Welcome to our double feature on ultra-processed foods, or UPFs.
In Part 1, we will dive into what ultra-processed foods (UPFs) are and how they affect your body and wellbeing. This is a hot topic at the moment, as what we put into our bodies is under scrutiny more than ever before. In fact, a recent publication in The Lancet found that bad diets are responsible for more deaths worldwide than smoking, being attributed to around 11 million deaths a year, and another study in the BMJ showed that UPFs were associated with a slightly higher mortality overall, with meat/poultry/seafood-based ready-to-eat products showing particularly strong association.
In Part 2 we will look at how to avoid UPFs, as well as strategies that you can put in place to ensure that you have a healthy lifestyle.
The rise and rise of the UPF
In modern times, food preparation and processing has increasingly become a feat of engineering – touched by human innovation just as much as the world around us. We might marvel at our technological achievements, like dams and skyscrapers, but there’s just as much science and R&D in the food production industry. UPFs are one example of this – and they’ve become staples in our diets due to their low cost, convenience and accessibility.
Understanding and Defining UPFs
Unlike simple processed foods, UPFs are manufactured through extensive industrial processes. As a result, they’re designed to be delicious and convenient with a long shelf-life. However, they are typically high in salt, sugar, additives, preservatives and unhealthy fats.
Before we start an in-depth discussion about UPFs, it should be noted that while a number of countries advise on the reduction or avoidance of UPFs due to the correlation between high intakes and poor health outcomes including heart disease, type 2 diabetes, obesity and cancer, it is difficult to untangle the impact of dietary patterns with lifestyles. This means that there is not necessarily any clear evidence of a causal association between food processing and health per se. In addition, at present in the UK there is no agreed definition of what constitutes a UPF.
However, whether or not there is an agreed definition of what a UPF is, the general consensus is that the more processing that a foodstuff has undergone, the worse it is likely to be for you. Alongside their likely poor nutritional value, it is suspected that UPFs are addictive: a recent study in the BMJ found “ultra-processed food addiction” was estimated to occur in 14% of adults and 12% of children, with data being derived from 281 studies across 36 different countries. While seeming harmless on the surface, this addiction could cause health issues in later life, impacting upon mortality and overall general population health.
The term UPF is derived from the NOVA classification system, which differentiates food types depending upon the extent and type of processing that has been applied. There are four distinct classifications:
- Unprocessed and minimally processed foods
- Processed culinary ingredients
- Processed foods
- “Ultra-processed” foods.
Using the NOVA classification system, UPFs are “products involving formulations of ingredients, most of exclusive industrial use, typically created by a series of industrial techniques and processes”. Examples include:
- Snack foods: For example potato chips, nachos, and other packaged snacks that are often high in salt and preservatives.
- Processed/reconstituted meat and fish products: Sausages, bacon, and some types of ham are often high in sodium and saturated fats, while turkey twizzlers and chicken nuggets are often heavily processed.
- Confectionery, desserts, and bakery products: Includes sweets, chocolate bars, ice cream and ready-made cakes as well as packaged bread, pastries, and other bakery products that often contain additives and preservatives to extend their shelf life.
- Cereals and breakfast bars: Breakfast cereals and energy/snack bars that are high in sugar and low in fibre.
- Instant and packaged soups: These often contain high levels of sodium and preservatives, with minimal nutritional value.
- Frozen foods: Including frozen pizzas, dinners, and snacks, which are typically high in calories, sodium, and additives.
- Sugary drinks: Fizzy drinks, sweetened juices, energy drinks, and flavoured coffees and teas that are high in sugar.
- Dairy: Some processed cheeses, flavoured yoghurt, and dairy-based desserts can be high in sugar and artificial ingredients.
- Pre-made sauces and dressings: Many of these contain high levels of sugar, salt, and preservatives.
- Meal replacements and supplements: Including protein shakes and diet bars, which may contain artificial flavours and sweeteners.
Understanding what UPFs are and the impact that they can have on health is crucial for addressing the health risks associated with their consumption. In addition, education of the public so they can make informed dietary choices is also important.
The importance of education about UPFs and their impact
To raise public awareness about UPFs, Dr Chris van Tulleken is on a mission to help people understand the dangers of UPF-heavy diets and their impact on overall health. In 2021, he challenged himself to eat a diet made up of mostly UPFs for a month. The results were eye-opening. Over the month, Chris reported poor sleep, heartburn, unhappy feelings, anxiety, sluggishness, low libido and piles from constipation. In addition he gained almost 7 kg in four weeks and there was brain activity in the areas linked with reward and, the more often you experience reward from foods, the more you have to consume to sustain the same enjoyment. Chris said “eating ultra-processed food became something my brain simply tells me to do, without me even wanting it”.
