Is Covenience in our Diet Killing Us? Is it by Design?

I have written several articles healthcare issues. A series of links have been provided at the bottom of this article for your convenience.

When we consider our biggest collective global problems, we might think of climate change, famine, traffic congestion/pollution, and rampant capitalism. But these are merely side effects of the real issue — the deep human desire for convenience.

Cars are now being built that can parallel park themselves, automatically brake for hazards, and even travel across a city without a driver. At the same time, drivers are probably relying less on their own instincts, knowing the on-board computer will correct their mistakes. Well, not always — sometimes there are accidents and fatalities involved.

This is probably why I see people driving around as if there’s no cell phone law in Ontario. Distracted driving is supposed to be against the law with a fine of $615 or more. But I see people balancing their steering wheel/large pop with their knees as they cruise down my street, while they stare blankly into their device. I would wave them down, but they probably wouldn’t notice.

Phoning it in daily

Speaking of smartphones, these have driven up our laziness a lot in the past couple of decades. We all have one now, and would rather text our neighbour than knock on their door. We’d rather online shop than actually head into a store (yes, online shopping has surpassed in-store.)

Meanwhile, I see people on my street driving to the local coffee shop, which is about a five-minute walk at most. So, some of these distracted drivers could easily get out of their vehicle and take a short stroll, but they won’t. A walk to the end of the street and around the corner seems unthinkable. We have normalized driving 200 metres for sake of convenience — and maybe to avoid getting run over.

Speaking of coffee shops and restaurants, people also line up in their running vehicles during their breakfast/lunch break/coffee break. They are willing to sit in line in their climate controlled cars listening to their tunes for 15 minutes waiting to order salty meals, rather than be there and back on foot in probably less time.

While the climate changes rapidly mostly due to human activity (even NASA acknowledges global warming), we are very unwilling to sacrifice any of our creature comforts (like driving to a nearby coffee shop) for the sake of the environment. Many people outright deny we’re in a global crisis, while others are of the mind that since they pay taxes, they are entitled to live any way they’d like. And that includes buying the biggest SUV or pickup truck possible truck to cruise around the city complaining about gas prices and carbon taxes.

We need to make some moves

And then there’s the lack of exercise that is killing people. No, this is not about shaming people who are perceived as overweight, at least by BMI standards that are continuously challenged. This is about people who sit in their cars to order/eat food, rather than taking a walk.

It’s about ordering in food for dinner rather than cooking, the latter requiring some effort. It’s much easier to use an app to have food delivered than to prepare food, clear the table, and then clean afterwards. (Like, what is this, 1957?)

Much of the food we order in is filled with sodium and other bad stuff that can lead to hypertension and possible heart issues. Sedentary lifestyles (mainly sitting around watching television while eating fried chicken) doesn’t help with this issue either. Some moderate exercise is needed to manage body weight, but much more importantly, to reduce the risk of diseases that can kill us.

Many active people have a bigger body type — don’t let mainstream beauty standards fool you. But you can’t ignore the estimate that 42% of America is obese — which can cause related conditions like high blood pressure, high cholesterol, type 2 diabetes, heart disease, and stroke.

Convenience is king

So, if you look at the so-called seven deadly sins, it’s not envy or lust that’s going to destroy us for good. Greed and gluttony are up there, but they’re still not the worst of the bunch. I say that sloth is the worst of our sins, judging by our lack of willingness to change in order to survive. It’s simply inconvenient to give up anything that makes our lives easier, even if it means saving some money or the planet.

At the same time, global fertility rates are going down due to a number of factors — including the desire to live a more carefree lifestyle. Sure, finding suitable housing that’s affordable is a factor, but wanting “a happy, child-free life” is also on the rise. If governments don’t find a way to get people breeding again — like paying them more benefits — we could end up with a shrinking population by the end of the century.

Listen, I’m not shaming childless adults — good for you for recognizing your independence. Also, raising just one child is very hard work that takes a lot of resources, as I’ve learned from personal experience. It’s not a choice that a lot of people should make, for their sake and the child’s.

So, as you can see, we demand convenience despite its horrible side effects. We continue to drive vehicles that burn oil, eat calorie-stuffed fast foods, and avoid exercise due to lack of motivation. After all, it’s not convenient to have to go to a gym three times a week. (Chronic pain and lack of mobility may also be factors, but they can be helped by — you guessed it — moving around more.)

More than half of the calories consumed in an average household in the U.S. or U.K. today comes from ultra-processed food items. Over the years, the food industry has developed numerous techniques to meet food demand with products that are easy to move, store and consume. However, recent studies link the consumption of ultra-processed foods with serious diseases like diabetes, obesity, and even cancer.

More than half of the calories consumed in an average household in the U.S. or U.K. comes from ultra-processed foods. Consumption is already high in the developed world and rapidly increasing in developing countries.

However, recent scientific studies have linked eating UPF with serious health issues like diabetes, obesity, and even cancer. Although current studies cannot prove causation, experts believe reducing UPF in a diet is essential for overall well-being.

“Eating this stuff regularly, every single day, every meal, accumulating all these chemicals in our body, they make us overeat by 25%,” said Tim Spector, a professor of epidemiology at King’s College London and the co-founder of ZOE – a personalized nutrition app.

“Most of the ultra-processed food that you find are higher in salt, fat and sugar. They are designed extremely tasty, they’re ready to eat and they are aggressively marketed, especially to children”, Dr Kiara Chang of Imperial College London noted.

In the U.K., where 1 in 4 people are obese, there are growing calls for the food industry and the government to act and offer healthier options to the population. The $128 billion British food and beverage industry is the largest manufacturing sector in the country, employing more than 400,000 people.

