Why can’t we just look at ingredients lists on food labels and avoid food additives that we know are harmful?
How Ultra-Processed Foods Could Cause Disease: Food Additives
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
So-called ultra-processed foods aren’t really “real food,” but they really can affect our health. Why do we need a new term, though? Can’t we just say we should stay away from junk food, defined as foods and beverages with high levels of concentrated calories and added saturated fats, sodium, and sugar? I mean that’s where most of our sugar, and about half of our calories, salt, and saturated fat come from.
But ultra-processed is not synonymous with junk. There are some junk foods that are not ultra-processed, and some ultra-processed foods don’t fit the definition of junk. For example, while a sausage is considered an ultra-processed meat, bacon is considered just a processed meat, though bacon would also meet junk food’s definition of a calorie-concentrated food loaded with added salt. What about an ultra-processed product like Diet Coke? It doesn’t have any calories, no sugar, no fat. Not junk food, but still ultra-processed and not necessarily good for you. So, there’s a limitation to exclusively focusing on the nutrient profile of ultra-processed foods. But how can they be bad if they’re fat-free, sugar-free, salt-free?
Health risks are not only related to the poor nutritional quality of ultra-processed foods, but also to the presence of additives. No apparent calories, fat, sugar, or salt, but contains caramel color, which results in the formation of 4-methylimidazole, which is a possible human carcinogen.
Contains aspartame, too, also recently classified as possibly cancer-causing in humans.
And Diet Coke contains phosphoric acid, which is a phosphate additive that may be damaging to health. In fact, that’s just the kind of additive that could help explain the link between ultra-processed foods and heart and kidney problems.
Contains a benzoate preservative, too. If you remove artificial colorings and benzoate preservatives from the diets of preschoolers, and then randomize the kids to be slipped a placebo or a cocktail of colorings and benzoate, you’ll see a significant reduction in hyperactive behavior during the withdrawal phase, and a significant increase in hyperactive behavior when the children got the colorings and benzoate compared to placebo. Of course, it could have been the colors, not the benzoate, but that’s one of the problems. As little as we know about the effects of these individual additives, we know even less about what combinations of them can do.
There is a large body of evidence suggesting toxicity from certain artificial food colors, benzoate preservatives, artificial sweeteners, and emulsifiers––in part sometimes through our gut microbiome. This may explain at least part of the connection between inflammatory bowel disease and ultra-processed foods.
Now industry apologists argue that the U.S. Food and Drug Administration carefully evaluates food additives to make sure they are safe––until they’re not. In fact, to show the system works, they cite the removal of six carcinogenic artificial flavors in 2018. Artificial flavors that had been in the food supply approved for safety since 1964. So, we were exposed for more than 50 years before they were banned.
Critics of the ultra-processed food concept puzzle at the fact that natural yogurt is considered minimally processed, and yogurt with added sugar is considered a processed food. But if the yogurt’s sweetened with artificial sweetener and contains less sugar, it is considered ultra-processed. You can see how the critics try to stick with the nutrient paradigm of hey, less sugar should be better, but that was before aspartame, sold as NutraSweet, was officially recognized as a potential human carcinogen in 2023.
Forty-two years earlier, when aspartame was first approved, the FDA’s own public board of inquiry opposed approval of the artificial sweetener, based on brain tumors in rats in the industry’s own studies. This included several FDA scientists who didn’t think it was safe. The FDA Commissioner rejected these concerns and approved it anyway, before leaving the agency to enjoy a $1,000 per day consultancy position with the aspartame company’s PR firm. And then, the FDA actually prevented the National Toxicology Program from doing further cancer testing. Meanwhile, literally tens of millions of pounds made it into the food supply.
Fine, critics of the ultra-processed label say. If there are some additives that are bad, let’s find out exactly which ones they are, and get rid of those. No need to guilty-until-proven-innocent broad brush all additives as potentially harmful. Take artificial food colors, though. What level of evidence do we need to remove something whose sole reason of existence is to make some Day-Glo marshmallows in kids’ cereals that much more eye-catching?