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How UPFs Link to Blood Pressure and Health
UPFs are closely linked to increased blood pressure (or hypertension), a key risk factor for cardiovascular disease and chronic conditions including heart disease, peripheral arterial disease, aortic aneurysms, kidney disease, and vascular dementia. Two recent studies highlighted some data to show their impact on overall health.
The first study at the University of Sydney followed 10,000 women over 15 years, finding that those who consumed the highest proportion of UPFs had a 39% greater likelihood of developing hypertension when compared with those with the lowest UPF intake. This relationship persisted even after accounting for the levels of salt, sugar, and fat in their diet. The second study involved over 325,000 men and women and revealed that individuals with the highest consumption of UPFs were 24% more likely to experience adverse cardiovascular events such as heart attacks, strokes, and angina.
These studies, presented at the 2023 European Society of Cardiology’s annual meeting, underscore the urgent need for action against the rising consumption of UPFs. This research also sheds light on the misconception that certain foods perceived as healthy, such as shop-bought sandwiches, wraps, soups, and low-fat yoghurt, are in fact UPFs.
Nutritional myths, especially those targeting consumers looking for healthier food alternatives, often lead to misinformation about UPFs. A prevalent misconception is that ‘diet’ or ‘low-calorie’ options are healthier, which is not always the case. These foods can still be high in other harmful ingredients, misleading consumers about their dietary choices. In some cases there can be advantage to choosing the ‘low fat’ or ‘low sugar’ option, but educating the public about other ‘hidden’ ingredients may also be useful and help people make informed dietary choices.
It has also been suggested that the harm caused by UPFs may extend beyond their high fat, sugar, and salt content, indicating the need for further research into the full scope of health risks they pose. The high prevalence of UPFs in diets and the potential risks they cause create significant concerns for future public health and the potential burden on healthcare systems.
But all hope is not lost, as you will see in Part 2 of this feature. In there, we will talk about the power of prevention and how inclusion of UPFs within diets is starting to be questioned. In addition, we’ll also discuss how simple changes to your lifestyle can help ensure that your heart and overall wellness is optimized, and how Aktiia can help you stick to any goals.
Disclaimer: The information in this article is for educational purposes only and not intended as medical advice. If you have any health concerns, please consult with your physician or qualified healthcare provider. Any changes to your diet or lifestyle should be made under medical supervision. The author and publisher are not responsible for any adverse effects resulting from the use or application of the information presented in this article.
Sources:
A. Afshin; P. J. Sur; K. A. Fay; L. Cornaby et al. (2019). Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 393 (10184), 1958. https://doi.org/10.1016/S0140-6736(19)30041-8
Z. Fang; S. L. Rossato; D. Hang and co-workers (2024). Association of ultra-processed food consumption with all cause and cause specific mortality: population based cohort study. BMJ, 385, e078476. https://doi.org/10.1136/bmj-2023-078476
British Nutrition Foundation position statement on the concept of ultra-processed foods (UPF). British Nutrition Foundation. https://www.nutrition.org.uk/news/position-statement-on-the-concept-of-ultra-processed-foods-upf (Accessed January 2025)
R. Rodrigues Petrus; P. J. do Amaral Sobral; C. Cecília Tadini; C. Bernardo Gonçalves (2021). The NOVA classification system: A critical perspective in food science. Trends in Food Science & Technology, 116, 603. https://doi.org/10.1016/j.tifs.2021.08.010
A. N. Gearhardt; N. B. Bueno; A. G. DiFeliceantonio and co-workers (2023). Social, clinical, and policy implications of ultra-processed food addiction. BMJ, 383, e075354. https://doi.org/10.1136/bmj-2023-075354
The easy ultra-processed food swaps Dr Chris Van Tulleken swears by. BBC. https://www.bbc.co.uk/food/articles/chris_van_tulleken_ultra_processed_food_swaps (Accessed January 2025)
What happened when I ate ultra-processed food for a month. BBC. https://www.bbc.co.uk/food/articles/van_tulleken (Accessed January 2025)
C. R. Oladele; N. Khandpur; S. Johnson and co-workers (2024). Ultra-Processed Food Consumption and Hypertension Risk in the REGARDS Cohort Study. Hypertension, 81 (12), 2520. https://doi.org/10.1161/hypertensionaha.123.22341
Ultra-processed food raises risk of heart disease, heart attack and stroke. British Heart Foundation. https://www.bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2023/august/ultra-processed-foods-linked-to-cardiovascular-risk (Accessed January 2025)
A. Pant; S. Gribbin; P. Machado; A. Hodge et al. (2024). Ultra-processed foods and incident cardiovascular disease and hypertension in middle-aged women. Eur. J. Nutr., 63 (3), 713. https://doi.org/10.1007/s00394-023-03297-4