“We are calling for food sector companies to report a set of health and sustainability metrics that would be on a mandatory basis,” said Sophie Lawrence, who leads a group of investors called the Investor Coalition for Food Policy, managing assets worth $7 trillion.

“We need to make sure that the government and businesses are acting to actually change the food environment people are living in,” said Rebecca Tobi, senior business and investment manager at the Food Foundation.

Between fast food joints on every corner and grocery shelves stuffed with processed foods – making healthy food choices in America ain’t easy. Unfortunately, poor diets can be dangerous to your health, and even deadly.

Almost half of all American adults have one or more chronic illnesses due to poor diet. And over 45% of US deaths from heart disease, stroke, or diabetes are linked to diet.

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The American diet is quite literally, killing us. Luckily, we have the power to change that. With some simple diet tweaks, you can improve your health and reduce your risk of chronic illness.

So read on to learn what the American diet is, why it’s harmful, and how to break the fast food spell and change your health for the better.

What is the Standard American Diet?

The Standard American Diet (SAD) is the dietary pattern the majority of Americans follow. It’s packed with processed foods, fast foods, added sugars, and sodium.

Wholesome foods such as fruits, veggies, whole grains, legumes, nuts, and seeds are largely forgotten.

To paint a picture, here are some common foods in the SAD diet:

Packaged foods filled with artificial flavors and colors
Fried foods
Red meat
Processed meats (deli meat, cold cuts, bacon, etc.)
Sugar-laden baked goods (cakes, cookies, etc.)
Refined grains (white bread, white pasta, white rice, etc.)
Sugar-sweetened drinks (soda, sports drinks, fruit drinks, flavored coffee drinks, etc.)
Dairy

In 2011, with obesity and chronic illness on the rise, the USDA revamped its guidelines. To make healthy eating simpler, they swapped the old food pyramid out for MyPlate.

MyPlate says that half of your plate should consist of fruits and veggies, with a quarter whole grains, and a quarter lean protein. Low-fat dairy is on the side, recommended at two cups per day.

While MyPlate is a step in the right direction, it hasn’t moved the needle much in getting Americans to clean up their diet. And it’s having some disastrous effects on Americans’ health.

The Sad Truth Behind the Standard American Diet

When you’re in a rush, it’s easier to swing by a drive-thru than to prepare a home-cooked meal. Prioritizing convenience over quality has become the norm.

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Usually, this means eating foods high in calories, trans and unsaturated fats, and excess sugars. In fact, the average American eats 3,600 calories a day! That’s far above the USDA dietary guidelines – and it shows on the scale.

Currently, 74% of American adults are overweight or obese. This increases your risk of chronic illness, including heart disease, stroke, diabetes, cancer, and fatty liver disease.

And poor diet is now one of the leading causes of death in America – even more so than smoking! Clearly, something’s not working.

So, let’s break down why the standard American diet is so SAD.

5 Major Problems with the American Diet

Excess calories aren’t the only issue with how Americans are eating. Here are five other flaws in the SAD diet.

Sugar overload

Sugar hides everywhere in the SAD diet. It’s even in foods touted as ‘healthy’ such as salad dressings, granola, and yogurt.

This is scary news considering research shows sugar is just as addictive as street drugs like cocaine. This may explain why the average American consumes 77 grams of sugar a day – or around 19 teaspoons. Over a year, that adds up to a whopping 60 pounds of sugar!

While sugar provides a quick energy source, it offers no nutrition. Eating high-sugar diets throws off your blood sugar and increases your risk of diabetes. Sugar also disrupts your gut microbiome, allowing the bad guys to outnumber the good ones.

Processed foods

Roughly 60% of the American diet is made up of processed foods. This includes soda, fast food, packaged foods, frozen meals, sweets, cereals, and canned soup.

These foods offer very little nutrition. But they’re also packed with sodium and added sugars, along with artificial flavors, colors, and preservatives.

And the more of them you eat, the more it shows on your waistline. Research shows people who buy more processed foods are more likely to be overweight or obese.

Not enough fruits and veggies

Fruits and veggies are nutritional powerhouses. They’re rich in vitamins, minerals, antioxidants, and anti-inflammatory compounds. But Americans don’t eat nearly enough of them.

The USDA recommends that US adults eat between 1.5-2.0 cups of fruits and 2-3 cups of vegetables every day. But only 12.4% of Americans meet the suggested fruit intake. And a measly 10% meet the recommended veggie intake.

Lack of fiber

Dietary fiber feeds your healthy gut bacteria, keeps your blood sugar in check, and keeps your bowels moving. Yet around 95% of Americans don’t get enough fiber.

This is partly due to not eating enough fiber-rich foods such as fruits, veggies, legumes, and whole grains. But the SAD diet is also packed with refined grain products, such as white rice and foods made with white flour.

These foods are made by removing the bran and germ from grains. While this helps extend shelf life, it strips away fiber, vitamins, and minerals in the process.

The wrong fats

Fast food and processed foods are loaded with trans fats which are harmful to your health. Trans fats increase bad LDL cholesterol and lower your good HDL cholesterol. But they also increase your risk of diabetes, heart disease, and stroke.

But not all fat is bad. Our bodies, and especially our brains need fat – just the right kind in the right amounts.

For example, omega-3 fatty acids are shown to lower inflammation, improve heart health, and keep your brain sharp. Omega-3s are found in foods such as salmon, sardines, and walnuts. But you won’t find them in the SAD diet.