I’ve long been concerned that Red Dye No. 3, why it hasn’t been banned from food––for example, given the dye was banned more than 30 years ago from inclusion in anything going on the skin, due to cancer risk. But it’s still okay to eat? Finally, just recently, the California Food Safety Act was signed banning Red Dye No. 3 from food and drinks sold in California, as of 2027. Consumer groups like Center for Science in the Public Interest continued to petition the FDA for a national ban to prohibit use of this carcinogen, and in 2025, the FDA finally agreed to ban it from food, 35 years after they removed it from cosmetics. It also starts to take effect in 2027. Until then, here’s a pro-tip suggestion for food companies: should you want to make your cherry popsicles red, maybe try adding some cherries.
If the harm of ultra-processed foods lies in potential harmful additives, why not just stick to so-called clean label foods, made with simple and recognizable ingredients, no matter how the food is processed? But that’s assuming additives are the only reason ultra-processed foods may be unhealthy. In fact, harmful additives are just one of many reasons ultra-processed foods may lead to increased risk of death and disease. I’ll address some of these others, next.
Please consider volunteering to help out on the site.
- Marti A. Ultra-processed foods are not “real food” but really affect your health. Nutrients. 2019;11(8):1902.
- Dunford EK, Popkin B, Ng SW. Junk food intake among adults in the united states. J Nutr. 2022;152(2):492-500.
- Vlassopoulos A, Katidi A, Noutsos S, Kapsokefalou M. Precision food composition data as a tool to decipher the riddle of ultra-processed foods and nutritional quality. Foods. 2024;13(8):1259.
- Scrinis G, Monteiro C. From ultra-processed foods to ultra-processed dietary patterns. Nat Food. 2022;3(9):671-673.
- Menichetti F, Leone A. Consumption of ultra-processed foods and health harm. Nutrients. 2023;15(13):2945.
- Smith TJS, Wolfson JA, Jiao D, et al. Caramel color in soft drinks and exposure to 4-methylimidazole: a quantitative risk assessment. PLoS One. 2015;10(2):e0118138.
- IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Some Chemicals Present in Industrial and Consumer Products, Food and Drinking-Water. Lyon (FR): International Agency for Research on Cancer; 2013. (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, No. 101.)
- Riboli E, Beland FA, Lachenmeier DW, et al. Carcinogenicity of aspartame, methyleugenol, and isoeugenol. Lancet Oncol. 2023;24(8):848-850.
- Ritz E, Hahn K, Ketteler M, Kuhlmann MK, Mann J. Phosphate additives in food—a health risk. Dtsch Arztebl Int. 2012;109(4):49-55.
- Calvo MS, Dunford EK, Uribarri J. Industrial use of phosphate food additives: a mechanism linking ultra-processed food intake to cardiorenal disease risk? Nutrients. 2023;15(16):3510.
- Bateman B, Warner JO, Hutchinson E, et al. The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children. Arch Dis Child. 2004;89(6):506-511.
- Lane MM, Gamage E, Du S, et al. Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. BMJ. 2024;384:e077310.
- Warner JO. Artificial food additives: hazardous to long-term health? Arch Dis Child. 2024;109(11):882-885.
- Sherling DH, Hennekens CH, Ferris AH. Newest updates to health providers on the hazards of ultra-processed foods and proposed solutions. Am J Med. 2024;137(5):395-398.
- Trumbo PR, Bleiweiss-Sande R, Campbell JK, et al. Toward a science-based classification of processed foods to support meaningful research and effective health policies. Front Nutr. 2024;11:1389601.
- Earthjustice v. FDA Petition for Writ of Mandamus. May 2, 2018.
- Sanchez-Siles L, Roman S, Fogliano V, Siegrist M. Naturalness and healthiness in “ultra-processed foods”: A multidisciplinary perspective and case study. Trends Food Sci. 2022;129:667-673.
- Huff J, LaDou J. Aspartame bioassay findings portend human cancer hazards. Int J Occup Environ Health. 2007;13(4):446-448.
- Soffritti M, Padovani M, Tibaldi E, Falcioni L, Manservisi F, Belpoggi F. The carcinogenic effects of aspartame: The urgent need for regulatory re-evaluation. Am J Ind Med. 2014;57(4):383-397.
