BTW, I noticed in early June a marked increase in interest on my post on ultra-processed foods with a large number of views coming from the United Kingdom. In mid-to-late June interest peaked from American viewers. The rush to my site coincided with the release of Ultra-Processed People.
The four-week ultra-processed food diet was van Tulleken’s way of attempting to understand these products and their potential health consequences. He would consume 80% UPF in this diet. Before starting the diet, he refrained from eating any UPF for four weeks. To his surprise he found that about 30% of his calories were coming from UPF. He noted that, to his surprise, not all UPF is junk food. He found it difficult to eliminate UPF from his food selection, as many of these products were convenient to prepare and consume. During these four weeks and endocrinologist specializing in obesity and diabetes monitored his health.
After UPF deprivation, the author looked forward to WEEK ONE, approaching it with curiosity. His daughter joined him at a breakfast of Coco Pops. He observed a burst of flavor and incredible textural experience with his first bite. He lost the joy of the experience after a few spoonsful. His daughter continued the experimental regimen by consuming additional bowls. During WEEK TWO, he went on a camping trip with his brother and two brothers-in-law. He consumed Doritos, Red Bull, Skittles, and Hairbo Supermix the first day and woke up sick and sad. Even ‘naturally wholesome museli’ qualified as a UPF, much to the amazement of his companions because of whey powder as an ingredient.
By WEEK THREE of the diet, our infectious disease specialist had thoroughly reviewed the literature critical of NOVA classification and the concept of ultra-processed foods. It was easy to disregard these articles because he could always find a connection between one or more of the authors and the food industry. These conflicts of interest allowed him to ignore the points of the literature, because if someone associated with the food industry said or wrote it, we could safely assume it was untrue. By now he was reading only scientific literature and consulting with scientists that claimed UPF was unhealthy. As he moved from confirmation bias to motivated reasoning, he had trouble eating food that all these experts were saying was harmful. All the additives were trying to make each “industrially produced edible substance” taste like real food. All the meals were uniform. He wasn’t hungry, but he wasn’t satisfied either.
WEEK FOUR came, and his waistline was growing. His family was gaining weight as well as they couldn’t stop eating UPF either. He became anxious leading to bad dreams. The author’s sleep patterns and digestive output were altered. He ached, he felt miserable and irritable, and his productivity at work declined. Yet he craved the food that was making him sick! He commiserated with his new-found friends who had warned him about the dangers of these products. He concluded that there must be a spectrum between harmful and not so harmful, but it is hard to determine which is which. Implicit in the NOVA classification scheme, all UPF products are equally harmful. At the end of his experiment, he had gained 13 pounds. Once he saw the results of his brain scan, he was horrified and stopped the diet right there.
Personal experimentation can provide insight into an unfamiliar topic and appreciation for its complexity. It can spur the experimenter to formulate questions that wouldn’t be considered otherwise. Drawing conclusions simply from personal experience is anecdotal and not reliable. The author also noted a pronounced weight difference between his brother and himself. He attributed the difference to his brother moving to the USA and eating too many ultra-processed foods. This conclusion is at odds with many studies on twins separated from each other and raised in different home environments.
Like me, the author cultivated his critical-thinking skills by participating in journal club in grad school. His experience differed from mine in at least one way. He found that 70% of the articles presented were “demolished” in the discussion, and 10% showed “evidence of naked fraud.” The remaining 20% would provide “new useful information.” In the journal club I attended, we found problems in many of the articles we read, but we tried to look more deeply to learn what each article could tell us. Sometimes we would take a careful look at the data as shown in the figures and tables, which would provide insight into the study not mentioned in the results and discussion. Maybe van Tulleken’s club could have benefitted from more than one discipline participating. Students from both food science and human nutrition participated in the journal club I attended.
He drew many conclusions from his experience and reading. First, it is not the sugar, a lack of exercise, nor impaired willpower that cause obesity. He cites several studies that show that exercise doesn’t lead to weight loss. Hunter-gatherers and sedentary office workers burn a similar number of calories in a day. Studies conducted by industry scientists support an energy-balance theory suggesting that weight is determined by a balance of calories consumed and calories burned. Since industry, particularly Coca-Cola believes it, it must be propaganda and wrong. Are we deluded if we believe that we can lose weight by exercising?
Yet, van Tulleken puts much weight in the NIH study conducted by Kevin Hall. This excellent study showed a direct relationship between calories consumed and changes in weight over the experimental period. Participants on a UPF diet gained 2 pounds over a 2-week period by consuming 500 calories a day more than those who did not consume UPF. The non-UPF subjects lost 2 pounds over that same 2-week period. It is easy to extrapolate to 50-plus-pounds weight loss or gain per year, but extrapolation beyond the data is always a dangerous practice. Our bodies tend to adjust to new diets over time through homeostasis. Another way of looking at the data is that the UPF group consumed 250 calories a day more than needed for replacement and the non-UPF group 250 calories per day under replacement. In addition, an unplanned loss of 50 pounds could be as unhealthy as an unplanned 50-pound gain.
Ultra-Processed People goes into great detail about the addictive nature of UPF. The author carefully cites the criteria for addictive substances described in the Diagnostic and Statistical Manual of Mental Disorders (DSM). He declares food to be addictive and considers UPF to be addictive substances. What he ignores is that ‘substance’ in the DSM has been viewed as a chemical or related family of chemicals such as alcohol or opioids. The idea that hyper-palatability of uncharacterized combinations of fat and sugar can be considered as addictive substances defies a basic understanding of chemistry. He does not accept a designation of a behavioral or eating addiction, similar to a gambling addiction, which could fit his criteria.
In agreement with the NOVA classification scheme, van Tulleken’s concept of ultra-processing is all about the additives. Throughout the book, he is obsessed with ingredient statements. Reference to actual food processes or ultra-processes are rare. His main concern lies with ingredients that sound like chemicals and can’t be found in most home kitchens. He prefers natural foods, but ‘natural’ too often is in the eye of the beholder and changes connotation over time. Sugar and salt are permitted culinary ingredients, but are they natural or processed by the time they make it to the modern American kitchen? And just how natural is the way we prepare foods in that home kitchen compared to food preparation a mere 100 years ago?
Take home lesson. The author serves a warning to all of us ultra-processed people that we are damaging our health and shortening our lifespans through poor food choices. At first, he questions whether these foods are as dangerous as they seem. In ignoring anyone who might have ties to the food industry and communicating with only critics of ultra-processed foods, he concludes that these products are indeed dangerous and should be avoided as much as possible. It is clear in his mind that consumption of such foods is to blame. Consumers are not responsible for the damage these products do their bodies. It is all about the dangerous ingredients added to ultra-processed foods by Big Food. Is van Tulleken right? Or does he oversimplify food and health?
Coming soon: Ultra-Processed Foods on Trial
In Defense of Processed Food 
2 thoughts on “Ultra-Processed People”