5 Simple Ways to Ditch the Standard American Diet

Wondering how to break free of the SAD diet to improve your health? Here are five ways to upgrade your diet to lower your risk of chronic disease.

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1 – Avoid processed foods

As a rule, eat more foods that come from nature, and less that come in a box. While packaged foods are convenient, they’re loaded with sugar, sodium, and harmful chemicals. So limit them as much as you can.

That said, it’s nearly impossible to avoid processed foods altogether. So become a label detective and choose healthier versions. If the ingredient list is a mile long and reads like a chemistry textbook – put it back.

2 – Treat food as medicine

Each meal is an opportunity to nourish yourself. What you eat impacts your weight, energy, hormones, and even your mood. So, give your body the building blocks it needs by eating nutrient-dense foods. These include fruits, vegetables, legumes, nuts, seeds, whole grains, healthy fats, and lean protein.

And don’t forget to add some spice! Herbs and spices are rich in phytonutrients and anti-inflammatory compounds. Plus, they add flavor to your meals so you’re more likely to stick to your healthy diet.

3 – Just say no to sugar

Limit sugar as much as possible. Read the labels and steer clear of anything with added sugars – especially the dreaded high fructose corn syrup. If you drink soda, swap it out for sparkling water.

When you do make sweet treats, opt for healthier sweeteners like maple syrup, dates, honey, stevia, or coconut sugar. But don’t go overboard on these either.

4 – Eat out less, eat in more

Eating out can be hard on your waistline and your wallet. So, aim to cook as many meals at home as possible. When you eat out, you don’t know what you’re getting. This can lead to eating more sodium, fat, and calories than you intended.

But when you prepare meals at home, you’re in total control of what goes on your plate. If you’re new to cooking, no worries! You can try a boxed meal prep service, explore cooking videos on YouTube, or ask a friend or family member for cooking lessons.

5 – Focus on quality, not just quantity

Instead of obsessing over calories, focus on upgrading the quality of your foods. Choose organic fruits and veggies, wild fish, grass-fed meat, and pasture-raised eggs. These foods are higher in nutrients and have lower levels of pesticides.

If eating all organic isn’t in your budget, do what you can. Follow the EWG’s ‘Dirty Dozen’ and ‘Clean Fifteen’ lists. These tell you which foods are okay to buy conventional and which are best to buy organic.

Roughly 60 percent of the calories in the average American diet come from highly processed foods. We’ve known for decades that eating such packaged products — like some breakfast cereals, snack bars, frozen meals and virtually all packaged sweets, among many other things — is linked to unwelcome health outcomes, like an increased risk of diabetes, obesity and even cancer. But more recent studies point to another major downside to these often delicious, always convenient foods: They appear to have a significant impact on our minds, too.

Research from the past ten or so years has shown that the more ultraprocessed foods a person eats, the higher the chances that they feel depressed and anxious. A few studies have suggested a link between eating UPFs and increased risk of cognitive decline.

What’s so insidious about these foods, and how can you avoid the mental fallout? Scientists are still working on answers, but here’s what we know so far.

What qualifies as an ultraprocessed food?

In 2009, Brazilian researchers put food on a four-part scale, from unprocessed and minimally processed (like fruits, vegetables, rice and flour) to processed (oils, butter, sugar, dairy products, some canned foods, and smoked meats and fish) and ultraprocessed. “Ultraprocessed foods include ingredients that are rarely used in homemade recipes — such as high-fructose corn syrup, hydrogenated oils, protein isolates and chemical additives” like colors, artificial flavors, sweeteners, emulsifiers and preservatives, said Eurídice Martínez Steele, a researcher in food processing at University of Sao Paulo, Brazil. This classification system is now used widely by nutrition researchers.

UPFs make up a majority of the packaged foods you find in the frozen food aisles at grocery stores and on the menu at fast-food restaurants — 70 percent of the packaged foods sold in the United States are considered ultraprocessed. They’re increasingly edging out healthier foods in people’s diets and are widely consumed across socioeconomic groups.

“Ultraprocessed foods are carefully formulated to be so palatable and satisfying that they’re almost addictive,” said Dr. Eric M. Hecht, an epidemiologist at the Schmidt College of Medicine at Florida Atlantic University. “The problem is that in order to make the products taste better and better, manufacturers make them less and less like real food.”

What effect do ultraprocessed foods have on mental health?

Recent research has demonstrated a link between highly processed foods and low mood. In one 2022 study of over 10,000 adults in the United States, the more UPFs participants ate, the more likely they were to report mild depression or feelings of anxiety. “There was a significant increase in mentally unhealthy days for those eating 60 percent or more of their calories from UPFs,” Dr. Hecht, the study’s author, said. “This is not proof of causation, but we can say that there seems to be an association.”

New research has also found a connection between high UPF consumption and cognitive decline. A 2022 study that followed nearly 11,000 Brazilian adults over a decade found a correlation between eating ultraprocessed foods and worse cognitive function (the ability to learn, remember, reason and solve problems). “While we have a natural decline in these abilities with age, we saw that this decline accelerated by 28 percent in people who consume more than 20 percent of their calories from UPFs,” said Natalia Gomes Goncalves, a postdoctoral researcher at the University of São Paulo Medical School and the lead author of the study.

It’s possible that eating a healthy diet may offset the detrimental effects of eating ultraprocessed foods. The Brazilian researchers found that following a healthy eating regimen, like the MIND diet — which is rich in whole grains, green leafy vegetables, legumes, nuts, berries, fish, chicken and olive oil — greatly reduced the dementia risk associated with consuming ultraprocessed foods. Those who followed the MIND diet but still ate UPFs “had no association between UPF consumption and cognitive decline,” Dr. Goncalves said, adding that researchers still don’t know what a safe quantity of UPFs is.