- Astrup A, Monteiro CA. Does the concept of “ultra-processed foods” help inform dietary guidelines, beyond conventional classification systems? Debate consensus. Am J Clin Nutr. 2022;116(6):1489-1491.
- US Food and Drug Administration. General specifications and general restrictions for provisional color additives for use in foods, drugs, and cosmetics. 21 CFR §81. Published in the Electronic Code of Federal Regulations. Updated June 2, 2025.
- California Legislature. Assembly Bill 418: The California Food Safety Act. 2023‑2024 Regular Session. Enrolled October 7, 2023. LegiScan.
- Center for Science in the Public Interest; Breast Cancer Prevention Partners; Public Citizen; Public Health Institute; Public Interest Research Group; Real Food for Kids; Lisa Y. Lefferts; Linda S. Birnbaum; Philip J. Landrigan; et al. Petition for removal of FD&C Red No. 3 from the permanent list of color additives. Color-additive petition pursuant to 21 U.S.C. §§ 379e, 721(b)(1). Submitted to Kristi Muldoon Jacobs, PhD, Acting Director, Office of Food Additive Safety, FDA. October 24, 2022.
- Chen A, Kayrala N, Trapeau M, Aoun M, Bordenave N. The clean label trend: An ineffective heuristic that disserves both consumers and the food industry? Compr Rev Food Sci Food Saf. 2022;21(6):4921-4938.
- Astrup A, Monteiro CA. Does the concept of “ultra-processed foods” help inform dietary guidelines, beyond conventional classification systems? NO. Am J Clin Nutr. 2022;116(6):1482-1488.
Motion graphics by Avo Media
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
So-called ultra-processed foods aren’t really “real food,” but they really can affect our health. Why do we need a new term, though? Can’t we just say we should stay away from junk food, defined as foods and beverages with high levels of concentrated calories and added saturated fats, sodium, and sugar? I mean that’s where most of our sugar, and about half of our calories, salt, and saturated fat come from.
But ultra-processed is not synonymous with junk. There are some junk foods that are not ultra-processed, and some ultra-processed foods don’t fit the definition of junk. For example, while a sausage is considered an ultra-processed meat, bacon is considered just a processed meat, though bacon would also meet junk food’s definition of a calorie-concentrated food loaded with added salt. What about an ultra-processed product like Diet Coke? It doesn’t have any calories, no sugar, no fat. Not junk food, but still ultra-processed and not necessarily good for you. So, there’s a limitation to exclusively focusing on the nutrient profile of ultra-processed foods. But how can they be bad if they’re fat-free, sugar-free, salt-free?
Health risks are not only related to the poor nutritional quality of ultra-processed foods, but also to the presence of additives. No apparent calories, fat, sugar, or salt, but contains caramel color, which results in the formation of 4-methylimidazole, which is a possible human carcinogen.
Contains aspartame, too, also recently classified as possibly cancer-causing in humans.
And Diet Coke contains phosphoric acid, which is a phosphate additive that may be damaging to health. In fact, that’s just the kind of additive that could help explain the link between ultra-processed foods and heart and kidney problems.
Contains a benzoate preservative, too. If you remove artificial colorings and benzoate preservatives from the diets of preschoolers, and then randomize the kids to be slipped a placebo or a cocktail of colorings and benzoate, you’ll see a significant reduction in hyperactive behavior during the withdrawal phase, and a significant increase in hyperactive behavior when the children got the colorings and benzoate compared to placebo. Of course, it could have been the colors, not the benzoate, but that’s one of the problems. As little as we know about the effects of these individual additives, we know even less about what combinations of them can do.
There is a large body of evidence suggesting toxicity from certain artificial food colors, benzoate preservatives, artificial sweeteners, and emulsifiers––in part sometimes through our gut microbiome. This may explain at least part of the connection between inflammatory bowel disease and ultra-processed foods.
Now industry apologists argue that the U.S. Food and Drug Administration carefully evaluates food additives to make sure they are safe––until they’re not. In fact, to show the system works, they cite the removal of six carcinogenic artificial flavors in 2018. Artificial flavors that had been in the food supply approved for safety since 1964. So, we were exposed for more than 50 years before they were banned.
