What happened when ultra-processed foods were matched for calories, sugar, fat, and fiber content in the first randomized controlled trial?
Ultra-Processed Junk Food Put to the Test
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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.
In the U.S., the term “junk food” is often used to describe commonly known less-healthy food categories such as candy, ice cream, and chips. However, there’s no consistent definition, and so nutrition researchers came up with the concept of ultra-processed.
The term ultra-processed “food,” if you want to call it that, describes industrial formulations that are typically seen in those long list of ingredients, which, besides salt, sugar, and fat, aren’t typically found in any cookbook––like various flavors, colors, sweeteners, emulsifiers, and other additives used to imitate real foods, or to disguise undesirable qualities of the final product. This roughly corresponds to my idea of red light foods in my traffic light system. And indeed, most of what people eat are in the red: soda, ice cream, candy, cakes, most bread and breakfast cereals, TV dinner-type ready-to-heat products, chicken nuggets, fish sticks, sausages, burgers, hot dogs … . There’s been a dramatic rise of ultra-processed foods. In fact, the U.S. food supply is dominated by them. More than 200,000 products were assessed, and 71 percent were classified as ultra-processed.
And, of course, they aren’t only in grocery stores. Sugary drinks and processed junk are ubiquitous even at non-food retailers, providing pervasive cues to consume products that are dense in calories, but poor in nutrition. As a former president of Coke put it, they want to keep Coca-Cola within an “arm’s reach of desire.” Another major candy brand boasted, “We put them everywhere: grocery stores and supermarkets, gas stations and chiropractors’ offices, bowling alleys and grocery stores, which we already mentioned. Not sorry.”
So, this is where we are today. What is the proportion of food consumed by U.S. children and adolescents that’s classified as junk? An unbelievable 56 percent to 70 percent of what our children and teens eat over the entire day is junk. Okay, yeah, but kids will be kids. In the United States of America, more than half of the calories taken in across the board are junk. In fact, around the world, ultra-processed foods consistently account for more than 50 percent of our dietary caloric intake in the higher-income countries. No wonder that unhealthy diets are humanity’s greatest killer, the leading risk factor for death on planet earth.
What exactly are the health consequences? The biological effects of modern foods have been studied using rats, showing they gorge themselves into dramatic weight gain, inflammation, and metabolic and cognitive abnormalities. And just as ultra-processed foods were taking over, a new eating disorder was recognized––binge eating, which grew into the most common form of eating disorder. And not surprisingly, binge foods were found to be 100 percent ultra-processed. No surprise, because these foods are engineered so you can’t have just one. People don’t tend to binge on broccoli.
About 9 out of 10 studies found that ultra-processed food consumption was associated with adverse health outcomes––not just obesity, but cancer, type 2 diabetes, cardiovascular diseases, irritable bowel syndrome, depression, frailty, and all-cause mortality, meaning living a shorter life. Studies on youth add asthma to the list, as well as higher DNA damage. Not a single study reported an association between ultra-processed foods and beneficial health outcomes.
In contrast, populations with low meat consumption, high fiber, and minimally processed food intake have far less chronic diseases, enjoy lower obesity rates, and live longer disease-free. But most findings were derived from observational studies. You don’t know for sure if ultra-processed foods themselves are to blame, until you put it to the test.
There had never been a randomized controlled trial on ultra-processed foods until now. Twenty people were essentially locked in a hospital ward, and received both ultra-processed and unprocessed diets for 14 days each, and here’s the kicker. Diets were matched for presented calories, sugar, fat, fiber, and macronutrients. See, in response to criticism, manufacturers are now proposing reformulating their products, keeping them ultra-processed but just tweaking them by adding some fiber, for instance, or reducing the sugar, fat, or salt. So, that’s why the researchers wanted to give the study subjects the same amount of calories, sugar, fat, fiber, carbs, and protein in each of the two diets in order to try to tease out the effect of ultra-processing. So, for instance, instead of giving people Cheerios and a muffin for breakfast in the ultra-processed weeks, or like egg and cheese muffin with turkey bacon and OJ, they gave people oatmeal with blueberries and almonds. Both meals had the same amount of overall sugar and fat, but the unprocessed option was presented more in whole food form. For lunch, the ultra-processed group might get a turkey sandwich with nonfat Greek yogurt, canned peaches, baked potato chips and sugar-free Crystal Light Lemonade, versus a Southwest entrée salad with black beans, avocados, and nuts, and grapes, and apples on the unprocessed diet. The same amount of calories offered, with the instruction to eat as much or as little as they wanted.