Why might ultraprocessed foods have this effect?

It’s unclear. “Many high-quality, randomized studies have shown the beneficial effect of a nutrient-dense diet on depression, but we still do not fully understand the role of food processing on mental health,” said Melissa Lane, a researcher at the Food & Mood Centre at Deakin University in Australia. However, there are some clues.

Much of the research has focused on how poor gut health might affect the brain. Diets that are high in ultraprocessed foods are typically low in fiber, which is mostly found in plant-based foods like whole grains, fruits, vegetables, nuts and seeds. Fiber helps feed the good bacteria in the gut. Fiber is also necessary for the production of short-chain fatty acids, the substances produced when it breaks down in the digestive system, and which play an important role in brain function, said Wolfgang Marx, the president of the International Society for Nutritional Psychiatry Research and a senior research fellow at Deakin University. “We know that people with depression and other mental disorders have a less diverse composition of gut bacteria and fewer short-chain fatty acids.”

Chemical additives in UPFs might also have an impact on gut flora. “Emerging evidence — mostly from animal studies, but also some human data — suggests that isolated nutrients (like fructose), additives such as artificial sweeteners (like aspartame and saccharin) or emulsifiers (like carboxymethylcellulose and polysorbate-80) can negatively influence the gut microbiome,” Dr. Marx said.

Poor gut microbiota diversity — as well as a diet high in sugar — may contribute to chronic inflammation, which has been linked to a host of mental and physical issues, Dr. Lane said. “Interactions between increased inflammation and the brain are thought to drive the development of depression,” she said.

It’s also worth considering the possibility that the link between highly processed foods and mental health works in both directions. “Diet does influence mood, but the reverse is also true,” said Dr. Frank Hu, a professor of nutrition and epidemiology at the Harvard T.H. Chan School of Public Health. “When you get stressed, anxious or depressed, you tend to eat more unhealthy foods, in particular ultraprocessed foods that are high in sugar, fat and chemical additives.”

How to recognize ultraprocessed foods

The best way to identify ultraprocessed foods is to read product labels. “A long list of ingredients, and especially one that includes ingredients you would never use in home cooking,” are clues that the food is ultraprocessed, said Whitney Linsenmeyer, an assistant professor of nutrition at Saint Louis University in Missouri and a spokeswoman for the Academy of Nutrition and Dietetics. Chemical names, unpronounceable words, and anything you would be unlikely to find in a kitchen cabinet are often signs that a food is in the ultraprocessed category.

You can still use convenience foods to make cooking easier without resorting to ultraprocessed foods. Products such as canned beans, frozen vegetables, precooked brown rice or canned fish are all shortcut ingredients that fit well within the scope of a healthy diet, provided there aren’t any industrial items on the ingredient list. “If the added ingredients are ones you would use yourself, like herbs, spices, salt or cooking oils,” Dr. Linsenmeyer said, “that’s an indication that the food, while processed, is not inherently bad for you.”

“Roughly 40 to 50 percent of the calories most Americans eat these days come from highly-processed foods, including fast food, take out along with snacks and convenience foods you see at eye level in the middle of the supermarket,” Catherine Anne Couch, PhD, RD said. Working with epidemiologists at the UAB School of Public Health who study how nutrition affects diseases, she finds that trend alarming.

“We’re seeing more and more research showing links between highly-processed foods and chronic long-term disease processes,” Couch said. “Two studies showed that for every 10 percent increase in consumption of highly-processed foods, risk for heart disease goes up 10 percent and risk for cancer goes up around 12 percent. Beyond that, diabetes, hypertension and obesity are closely related to how our nutritional habits are changing. Now we even see questions about how cognitive decline might relate to what we’re eating.”

What exactly is processed food? How do you define the difference between real food and highly-processed food?

“Foods are ranked in four categories,” Couch said. “Category one is usually only washed and packaged foods like eggs or tomatoes. At the most, veggies or fruit might be chopped and bagged, ready for a veggie tray.

“Category two is typically an ingredient that requires a bit of processing to make it what it is. Olive oil would need to be pressed, and butter would have to be churned.

“Category three might be canned, bottled or frozen. It could be as simple as canned fruit with a little sugar added, or ham in a can with water and natural juices. As long as you’re shopping in the first three categories, you’ll probably be doing fine as long as you read the ingredients on category three. You should recognize the ingredients, the list should be short, and you should be able to find most of them in an average kitchen.”

The difficulty comes when you get to category four—highly-processed foods. They can be on the shelf just down the aisle from foods that have a body friendly ingredient list. However, they may have up to 500 additives including some you may have never heard of. The amount of research done on the long-term effects of consuming them may vary.

These ingredients range from preservatives to bulking agents, emulsifiers, colors to make them more appetizing, flavor enhancers like sodium, and trans fats, if that’s the fat that tastes best.

“Popular brands and fast food restaurants build their business on making their foods highly palatable so people want to consume more of them, more often,” Couch said. “One study showed that people who consume highly-processed foods ate 500 calories a day more than people who ate whole foods. That many calories soon adds up to a battle with insulin resistance and obesity.”

People who habitually eat real food also have a built-in advantage at staying fit through life because, while highly-processed foods pass through the stomach quickly, whole foods stick around longer and generally take more energy to digest. It may only be a few calories per meal, but over a number of years, it can add up to the difference between being fit or having to battle middle-age spread.

In the millennia of evolution that shaped our digestive systems, it’s easy to see that we made a wrong turn a few generations ago. Unfortunately, it’s harder to see how we’re going to get back to eating and enjoying healthy food.