Critics of the ultra-processed food concept puzzle at the fact that natural yogurt is considered minimally processed, and yogurt with added sugar is considered a processed food. But if the yogurt’s sweetened with artificial sweetener and contains less sugar, it is considered ultra-processed. You can see how the critics try to stick with the nutrient paradigm of hey, less sugar should be better, but that was before aspartame, sold as NutraSweet, was officially recognized as a potential human carcinogen in 2023.
Forty-two years earlier, when aspartame was first approved, the FDA’s own public board of inquiry opposed approval of the artificial sweetener, based on brain tumors in rats in the industry’s own studies. This included several FDA scientists who didn’t think it was safe. The FDA Commissioner rejected these concerns and approved it anyway, before leaving the agency to enjoy a $1,000 per day consultancy position with the aspartame company’s PR firm. And then, the FDA actually prevented the National Toxicology Program from doing further cancer testing. Meanwhile, literally tens of millions of pounds made it into the food supply.
Fine, critics of the ultra-processed label say. If there are some additives that are bad, let’s find out exactly which ones they are, and get rid of those. No need to guilty-until-proven-innocent broad brush all additives as potentially harmful. Take artificial food colors, though. What level of evidence do we need to remove something whose sole reason of existence is to make some Day-Glo marshmallows in kids’ cereals that much more eye-catching?
I’ve long been concerned that Red Dye No. 3, why it hasn’t been banned from food––for example, given the dye was banned more than 30 years ago from inclusion in anything going on the skin, due to cancer risk. But it’s still okay to eat? Finally, just recently, the California Food Safety Act was signed banning Red Dye No. 3 from food and drinks sold in California, as of 2027. Consumer groups like Center for Science in the Public Interest continued to petition the FDA for a national ban to prohibit use of this carcinogen, and in 2025, the FDA finally agreed to ban it from food, 35 years after they removed it from cosmetics. It also starts to take effect in 2027. Until then, here’s a pro-tip suggestion for food companies: should you want to make your cherry popsicles red, maybe try adding some cherries.
If the harm of ultra-processed foods lies in potential harmful additives, why not just stick to so-called clean label foods, made with simple and recognizable ingredients, no matter how the food is processed? But that’s assuming additives are the only reason ultra-processed foods may be unhealthy. In fact, harmful additives are just one of many reasons ultra-processed foods may lead to increased risk of death and disease. I’ll address some of these others, next.
Please consider volunteering to help out on the site.
- Marti A. Ultra-processed foods are not “real food” but really affect your health. Nutrients. 2019;11(8):1902.
- Dunford EK, Popkin B, Ng SW. Junk food intake among adults in the united states. J Nutr. 2022;152(2):492-500.
- Vlassopoulos A, Katidi A, Noutsos S, Kapsokefalou M. Precision food composition data as a tool to decipher the riddle of ultra-processed foods and nutritional quality. Foods. 2024;13(8):1259.
- Scrinis G, Monteiro C. From ultra-processed foods to ultra-processed dietary patterns. Nat Food. 2022;3(9):671-673.
- Menichetti F, Leone A. Consumption of ultra-processed foods and health harm. Nutrients. 2023;15(13):2945.
- Smith TJS, Wolfson JA, Jiao D, et al. Caramel color in soft drinks and exposure to 4-methylimidazole: a quantitative risk assessment. PLoS One. 2015;10(2):e0118138.
- IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Some Chemicals Present in Industrial and Consumer Products, Food and Drinking-Water. Lyon (FR): International Agency for Research on Cancer; 2013. (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, No. 101.)
- Riboli E, Beland FA, Lachenmeier DW, et al. Carcinogenicity of aspartame, methyleugenol, and isoeugenol. Lancet Oncol. 2023;24(8):848-850.
- Ritz E, Hahn K, Ketteler M, Kuhlmann MK, Mann J. Phosphate additives in food—a health risk. Dtsch Arztebl Int. 2012;109(4):49-55.
- Calvo MS, Dunford EK, Uribarri J. Industrial use of phosphate food additives: a mechanism linking ultra-processed food intake to cardiorenal disease risk? Nutrients. 2023;15(16):3510.
- Bateman B, Warner JO, Hutchinson E, et al. The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children. Arch Dis Child. 2004;89(6):506-511.
