Currently browsing posts about: Ultraprocessed

Canada has joined the ranks of countries with front-of-package food labels alerting customers to products high in salt, sugar, and saturated fat.

I learned about this in a press release from Kate Comeau, Communications Advisor, Mission, Canada | Heart & Stroke

The official announcement from Health Canada is here. 

It comes with an explanatory Infographic.

I think the warning labels used in some Latin American countries work better, but this is a big step forward and is likely to cover the great majority of ultra-processed foods—and those are the ones that are best avoided.

Congratulations to Canadians who pushed for this.  Progress!

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.

The American Journal of Public Health has just published a first look—ahead of its print in June—at my most recent article, Regulating the Food Industry: An Aspirational Agenda [if you are not a member of the American Public Health Association, this will be behind a paywall, alas].

It begins:

I end it with policy recommendations for:

• Dietary guidelines
• Mass media campaigns
• Taxes
• Warning labels
• Marketing restrictions
• Portion size restrictions
• Farm subsidies

Hence, aspirational.

And, I say,

While we are thinking in aspirational terms, let us not forget root causes. We must also demand policies that link agriculture to public health, keep corporate money out of politics, reduce corporate concentration, and require Wall Street evaluate corporations on the basis of social as well as fiscal responsibility.  In comparison with those challenges, takin gon the food industry should be easy.

Let’s get to work.

Tara Kenny, a postdoctoral researcher in Ireland sent me this one.

The paper: Perspective Nutrition research challenges and processed food and health. Michael J. Gibney and Ciarán Forde. Nature Food, 2022.

Purpose: “If public health nutrition is to consider the degree of food processing as an important element of the link between food and health, certain gaps in research must be acknowledged.”

Method: The paper compares and critiques differing classification systems for processed foods, emphasizes the physical and sensory aspects of food products as reasons for consumption, and suggests areas for further research.

Conclusion: “The NOVA recommendation that HPFs be avoided poses a considerable challenge, given that a wide body of evidence across the globe shows that almost two-thirds of all energy comes from HPFs…Finally, notwithstanding the opposition of NOVA to the reformulation of HPFs, the value of this approach is internationally recognized.”

Competing interests: “M.J.G. has engaged in paid and non-paid consultancy for a wide range of food companies that manufacture processed foods. He has provided online presentations on ultraprocessed foods to the staff of Unilever and Mondelez. C.G.F. is currently a paid member of the Kerry Health and Nutrition Institute.”

Comment: The paper is a critique of the term ultra-processed (the authors prefer Highly Processed Foods or HPF), of the NOVA classification system for levels of food processing, and of the idea that ultra-processed foods continue to remain in the category of ultra-processed even when reformulated.

Dr. Kenny provided a deeper analysis of the conflicts of interest inherent in this paper; she read the references to several statements in the paragraph that follows the subtitle, “First, do no harm”.

• Ample evidence exists to show that there are no differences in postprandial glucose or insulin response following the ingestion of breads, varying from wholegrain to white and to those with and without additives (Breen et al & Gibney, MRC Human Nutrition Research, Government Agency)
• Similarly, studies show that the nutrient intakes of infants fed on home-prepared infant and toddler foods are not materially different to those of infants fed on industrially prepared products with the exception of sodium, which was higher in the infants fed with home-prepared foods (Reidy et al, 2018 – lead author is head of Nutrition Science for Baby Food, Nestlé Infant Nutrition, Global R&D and leads the Feeding Infants and Toddlers Studies globally. Three additional authors are also Nestle employees).
• Breakfast cereals, normally served with milk, make a very important contribution to micronutrient intake (Gibney et al, 2018 – funded by Cereal Partners Worldwide and General Mills Inc.)
• The advent of low-fat spreads optimized for fatty-acid profile have contributed to a substantial reduction in the intake of saturated fatty acids (Li et al & Gibney).
• Beverages sweetened with artificial sweeteners help reduce the intake of added sugars. These filters should also include foods that are generally regarded as ‘treats’ that have a negligible population impact on nutrient intake (for example, ice cream and chocolate). For example, a study of chocolate intake in 11 European countries showed that the contribution of chocolate to added sugar intake averaged 5% (Azaïs-Braesco et al, funded by Danone Nutricia Research)…”.

She also provided a link to a much more detailed conflict-of-interest statement filed as a correction to another paper co-authored by Mike Gibney.

I’ve written frequently about ultra-processed foods and why I think the NOVA classification is so useful.  See, for example, this post (the classification system) and this one (Kevin Hall’s study).