“Health professionals need to understand the critical role real food plays in preventing disease and helping people heal,” Couch said. “We have to get that message through to patients and point them in the right direction to learn how to eat healthier.”

We’ve lost a generation of cooks who picked dinner from the garden and knew how to get it on the table in half an hour, building flavors with savory fresh ingredients and herbs to make homemade taste preferable to takeout. Before we lose another, we need cooking classes, even if they are on YouTube. The person who cooks needs to know about convenience techniques like sheet pan meals; making two and freezing one; slow cookers; and once a month freezer prep meals.

A second class could teach people how to grow their own food. Even a 2 x 2 foot space on a deck is enough room for a tower garden to grow 30 or more salad vegetables or strawberry plants. Children need a chance to see first-hand what real food is and how much fun it is to eat the food you grow.

Conclusion

The average American eats around 130 pounds of wheat flour per year, and around 65 pounds of added sugar. This begs the question: how bad are processed foods for your health?

Now this is a trick question, we’ll just say that up front. But it’s also a very important question.

Humans have processed their foods for thousands of years, in order to save the time and tedium of chewing tough meats and overly fibrous plants. Basically, we’re not cows, and we don’t really have the stomach or jaw to be chewing all day long.

And while our ancestors ate a lot more unprocessed food than we do, some also supplemented their diets with flour on occasion. Flour!

Around ten million years ago, our ape ancestors developed an enzyme to metabolize alcohol, which could be naturally found in rotten fruit. A few million years later, these occasionally drunk apes gave rise to humans who purposely processed (via fermentation) plants into beer, wine, and other alcohols. Fermentation of milk allowed for yogurt production stretching at least as far back as ancient India 6,000 years ago. Overall, fermentation provided not just a tangy new flavor and a bit of a buzz in some cases, but also a great way to process foods into a more well-preserved form. Other processing methods are also an integral part of human history, such as the widespread practice of curing meats.

Processed foods are not new, they just make up a much larger part of our diet. Modern methods of processing differ from our ancestors as well – with less fermentation, more flour or other ultra-processing, and more monoculture (hello, corn and soy domination!).

The overall health impact of processed foods is really hard to pin down, because there are so many different kinds of foods processed in different ways. So let’s start with an easily quantified harm of processing … allergens.

Everyone knows that allergies on the rise, which is terrible for those affected (especially kids) who at risk of dying from even tiny amounts of allergens, especially peanuts.

Unfortunately, highly processed food made in factories is at higher risk for contamination with allergens. For example, over 80% of oat samples in one study were found to be contaminated with gluten, and factories are not always careful about controlling peanut exposure.

Outside of allergens, other risks are much harder to pin down. Processed red meat has been labeled a carcinogen by the World Health Organization, and various processed foods have been linked to a bunch of conditions … from instant noodles linked to eczema in Korea, to ultra-processed foods linked to worse cardiovascular profiles in Brazilian children.

But what does that really mean? Most of that evidence is observational, since you can’t do a randomized trial that assigns people to eat junk food for years, and then check how bad their health gets. So we’re limited to using that evidence to generate hypotheses, and then trying to understand the mechanisms behind what happens in our bodies.

For example, acellular carbohydrates like flour and processed sugar may predispose people to chronic disease (if eaten in large amounts) due to energy density and possible gut impacts. Large amounts of meat cooked at high temperatures can increase cancer risk through compounds like heterocyclic amines. And so on, and so on.

The bottom line is that processed food is not inherently harmful, for two distinct reasons. First is that “processed food” isn’t one monolithic thing. Frozen mashed sweet potatoes are technically processed, but their health effect will be much different than deep fried Oreos. Second, chronic disease is nearly always dependent on dose: having cake on yours and your friends’ birthdays is different than eating donuts every day.

The most prudent way to assess the risk of processed food is combining observational evidence with some some mechanistic evidence. In other words, do humans who eat varying amounts of this processed food develop disease? If so, do the mechanisms make sense for the processed food impacting physiological mechanisms that cause disease?

To rephrase the takeaway: sugar isn’t evil, nor is flour or cured meat or other processed food. But we humans are not robots, and some people can’t stop themselves from eating too much processed food, in effect eating their way into shorter lifespans caused by chronic conditions. It’s wise to be aware of both the evidence and your personal food habits and triggers for overeating junk food.

Federal food law is clear: It bans “any poisonous or deleterious substance which may render [a food] injurious to health.”

For decades, regulators have used that provision mostly to crack down on food contaminated with toxic chemicals or microbes such as Listeria and salmonella that can make us acutely ill. It’s important to protect people from these harms, but let’s also put them in perspective: These regulated contaminants kill an estimated 1,400 Americans per year. By contrast, 1,600 Americans die every day from chronic food illness, such as obesity, diabetes, heart disease, and cancer.

In recent years, evidence has mounted that these chronic illnesses are caused by deleterious substances in ultra-processed foods. From heat-and-eat meals such as frozen pizza to sweetened breakfast cereals, ultra-processed foods are industrial formulations of ingredients from substances extracted from foods or synthesized in laboratories. They are also staples of our diets.

It is time for the U.S. Food and Drug Administration and the U.S. Department of Agriculture to use their authority under federal law to protect us from these highly processed foods. This would be a paradigm shift — but it is also common sense: FDA and USDA must make at least as much effort preventing chronic food illness as they do acute food illness.

About 678,000 Americans die each year from chronic food illness. That toll is higher than all our combat deaths in every war in American history—combined. That’s right: there are more deaths each year from our food than all the combat deaths from the Revolutionary War through the wars in Afghanistan and Iraq.