- Lane MM, Gamage E, Du S, et al. Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. BMJ. 2024;384:e077310.
- Warner JO. Artificial food additives: hazardous to long-term health? Arch Dis Child. 2024;109(11):882-885.
- Sherling DH, Hennekens CH, Ferris AH. Newest updates to health providers on the hazards of ultra-processed foods and proposed solutions. Am J Med. 2024;137(5):395-398.
- Trumbo PR, Bleiweiss-Sande R, Campbell JK, et al. Toward a science-based classification of processed foods to support meaningful research and effective health policies. Front Nutr. 2024;11:1389601.
- Earthjustice v. FDA Petition for Writ of Mandamus. May 2, 2018.
- Sanchez-Siles L, Roman S, Fogliano V, Siegrist M. Naturalness and healthiness in “ultra-processed foods”: A multidisciplinary perspective and case study. Trends Food Sci. 2022;129:667-673.
- Huff J, LaDou J. Aspartame bioassay findings portend human cancer hazards. Int J Occup Environ Health. 2007;13(4):446-448.
- Soffritti M, Padovani M, Tibaldi E, Falcioni L, Manservisi F, Belpoggi F. The carcinogenic effects of aspartame: The urgent need for regulatory re-evaluation. Am J Ind Med. 2014;57(4):383-397.
- Astrup A, Monteiro CA. Does the concept of “ultra-processed foods” help inform dietary guidelines, beyond conventional classification systems? Debate consensus. Am J Clin Nutr. 2022;116(6):1489-1491.
- US Food and Drug Administration. General specifications and general restrictions for provisional color additives for use in foods, drugs, and cosmetics. 21 CFR §81. Published in the Electronic Code of Federal Regulations. Updated June 2, 2025.
- California Legislature. Assembly Bill 418: The California Food Safety Act. 2023‑2024 Regular Session. Enrolled October 7, 2023. LegiScan.
- Center for Science in the Public Interest; Breast Cancer Prevention Partners; Public Citizen; Public Health Institute; Public Interest Research Group; Real Food for Kids; Lisa Y. Lefferts; Linda S. Birnbaum; Philip J. Landrigan; et al. Petition for removal of FD&C Red No. 3 from the permanent list of color additives. Color-additive petition pursuant to 21 U.S.C. §§ 379e, 721(b)(1). Submitted to Kristi Muldoon Jacobs, PhD, Acting Director, Office of Food Additive Safety, FDA. October 24, 2022.
- Chen A, Kayrala N, Trapeau M, Aoun M, Bordenave N. The clean label trend: An ineffective heuristic that disserves both consumers and the food industry? Compr Rev Food Sci Food Saf. 2022;21(6):4921-4938.
- Astrup A, Monteiro CA. Does the concept of “ultra-processed foods” help inform dietary guidelines, beyond conventional classification systems? NO. Am J Clin Nutr. 2022;116(6):1482-1488.
Motion graphics by Avo Media
Republishing "How Ultra-Processed Foods Could Cause Disease: Food Additives"
Terms
You may republish this material online or in print under our Creative Commons licence. You must attribute the article to NutritionFacts.org with a link back to our website in your republication.
If any changes are made to the original text or video, you must indicate, reasonably, what has changed about the article or video.
You may not use our material for commercial purposes.
You may not apply legal terms or technological measures that restrict others from doing anything permitted here.
If you have any questions, please Contact Us
Title
How Ultra-Processed Foods Could Cause Disease: Food Additives
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
If you missed the previous videos in this series, check out:
- What Are Ultra-Processed Foods?
- How Bad Are Ultra-Processed Foods?
- Which Ultra-Processed Foods Are the Worst in Driving the Association with Death and Disease?
- Do the Health Impacts of Ultra-Processed Foods Apply to Plant-Based Meat Alternatives?
Stay tuned for the rest of this extended video series on ultra-processed foods, coming out over the next several months.
If you don’t want to wait for each video to be released, we’ve compiled all the information into a brand-new book, Ultra-Processed Foods: Concerns, Controversies, and Exceptions.
If you haven't yet, you can subscribe to our free newsletter. With your subscription, you'll also get notifications for just-released blogs and videos. Check out our information page about our translated resources.
Previous Video
