers concluded that “even if a causal link between ultra-processed foods and chronic disease cannot be established do far, the accumulation of consistent data leads public health authorities in several countries such as France or Brazil to recommend privileging the consumption of unprocessed/minimally processed foods and limiting the consumption of ultra-processed food in the name of the precautionary principle.”

Among a smaller cohort of 33 256 participants, the researchers also found that eating organic foods was associated with a lower risk of type 2 diabetes (Kesse-Guyot et al., 2020). While they did not specify the foods that comprised the organic food diet, they assumed it to be high-quality.

What the NutriNet-Santè study found about ultra-processed foods and obesity

A total of 110 260 adults were included in this study; 78.2% were women (Beslay et al., 2020). The mean age of the participants was 43 years, 64.6% were highly educated, and the average BMI was 23.8. 

Participants were grouped into four quartiles based on how much ultra-processed food they ate; those in the first quartile ate the least ultra-processed foods, and those in the fourth quartile ate the most. 

Participants in the fourth quartile had higher BMIs at baseline than those in the first quartile. And while BMI increased in all participants over time, those who ate the least amounts of ultra-processed foods had the lowest increases. 

“In this large prospective cohort, participants consuming more ultra-processed foods tended to present higher BMI increase during follow-up and had increased risk of becoming overweight and obese, independently of their baseline BMI. These associations remained statistically significant after adjusting for a wide range of socioeconomic and lifestyle factors, and after further adjustments for several indicators of the nutritional quality of the diet,” the researchers wrote. 

After a mean follow-up period of four years, 7 063 participants became overweight. The risk of becoming overweight increased as ultra-processed food intake increased, with those in the fourth quartile showing the highest risk of becoming overweight. 

Similar findings were observed for obesity. After a mean follow-up period of five years, 3,066 participants became obese. Notably, those with the highest intakes of ultra-processed foods had the highest risk of becoming obese. 

“We also observed an increased risk of overweight and obesity in participants consuming more ultra-processed foods….The positive association observed between ultra-processed foods and weight gain may be partly explained by their poorer nutritional quality,” the researchers wrote.

“On average, ultra-processed foods tend to be higher in saturated fats, sugar, and energy and poorer in dietary fibre, i.e., nutritional factors known to favour obesity onset,” they added.

Further analysis showed that ultra-processed beverages, dairy products, fats and sauces, and meat, fish, and egg were associated with higher overweight and obesity risks. But ultra-processed starchy foods and breakfast cereals were linked to a higher risk of only overweight. 

Conversely, eating these foods in their unprocessed forms was not associated with an increased risk of obesity or overweight except for products based on meat, fish, or eggs. 

For every 100g increase in unprocessed meat, fish or egg intake, there was a 16% and 17% increased risk in overweight and obesity, respectively. Interestingly, eating any type of unprocessed or minimally processed foods was linked to a significantly lower risk of overweight. 

Still, “the results of this large-scale prospective study based on detailed and validated dietary data highlight positive associations between the dietary contribution of ultra-processed foods with weight gain and risks of overweight and obesity,” the researchers wrote. 

“These associations may be partly explained by the nutritional profile of ultra-processed foods, but some other dimensions specific to food processing (e.g., food matrix modification, particular food additives and contact materials, neo-formed contaminants) probably play a key role,” they added.

“These findings might help physicians and dietitians in clinical practice by providing evidence about the role of UPF in weight gain and obesity management,” they wrote. 

Dear Reader,

Whether you choose to label ultra-processed foods as good or bad is irrelevant. The available evidence, albeit largely observational, shows that eating a diet containing large amounts of ultra-processed foods with few unprocessed or minimally processed food is detrimental to your health. 

We are continuously bombarded with toxins in the air, water, and other sources we can’t control. But we can limit the number of toxins and non-nutritive compounds we knowingly ingest through food. 

Help your body keep you healthy by eating whole, natural foods that boost your immunity and keep your body functioning optimally. 

You don’t need to eliminate ultra-processed foods from your diet (if you don’t want to), but you can dramatically reduce the amount you eat to boost your health. 

Please believe me when I say that the long-term benefits of decreasing your intake significantly outweigh any short-term discomfort.

You CAN do it.           

And if you need help, don’t hesitate to schedule a free consultation via the link on the bottom right corner of this page. I’d be delighted to support you. 


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