In addition to deaths, poor diet causes tremendous suffering. For instance, two-thirds of severe COVID cases resulting in hospitalization have been attributed to four diet-caused diseases: obesity, diabetes, hypertension, and heart failure. In other words, these hospitalizations could have been prevented if the patient didn’t have these diseases. All told, the economic cost of nutrition-related chronic diseases has been estimated at $16 trillion over the period from 2011 to 2020.

About 678,000 Americans die each year from chronic food illness. That toll is higher than all our combat deaths in every war in American history–combined.

Mounting evidence suggests that ultra-processed foods are causing much of this harm.

In a recent study conducted by the National Institutes of Health to discover the cause of sharp increases in obesity in the U.S., volunteers were randomly assigned to either eat minimally processed foods or ultra-processed foods matched for daily nutrients like carbohydrates, sodium, fat, and sugar. Investigators thought weight gain would be the same in both groups, since nutrient composition was equivalent. They were wrong.

While on the ultra-processed diet, people ate an additional 500 calories per day and began to rapidly gain weight. When the same people were later assigned to eat the minimally processed diet, they lost weight.

This is an important finding, because it raises the possibility that it’s the additives and processing—not just the percentage of fat or sugar in a diet—that make us sick. More research is urgently needed.

Our regulatory agencies clearly have the legal authority to take on this threat to public health. Congress revealed its intent in a 1958 amendment that provides that no food additive shall be deemed safe if it is found to induce cancer, a chronic illness, when ingested by humans or animals. There is recent precedent for using our food safety laws to regulate chronic food illness. In 2015, the FDA banned artificial trans fats from food on the grounds that it caused heart disease, another chronic illness linked to diet.

The agencies should use this same authority to regulate the design of ultra-processed foods. Our food must continue to be delicious, affordable, and convenient—traits Americans appropriately demand—but can be eaten daily without making us sick.

Our laws make clear that action is required. What’s missing is leadership and funding.

Our food must continue to be delicious, affordable, and convenient—traits Americans appropriately demand—but can be eaten daily without making us sick.

The leadership must come from Robert M. Califf, our FDA Commissioner, and José Emilio Esteban, the newly confirmed under secretary for food safety at USDA. Through appropriate regulation and enforcement, they must provide food companies with legal incentives to design foods that promote health and well-being — and these incentives ought to be equal to those the marketplace provides for taste, cost, and convenience.

As for funding, the President and Congress must provide the needed budget. The president should ask for at least $200 million to address chronic food illness in his Fiscal Year 2024 budget and Congress should appropriate it. It won’t be easy. In last year’s budget, the president asked for $135 million to cover USDA nutrition security, FDA nutrition regulation, and NIH nutrition research. He received $0.

In a recent event promoting his proposed redesign of FDA’s food program, Califf acknowledged that nutrition initiatives require more funding and said: “We need leaders who will be very persuasive with government.”

He needs to be that persuasive leader — making nutrition a priority and getting FDA’s food programs the resources they need to be effective.

There is precedent for FDA and USDA collaborating in a moment of food-related crisis. In 1993, the nation was hit with a deadly Shiga toxin-producing E. coli (STEC) outbreak from contaminated Jack in the Box hamburgers. At the time, there were eight cases per 100,000 population of these deadly infections. USDA declared these bacteria an adulterant and adopted FDA’s use of preventive controls. It then worked with the meat industry to provide the needed training and technical assistance to keep STEC out of our meat. Finally, USDA inspectors — who are a constant presence in meat-packing plants— reinforced these steps. Today, STEC cases are down to about 1 case per 100,000. Our food is safer now due to USDA’s stronger food safety laws, bigger budget, and effective collaboration with FDA.

Now is the time to apply that model to address the threat of chronic food illness. FDA and USDA must work together to design a 21^st century food safety system to protect us not just from acute cases of food poisoning but also from the deadly toll of chronic exposure to ultra-processed food. Our lives literally depend on it.

Appendix

Melted, pounded, extruded: Why many ultra-processed foods are unhealthy

Would you eat food that’s been predigested?

Experts say that’s what we’re doing when we consume many popular packaged foods — those breads, cereals, snack chips and frozen meals that have been refined, pounded, heated, melted, shaped, extruded and packed with additives.

A growing body of research suggests that the extent of industrial processing that your food undergoes can alter its effects on your body, determining its impact on your appetite, hormones, weight gain, and likelihood of developing obesity and chronic diseases.

This extreme processing creates foods that are so easily absorbed by the body that they’re essentially predigested. Many foods also are engineered to overcome our satiety mechanisms, which drives us to overeat and gain weight, experts say.

In recent years, scientists have adopted a new name for foods that are intensely manipulated by food manufacturers: ultra-processed.

Across the globe, governments are embracing the idea that ultra-processed foods are a big contributor to poor health. Many countries have issued dietary guidelines encouraging people to include more unprocessed foods in their diet, and some, like Brazil, Belgium, Israel and Uruguay, have published dietary guidelines explicitly urging people not to eat ultra-processed foods.

In the United States, where ultra-processed foods make up 58 percent of the calories Americans consume, government experts are examining the link between ultra-processed foods and obesity, and their findings could influence the government’s influential Dietary Guidelines for Americans.

But supporters of the packaged food industry say processed foods are an essential part of the food supply.

“Processed foods in general help create a more affordable, available, and accessible food environment,” said Bryan Hitchcock, chief science and technology officer for the Institute of Food Technologists, in an email. “Processing technologies, particularly at the industrial scale, add value, safety and nutrition while reducing costs and food loss and waste.”