So, what happened? On the ultra-processed diet, they ate about 500 more calories a day. And so, no surprise, they gained about two pounds on the processed diet, or actively lost two pounds on the less processed diet. So, it wasn’t just the unbalanced nutrient profile of ultra-processed foods. So, simply tweaking them wouldn’t magically make them healthy. But that’s what the industry would rather do. Reformulation is referred to as the “unobtrusive strategy,” creating the prospect of nutritional improvement without dietary change. But what this study showed is it may be better to limit the consumption of ultra-processed foods altogether.
Why does the industry love them so much? They’re made with dirt-cheap ingredients, like taxpayer-subsidized corn syrup, allowing for huge corporate profit margins. But at what cost? The food industry takes in over a trillion dollars, yet most of our healthcare dollars go to treat chronic disease exacerbated by these very same foods, like diabetes and heart disease. So, you could argue we lose triple what the food industry pockets. The food industry argues that in modern societies, it’s “unrealistic” to advise people to avoid ultra-processed foods, given societal time constraints and the difficulties of food prep, but this may just be acquiescing to the same propaganda and disinformation campaign that the processed food industry has used to co-opt families for decades. Those who don’t think healthy foods can’t be convenient have never met an apple.
That was a response to Dr. Lustig’s essay on processed food as a failed experiment. I don’t like his mother-blaming, but I do appreciate his prescription. “There’s only one recourse—real food”. We need to start thinking outside of the box.
Please consider volunteering to help out on the site.
- Dunford EK, Popkin BM, Ng SW. Recent trends in junk food intake in u. S. Children and adolescents, 2003-2016. Am J Prev Med. 2020;59(1):49-58.
- Martínez Steele E, Baraldi LG, Louzada ML da C, Moubarac J-C, Mozaffarian D, Monteiro CA. Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. BMJ Open. 2016;6(3):e009892.
- Greger M, Stone G. How Not to Die. Flatiron Books. 2015.
- Adams J, Hofman K, Moubarac J-C, Thow AM. Public health response to ultra-processed food and drinks. BMJ. 2020;369:m2391.
- Ayton A, Ibrahim A. The dramatic rise of ultra-processed foods. BMJ. 2019;366:l4970.
- Baldridge AS, Huffman MD, Taylor F, et al. The healthfulness of the us packaged food and beverage supply: a cross-sectional study. Nutrients. 2019;11(8):1704.
- Mezzacca TA, Anekwe AV, Farley SM, et al. Ubiquity of sugary drinks and processed food throughout food and non-food retail settings in nyc. J Community Health. 2020;45(5):973-8.
- Healthy eating saves lives. Institute for Health Metrics and Evaluation.
- Ayton A, Ibrahim A. Obesity is a public health emergency. BMJ. 2019;366:l5463.
- Ayton A, Ibrahim A. The Western diet: a blind spot of eating disorder research?-a narrative review and recommendations for treatment and research. Nutr Rev. 2020;78(7):579-96.
- Ayton A, Ibrahim A, Dugan J, Galvin E, Wright OW. Ultra-processed foods and binge eating: A retrospective observational study. Nutrition. 2021;84:111023.
- Elizabeth L, Machado P, Zinöcker M, Baker P, Lawrence M. Ultra-processed foods and health outcomes: a narrative review. Nutrients. 2020;12(7):1955.
- Edalati S, Bagherzadeh F, Asghari Jafarabadi M, Ebrahimi-Mamaghani M. Higher ultra-processed food intake is associated with higher DNA damage in healthy adolescents. Br J Nutr. 2021;125(5):568-76.
- Laster J, Frame LA. Beyond the calories-is the problem in the processing? Curr Treat Options Gastroenterol. 2019;17(4):577-86.
- 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. Cell Metab. 2019;30(1):67-77.e3.
- Monteiro CA, Cannon G, Moubarac J-C, Levy RB, Louzada MLC, Jaime PC. Freshly prepared meals and not ultra-processed foods. Cell Metab. 2019;30(1):5-6.
- 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. Supplemental Information. Cell Metab. 2019;30(1):67-77.e3.
- Scrinis G, Monteiro CA. Ultra-processed foods and the limits of product reformulation. Public Health Nutr. 2018;21(1):247-52.
- Martínez-González MÁ, Martín-Calvo N. Ultraprocessed foods and public health: a need for education. Mayo Clin Proc. 2019;94(11):2156-7.
- Lustig RH. Processed food-an experiment that failed. JAMA Pediatr. 2017;171(3):212-4.
- Lawrence MA, Baker PI. Ultra-processed food and adverse health outcomes. BMJ. 2019;365:l2289.
- Lustig RH. Ethical considerations for nutrition counseling about processed food—reply. JAMA Pediatrics. 2017;171(9):914-5.
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.
In the U.S., the term “junk food” is often used to describe commonly known less-healthy food categories such as candy, ice cream, and chips. However, there’s no consistent definition, and so nutrition researchers came up with the concept of ultra-processed.