Despite the opinions expressed in the Nature Food paper, reducing intake of ultra-processed foods seems like a really good idea.

Let’s start 2022 off with a review sent to me by a reader who wishes to remain anonymous.

The review: Implementing the 2020–2025 Dietary Guidelines for Americans: Recommendations for a path forward. Sanders, L. M., Allen, J. C., Blankenship, J., Decker, E. A., Christ-Erwin, M., Hentges, E. J., Jones, J. M., Mohamedshah, F. Y., Ohlhorst, S. D., Ruff, J., &Wegner, J. (2021). J Food Sci. 86:5087–5099.  https://doi.org/10.1111/1750-3841.15969

Method: Based on a workshop aimed at developing strategies to promote adoption of dietary guideline recommendations.

Workshop funding: a grant from USDA with contributions from the Institute of Food Technologists.

Conflicts of interest: Mary Christ-Erwin is President and Owner of MCE Food and Agriculture Consulting and received an honorarium from the grant for moderating the meeting and panel and roundtable discussions. Julie M. Jones is a Scientific Advisor to USA Rice, Grain Foods Foundation, and the Quality Carbohydrate Coalition. John Ruff is an Investment Committee Member for Sathguru Catalyser Advisors Private Limited, the Asset Management Company of Innovation in Food and Agriculture Fund (IFA Fund) that invests in innovation-driven growth enterprises in the Food and Agriculture sectors, based in India. He is reimbursed for meeting fees and expenses related to attending committee meetings but has no investments in the fund. Lisa M. Sanders [Note: First author who wrote original draft] is the owner of Cornerstone Nutrition, LLC, a consultancy which has received funding from Kellogg Company, PepsiCo, and The Coca-Cola Company. Dr Sanders receivedwriting fees fromthe grant for development of this manuscript. JillWegner is an employee of Nestle. Jonathan C. Allen, Jeanne Blankenship, Eric A. Decker, Eric J.Hentges, Farida Y. Mohamedshah, and Sarah D. Ohlhorst have no conflicts to declare.

Comment: This workshop reflects a food industry perspective on the dietary guidelines.  Some of its reocmmendations make sense.  Others raise eyebrows, or should.

• The first recommendation: “Emphasize health benefits…gained through cooking at home.
• My favorite recommendation: “Leverage the current interest in science to debunk myths about food processing by demonstrating the similarity of techniques used to make foods at home and at scale in food industry, to show how food processing can contribute to the solution.”

This review is an excellent example of why the food industry needs to firmly excluded from nutrition policy discussions (for details on why, see my book, Unsavory Truth).

My strongest criticism of the 2020 dietary guidelines is that they fail to say anything about the health benefits of reducing consumption of ultra-processed foods (the junk food category strongly associated with excessive calorie intake, weight gain, and poor health).

Yet here we have a published review in a food science journal arguing for debunking “myths” about food processing.

They are not myths.  Evidence is abundant.

See, for example:

• Monteiro CA, Cannon G, Levy RB, et al.  Ultra-processed foods: what they are and how to identify them.  Public Health Nutr; 2019;22(5):936–941.
• Lawrence MA, Baker PI.  Ultra-processed food and adverse health outcomes.  BMJ. 2019 May 29;365:l2289.  doi: 10.1136/bmj.l2289.
• Hall KD, Ayuketah A, Brychta R, et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake [errata in Cell Metab. 2019;30(1):226 and Cell Metab. 2020;32(4):690]. Cell Metab. 2019;30(1):67–77.e3. doi: 10.1016/j.cmet.2019.05.008.

I am not a litigious person and much prefer to stay out of the legal system.

But I am a big fan of Bill Marler, who represents victims of food poisonings, not least because his lawsuits against companies with sloppy food safety procedures should encourage them to clean up their processes.

I’m not sure what to think of NPR’s account of Spencer Sheehan’s 400 or so lawsuits against food companies for misleading labeling.

The one that triggered off the article is on behalf of a woman suing Kellogg over the number of strawberries in Strawberry Pop-Tarts.

Enriched flour (wheat flour, niacin, reduced iron, vitamin B1 [thiamin mononitrate], vitamin B2 [riboflavin], folic acid), corn syrup, high fructose corn syrup, dextrose, soybean and palm oil (with TBHQ for freshness), sugar, bleached wheat flour. Contains 2% or less of wheat starch, salt, dried strawberries, dried pears, dried apples, leavening (baking soda, sodium acid pyrophosphate, monocalcium phosphate), citric acid, gelatin, modified wheat starch, yellow corn flour, caramel color, xanthan gum, cornstarch, turmeric extract color, soy lecithin, red 40, yellow 6, blue 1, color added.