How ‘extrusion cooking’ alters your food

Many ultra-processed foods start with fiber-rich grains like wheat, rice, oats and corn. Food companies use high-speed steel rollers to mill these grains into flour or small particles. In some cases, the grains are refined, meaning their fiber and nutrient-rich components, the bran and germ, are removed.

These refined starches are often used to thicken and improve the “mouthfeel” of processed foods like puddings, sauces, salad dressings, canned soups, stews and baked goods. But they’re also used to make a variety of other ultra-processed foods through a manufacturing technique called extrusion cooking.

Cooking extruders have spawned a multibillion-dollar industry: They are widely used by food companies to mass produce many of the starchy and sugary packaged foods that line grocery store shelves.

Cooking extruders contain rotating screws inside a large steel barrel. Flour, water and other ingredients are poured into one side of the machine as the rotating screws blend and force the mixture through the barrel.

While the process can vary, the machine typically twists and heats the mixture, generating intense pressures, shear forces and temperatures that melt the mixture. This process disrupts the food matrix of the starch: It breaks open the rigid cell walls inside the starch and destroys its microscopic granules, which contain long chains of glucose, a type of sugar.

Eventually, the “melt,” as the mixture inside the cooking extruder is called, is forced out of the machine through a small hole called a die. As it exits, the melt encounters a drop in atmospheric pressure that causes it to expand.

The final product, called the “extrudate,” can be shaped into an endless variety of ultra-processed foods: breakfast cereals, corn chips and puffs, snack bars, cookies, doughnuts, croutons, breadsticks, baby foods and more.

Extrusion technology is efficient and economical. It allows manufacturers to make a wide range of shelf-stable, ready-to-eat foods.

But the process also appears to accelerate the speed at which our digestive tracts absorb glucose and other nutrients from food, causing greater spikes in blood sugar and insulin levels, studies show.

“Extrusion cooking at very drastic pressures and temperatures is a kind of predigestion of your food,” said Anthony Fardet, a nutrition scientist at the French National Institute for Agriculture, Food, and Environment who studies the effects of food processing on health.

Fardet and his colleagues have found in their studies that ultra-processed foods are less satiating than minimally processed foods and that they have a more potent effect on blood sugar levels.

“Ultra-processing breaks the links between nutrients, it creates new links that our bodies may not recognize, and by doing this it disturbs the digestive process,” he said.

Finding your bliss point

Extrusion cooking turns grains and starches into wads of carbohydrate that can be easily chewed without sticking to your teeth, allowing for faster eating, swallowing and absorption, said David Kessler, the former head of the Food and Drug Administration and the author of “Fast Carbs, Slow Carbs.”

But perhaps most importantly, these foods are used as “delivery devices” for sugar, salt, fat and countless flavors and additives. They serve as a “palette,” said Kessler, for the “rainbow of flavors” that food companies use to make their products irresistible in a way that can trigger compulsive eating.

Ultra-processed foods are formulations of purified ingredients that are designed to achieve a certain “bliss point,” which prevents us from being able to regulate how much we eat, says Carlos Monteiro, a nutrition professor at the University of São Paulo.

“The way food is processed today has completely changed,” Monteiro added. “We’re putting inside of our bodies a lot of chemical compounds that are not nutrients — things that shouldn’t be in food.”

A new way to classify food

Monteiro developed what is now known as the NOVA classification system for identifying ultra-processed foods after noticing startling changes in Brazil’s food system and obesity rates, which skyrocketed from just four percent of adults in 1975 to roughly 26 percent of adults today.

Monteiro discovered that Brazilian families were increasingly replacing homemade meals with cheap and convenient alternatives — things like soft drinks, breakfast cereals and snack bars made by transnational food companies.

The NOVA system identifies four food groups based on how little or how much has been done to a food.

The first is unprocessed or “minimally processed foods” obtained directly from plants or animals with little or no alteration, like whole grains, vegetables, eggs, milk and meat.

The second group, “culinary ingredients,” includes things that people use to cook and season foods in homes and restaurants: oils, butter, sugar, spices, and salt, for example.

Making up the third group are “processed foods” such as canned vegetables, bacon, cheeses and freshly made breads. Processed foods contain multiple ingredients, but they are still “recognized as versions of the original foods.”

Then there are ultra-processed foods, which NOVA defines as “industrial formulations” made up entirely of substances extracted from other foods or “synthesized in laboratories.” These foods are manufactured through industrial techniques like “extrusion, molding and preprocessing by frying,” and the additives they contain are used to make them “hyper-palatable.”

Supporting ultra-processed food

Ultra-processed foods have many defenders who say people shouldn’t be discouraged from eating affordable, nutrient-enriched foods with a long shelf life.

Hitchcock, from the Institute of Food Technologists, said the NOVA system “does not capture the nuance” to help consumers identify healthful processed foods.

“Many ultra-processed foods deliver on nutrition, convenience and more while others are high in sodium, added sugar and unhealthy fats,” Hitchcock said. “Clarifying which to include more often, and which to reserve for occasional consumption, is essential.”

One prominent critic of the NOVA system is Rick Mattes, a nutrition scientist at Purdue University. Mattes served on the federal government’s Dietary Guidelines Advisory Committee and works closely with the food industry. He sits on the scientific advisory board at Mars, the candy-maker, and the Grain Foods Foundation, a trade group that represents the baking and milling industries.

Mattes said that the large number of epidemiological studies linking ultra-processed foods to poor health don’t prove cause and effect or identify any mechanisms that would explain why they’re harmful.