The term ultra-processed “food,” if you want to call it that, describes industrial formulations that are typically seen in those long list of ingredients, which, besides salt, sugar, and fat, aren’t typically found in any cookbook––like various flavors, colors, sweeteners, emulsifiers, and other additives used to imitate real foods, or to disguise undesirable qualities of the final product. This roughly corresponds to my idea of red light foods in my traffic light system. And indeed, most of what people eat are in the red: soda, ice cream, candy, cakes, most bread and breakfast cereals, TV dinner-type ready-to-heat products, chicken nuggets, fish sticks, sausages, burgers, hot dogs … . There’s been a dramatic rise of ultra-processed foods. In fact, the U.S. food supply is dominated by them. More than 200,000 products were assessed, and 71 percent were classified as ultra-processed.
And, of course, they aren’t only in grocery stores. Sugary drinks and processed junk are ubiquitous even at non-food retailers, providing pervasive cues to consume products that are dense in calories, but poor in nutrition. As a former president of Coke put it, they want to keep Coca-Cola within an “arm’s reach of desire.” Another major candy brand boasted, “We put them everywhere: grocery stores and supermarkets, gas stations and chiropractors’ offices, bowling alleys and grocery stores, which we already mentioned. Not sorry.”
So, this is where we are today. What is the proportion of food consumed by U.S. children and adolescents that’s classified as junk? An unbelievable 56 percent to 70 percent of what our children and teens eat over the entire day is junk. Okay, yeah, but kids will be kids. In the United States of America, more than half of the calories taken in across the board are junk. In fact, around the world, ultra-processed foods consistently account for more than 50 percent of our dietary caloric intake in the higher-income countries. No wonder that unhealthy diets are humanity’s greatest killer, the leading risk factor for death on planet earth.
What exactly are the health consequences? The biological effects of modern foods have been studied using rats, showing they gorge themselves into dramatic weight gain, inflammation, and metabolic and cognitive abnormalities. And just as ultra-processed foods were taking over, a new eating disorder was recognized––binge eating, which grew into the most common form of eating disorder. And not surprisingly, binge foods were found to be 100 percent ultra-processed. No surprise, because these foods are engineered so you can’t have just one. People don’t tend to binge on broccoli.
About 9 out of 10 studies found that ultra-processed food consumption was associated with adverse health outcomes––not just obesity, but cancer, type 2 diabetes, cardiovascular diseases, irritable bowel syndrome, depression, frailty, and all-cause mortality, meaning living a shorter life. Studies on youth add asthma to the list, as well as higher DNA damage. Not a single study reported an association between ultra-processed foods and beneficial health outcomes.
In contrast, populations with low meat consumption, high fiber, and minimally processed food intake have far less chronic diseases, enjoy lower obesity rates, and live longer disease-free. But most findings were derived from observational studies. You don’t know for sure if ultra-processed foods themselves are to blame, until you put it to the test.
There had never been a randomized controlled trial on ultra-processed foods until now. Twenty people were essentially locked in a hospital ward, and received both ultra-processed and unprocessed diets for 14 days each, and here’s the kicker. Diets were matched for presented calories, sugar, fat, fiber, and macronutrients. See, in response to criticism, manufacturers are now proposing reformulating their products, keeping them ultra-processed but just tweaking them by adding some fiber, for instance, or reducing the sugar, fat, or salt. So, that’s why the researchers wanted to give the study subjects the same amount of calories, sugar, fat, fiber, carbs, and protein in each of the two diets in order to try to tease out the effect of ultra-processing. So, for instance, instead of giving people Cheerios and a muffin for breakfast in the ultra-processed weeks, or like egg and cheese muffin with turkey bacon and OJ, they gave people oatmeal with blueberries and almonds. Both meals had the same amount of overall sugar and fat, but the unprocessed option was presented more in whole food form. For lunch, the ultra-processed group might get a turkey sandwich with nonfat Greek yogurt, canned peaches, baked potato chips and sugar-free Crystal Light Lemonade, versus a Southwest entrée salad with black beans, avocados, and nuts, and grapes, and apples on the unprocessed diet. The same amount of calories offered, with the instruction to eat as much or as little as they wanted.
So, what happened? On the ultra-processed diet, they ate about 500 more calories a day. And so, no surprise, they gained about two pounds on the processed diet, or actively lost two pounds on the less processed diet. So, it wasn’t just the unbalanced nutrient profile of ultra-processed foods. So, simply tweaking them wouldn’t magically make them healthy. But that’s what the industry would rather do. Reformulation is referred to as the “unobtrusive strategy,” creating the prospect of nutritional improvement without dietary change. But what this study showed is it may be better to limit the consumption of ultra-processed foods altogether.