Some of his other cases:

Keebler and Betty Crocker and others over “fudge” cookies and baking mixes that contained no milkfat.

Frito-Lay alleging it didn’t use enough real lime juice in its “hint of lime” Tostitos.

Coors suggesting its pineapple-and-mango-flavored Vizzy Hard Seltzers are sources of Vitamin C “nutritionally-equivalent” to actual pineapples and mangos.

Snack Pack pudding — advertised as “made with real milk” — actually made with fat-free skim milk.

Many cases targeting vanilla products — soda, soy milk, yogurt, ice cream — that use synthetic vanilla or other flavors alongside or in place of the more expensive natural vanilla.

NPR says

Most of Sheehan’s suits, including the strawberry Pop-Tart cases, allege damages based on the so-called “price premium theory,” which says that products are sold at higher prices than they would have otherwise commanded had the companies marketed them honestly.

Are these cases frivolous or in the public interest?

I’m for anything that gets the makers of ultra-processed foods to advertise them for what they are, not for what they aspire to be.

Hat tip to Lisa Young for sending this one.

I am indebted to Bill Tonelli who took this photo on October 10 in Viterbo, Italy, about an hour outside of Rome.

The shop, he reports, sells American snacks—candy, chips, soda—with no pretense of worry about health or sustainability.

He sent me to the store’s website:

Benvenuti nel regno degli snack americani (Welcome to the kingdom of American snacks)

Tantissimi snack e bevande made in USA come Hershey’s, Reese’s, Monster Energy, Doritos, Cheetos, Dr. Pepper e tantissimi altri ti aspettano ! (And many others are waiting for you!)

Chronic (“noncommunicable”) diseases—heart disease, cancer, and diabetes—account for half of annual deaths in the United States at enormous physical and economic cost to individuals and to society.  These conditions are related to diet; obesity is a risk factor for all three.

Despite the widespread prevalence of obesity (the CDC says 73.6% of American adults are overweight or severely overweight) and its associated chronic conditions, no concerted government effort is aimed at prevention.

This is also true on the international level.  The UN’s Sustainable Development Goals barely mention reduction of noncommunicable diseases.  You have to go to the fourth sub-goal of SDG 3, Good Health and Well-Being, to find:

By 2030, reduce by one third premature mortality from non-communicable disaeases through prevention and treatment and promote mental health and well-being.

Why is so little attention focused on diet-related conditions?  To prevent them, people have to eat more of healthier foods and less of unhealthier foods—public health measures strongly opposed by the food industry.  [For detailed evidence on this point, see Swinburn BA, et al.  The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report.  Lancet. 2019;393:791-846].

Representatives Rosa DeLauro and Tim Ryan have the same question.  They asked the Government Accountability Office (GAO) to look into government efforts to prevent chronic disease.

The result: Chronic Health Conditions:Federal Strategy Needed to Coordinate Diet-Related Efforts.

It’s not that the US government ignores chronic disease; on the contrary.  The GAO identified an astounding 200 federal efforts to reduce these conditions—but fragmented among an even more astounding 21 federal agencies.

Most of these are focused on research.

These programs are all over the place, and nobody is in charge.

Agency Officials Say They Lack Authority to Lead a Federal Strategy on Diet:  Despite their support for a federal strategy to coordinate diet-related efforts, no agency officials we interviewed asserted that their agencies had the authority to lead a federal strategy that would have reasonable assurance of being sustained across administrations. Officials from six agencies said they would not have the authority, and officials from the remaining 10 agencies said they did not know or were not in a position to comment. Some officials stated that they would have the authority to lead a strategy for their agency alone but not for the entire federal government.

The GAO came to the obvious conclusion.

Congress should consider identifying and directing a federal entity to lead the development and implementation of a federal strategy to coordinate diet-related efforts that aim to reduce Americans’ risk of chronic health conditions. The strategy could incorporate elements from the 2011 National Prevention Strategy and should address outcomes and accountability, resources, and leadership.

Leadership!  Here’s my list.

• Say what a healthy diet is in plain English.
• Tell the public to avoid or minimize ultra-processed foods.
• Establish policies—from agriculture to public health—to promote healthful diets and discourage unhealthful diets.

This will take courage.  Hence: Leadership.