Urging people to avoid a broad category of foods could do serious harm, Mattes said. Many packaged foods are enriched or fortified with vitamins and minerals, including “shortfall nutrients” that a lot of Americans don’t get enough of.

“We have to run clinical trials and study mechanisms,” he said. “Without mechanisms we don’t know what is responsible in these foods, and as a result we don’t know what to tell people to minimize or avoid.”

Eating 50 calories a minute

For a time, Kevin Hall, a nutrition and metabolism scientist at the National Institutes of Health, was also skeptical that ultra-processed foods were harmful.

To test the idea, he designed a study that compared what happened when men and women were recruited to live in a lab and fed different diets. In one phase of the study, the participants ate mostly ultra-processed foods for two weeks. Their daily meals consisted of things like honey nut oat cereal, flavored yogurt, blueberry muffins, canned ravioli, steak strips, mashed potatoes from a packet, baked potato chips, goldfish crackers, diet lemonade and low-fat chocolate milk.

In a second phase of the study, the participants were fed a diet of mostly homemade, unprocessed foods for two weeks that was matched for nutrients like salt, sugar, fat, and fiber. Their meals consisted of foods such as Greek yogurt with walnuts and fruit, spinach salad with grilled chicken, apple slices, bulgur and fresh vinaigrette, and beef tender roast with rice pilaf, steamed vegetables, balsamic vinaigrette, pecans and orange slices.

In both cases, the participants were allowed to eat as much or as little of the foods and snacks as they wanted.

“If it was really about the nutrients — and not about the processing — then there shouldn’t be any major difference in calorie intake between these two diets,” said Hall. “I thought that was going to be the result of the study.”

But, he added, “I was hugely wrong.”

When people ate the ultra-processed diet, they consumed substantially more calories — about 500 more calories a day compared to when they ate the mostly unprocessed diet. The result: They gained weight and body fat.

The researchers also noticed a difference in how quickly the participants consumed their food. They ate the ultra-processed meals significantly faster, at a rate of about 50 calories per minute, compared to just 30 calories per minute on the unprocessed diet.

In an email, Hitchcock at the IFT called Hall’s study “landmark research with important insights.” But he said more research was needed. “The results created as many questions for research as it answered,” he added.

Mattes applauded Hall for doing a clinical trial on ultra-processed foods. But he said the study was small and showed a “cruise ship” phenomenon. People initially ate a lot more food on the ultra-processed diet, but their daily calorie intake trended downward throughout the course of the study.

“If you put people in a new environment and give them very palatable foods they’ll consume a lot of them for a while,” he said. “But eventually they’ll start adjusting.”

Pre-chewed food

Humans have been cooking, grinding, preserving and processing food for thousands of years. Cooking makes food easier to digest. It liberates nutrients, allowing our bodies to extract more fat, carbs and calories from our food. The advent of cooking helped give our ancestors the energy their bodies needed to gain weight and grow bigger brains.

Our bodies absorb more energy from meat and starches that have been cooked. But modern food technology takes processing to another level.

Fiber, a type of carbohydrate found in plant-based foods, is one of the main casualties of ultra-processing. Fiber slows digestion. It reduces blood sugar spikes, delays the return of hunger after you eat and travels down to your colon, where it nourishes the trillions of microbes that make up your gut microbiome. These microbes turn fiber into health-promoting compounds such as short-chain fatty acids.

A study published in May found that people absorbed significantly more calories when they ate a diet of highly processed foods compared to when they ate a mostly unprocessed, fiber-rich diet.

The highly processed foods — the researchers referred to them as “pre-chewed” — were quickly absorbed in the upper gastrointestinal tract, essentially starving the gut microbes that reside farther down in the colon. But on the unprocessed diet, people excreted more calories in their stool and lost slightly more weight and body fat. They had higher circulating levels of short-chain fatty acids and increased levels of GLP-1, a gut hormone that promotes fullness and satiety.

Can processed foods be reformulated?

Hall at NIH welcomes debate about ultra-processed foods. But he says his hope is that research into their health effects will galvanize the food industry to reformulate them so they’re less harmful.

He’s conducting a new study to determine whether the energy density of meals and the amount of hyper-palatable foods they contain are what drive people to gorge on them.

Hall expects the results to be published in 2025. In the meantime, his advice for the public is to reduce your intake of ultra-processed foods if possible — but he knows that this message for a lot of people isn’t very practical.

“I know that it’s only the privileged that can avoid these foods because they have the time, the money or the skill and ability to prepare alternatives,” he said. “For the rest of us who rely on ultra-processed foods — myself included — avoiding them is very difficult.”

Ultra-processed foods:
A global threat to public health

Resources

cnbc.com, “Is modern food making us sick?” By Idil Karsit; medium.com, “Convenience Is Killing Us All.” By Jeff Hayward; drcindyjakubiec.com, “How the American Diet Has Been Weaponized for Mass Destruction.” By Dr. Cindy Jakubiec; nytimes, “The Link Between Highly Processed Foods and Brain Health.” By Sally Wadyka; birminghammedicalnews.com, “Is Living On Highly-Processed Foods Killing Us?” By Laura Freeman; washingtonpost.com, “Melted, pounded, extruded: Why many ultra-processed foods are unhealthy”. By Anahad O’Connor and Aaron Steckelberg; examine.com, “How Harmful Are Processed Foods?” By Kamal Patel, MPH, MBA; harvardpublichealth.org, “Processed foods are making us sick. It’s time for the FDA and USDA to step in.” By Jerold Mande; globalfoodresearchprogram.org, “Ultra-processed foods:
A global threat to public health.” By University Of North Carolina at Chapel Hill Staff;