Why does the industry love them so much? They’re made with dirt-cheap ingredients, like taxpayer-subsidized corn syrup, allowing for huge corporate profit margins. But at what cost? The food industry takes in over a trillion dollars, yet most of our healthcare dollars go to treat chronic disease exacerbated by these very same foods, like diabetes and heart disease. So, you could argue we lose triple what the food industry pockets. The food industry argues that in modern societies, it’s “unrealistic” to advise people to avoid ultra-processed foods, given societal time constraints and the difficulties of food prep, but this may just be acquiescing to the same propaganda and disinformation campaign that the processed food industry has used to co-opt families for decades. Those who don’t think healthy foods can’t be convenient have never met an apple.
That was a response to Dr. Lustig’s essay on processed food as a failed experiment. I don’t like his mother-blaming, but I do appreciate his prescription. “There’s only one recourse—real food”. We need to start thinking outside of the box.
Please consider volunteering to help out on the site.
- Dunford EK, Popkin BM, Ng SW. Recent trends in junk food intake in u. S. Children and adolescents, 2003-2016. Am J Prev Med. 2020;59(1):49-58.
- Martínez Steele E, Baraldi LG, Louzada ML da C, Moubarac J-C, Mozaffarian D, Monteiro CA. Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. BMJ Open. 2016;6(3):e009892.
- Greger M, Stone G. How Not to Die. Flatiron Books. 2015.
- Adams J, Hofman K, Moubarac J-C, Thow AM. Public health response to ultra-processed food and drinks. BMJ. 2020;369:m2391.
- Ayton A, Ibrahim A. The dramatic rise of ultra-processed foods. BMJ. 2019;366:l4970.
- Baldridge AS, Huffman MD, Taylor F, et al. The healthfulness of the us packaged food and beverage supply: a cross-sectional study. Nutrients. 2019;11(8):1704.
- Mezzacca TA, Anekwe AV, Farley SM, et al. Ubiquity of sugary drinks and processed food throughout food and non-food retail settings in nyc. J Community Health. 2020;45(5):973-8.
- Healthy eating saves lives. Institute for Health Metrics and Evaluation.
- Ayton A, Ibrahim A. Obesity is a public health emergency. BMJ. 2019;366:l5463.
- Ayton A, Ibrahim A. The Western diet: a blind spot of eating disorder research?-a narrative review and recommendations for treatment and research. Nutr Rev. 2020;78(7):579-96.
- Ayton A, Ibrahim A, Dugan J, Galvin E, Wright OW. Ultra-processed foods and binge eating: A retrospective observational study. Nutrition. 2021;84:111023.
- Elizabeth L, Machado P, Zinöcker M, Baker P, Lawrence M. Ultra-processed foods and health outcomes: a narrative review. Nutrients. 2020;12(7):1955.
- Edalati S, Bagherzadeh F, Asghari Jafarabadi M, Ebrahimi-Mamaghani M. Higher ultra-processed food intake is associated with higher DNA damage in healthy adolescents. Br J Nutr. 2021;125(5):568-76.
- Laster J, Frame LA. Beyond the calories-is the problem in the processing? Curr Treat Options Gastroenterol. 2019;17(4):577-86.
- 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. Cell Metab. 2019;30(1):67-77.e3.
- Monteiro CA, Cannon G, Moubarac J-C, Levy RB, Louzada MLC, Jaime PC. Freshly prepared meals and not ultra-processed foods. Cell Metab. 2019;30(1):5-6.
- 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. Supplemental Information. Cell Metab. 2019;30(1):67-77.e3.
- Scrinis G, Monteiro CA. Ultra-processed foods and the limits of product reformulation. Public Health Nutr. 2018;21(1):247-52.
- Martínez-González MÁ, Martín-Calvo N. Ultraprocessed foods and public health: a need for education. Mayo Clin Proc. 2019;94(11):2156-7.
- Lustig RH. Processed food-an experiment that failed. JAMA Pediatr. 2017;171(3):212-4.
- Lawrence MA, Baker PI. Ultra-processed food and adverse health outcomes. BMJ. 2019;365:l2289.
- Lustig RH. Ethical considerations for nutrition counseling about processed food—reply. JAMA Pediatrics. 2017;171(9):914-5.
Motion graphics by Avo Media
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Ultra-Processed Junk Food Put to the Test
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Content URLDoctor's Note
It’s no surprise processed foods are wreaking havoc with our health. Learn about The Role of Processed Foods in the Obesity Epidemic. Is there a solution? Yes. Cut the Calorie-Rich-And-Processed Foods.
This is the third video in a series on junk food. If you missed the first two, check out Do Healthy Fast Food Options Lead to Healthier Choices? and How We Won the Fight to Ban Trans Fat.
I mentioned my traffic light system for choosing the healthiest foods. Learn all about it in Dining by Traffic Light: Green Is for Go, Red Is for Stop.
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