What doctors wish patients knew about ultra-processed foods

For runners, ultra-processed food may become their go-to diet, sacrificing nutrition for convenience. Although it may be convenient, eating ultra-processed foods on a regular basis increases a person’s risk of health complications including cardiovascular disease, certain cancers, obesity and type 2 diabetes. But it is difficult to tell when the these foods on your plate.

Research has shown that diets high in ultra-processed foods are linked to more than 30 health conditions, according to an umbrella review of meta-analyses published in. The BMJ. Meanwhile, greater exposure to ultra-processed foods was associated with a higher risk of dying from any cause. There were also strong links with higher consumption and deaths related to cardiovascular disease, mental health disorders and type 2 diabetes.

The AMA’s What Doctors Wish Patients Knows ™ series gives physicians a platform to share what they want patients to understand about today’s health care headlines.

In this installment, two physicians took time to discuss what patients need to know about ultra-processed foods and healthier steps to take. These AMA members are:

• Stephen Devries, MD, a preventive cardiologist and executive director of the non-profit educational Gaples Institute in Chicago.
• Neha Sachdev, MD, MS, a family physician who is the director of clinical engagement and equitable care at the AMA.

“Ultra-processed foods are industrial creations made with whole foods that contain little—if any—often large amounts of added sugar and salt,” explained Dr. Devries, noting ultra-processed foods “are usually infused with artificial colors and additives.”

“Ultra-processed foods are altered from their natural forms. This can be done to display foods in a certain way or to preserve foods for longer,” said Dr Sachdev. “Compare a carton of eggs you buy with a carton of frozen eggs. Although both of these items contain eggs, these are very different foods that have gone through very different journeys to reach store shelves.”

Some other examples of ultra-processed foods include:

• Salty, sweet, savory or salty packaged snacks.
• Ice creams and frozen desserts.
• Cola, soda and other carbonated soft drinks.
• Energy and sports drinks.
• Canned, packaged, dehydrated and other instant soups.
• Packaged meat, fish, vegetables, bread and buns.
• Breakfast cereals and bars.
• Sweetened juices.
• Margarines and sheets.
• Infant formulas and drinks.
• meal replacement shakes such as Slim Fast.

Processed and ultra-processed are not just about the food you eat. The drinks you drink can also be involved.

For example, “tap water is not processed, but energy drinks and sodas are,” said Dr. Sachdev. “It’s so important to pay attention to the drinks you drink and the foods you eat.”

“Ultra-processed foods are clever manipulations of mostly unhealthy ingredients given to an audience to appeal to the popular eye – tasty by design, but it’s all a trick,” said Dr. Devries. “For example, our bodies are naturally drawn by evolution to the sweetness of fruits because of their nutritional value.”

That’s why “ultra-processed foods appeal to the palate with sweetness but lack the nutritional value historically associated with that taste,” he explained. “The problem with ultra-processed foods lies in the ingredients that are added to improve shelf life, including unhealthy fats and preservative chemicals that can have negative health outcomes.”

As a result, “ultra-processed foods have a better shelf life than human life,” said Dr. Devries.

“Processed foods are more nutrient dense than ultra-processed and are usually less refined and have little or no additives,” Dr. Devries said, noting “they’re generally healthier than their ultra-processed counterparts.

“Examples of processed foods are whole wheat bread, extra virgin olive oil and tofu,” he said.

“Ultra-processed foods have serious health consequences. A large study conducted over 19 years showed a 31% higher mortality for the highest compared to the lowest consumers of ultra-processed foods,” explained Dr. Devries. “Concerns include recent documentation of an increased risk of type 2 diabetes, cardiovascular disease and dementia.”

“The stakes are high because ultra-processed foods are so widely consumed. Recent data shows that 57% of caloric intake in adults comes from ultra-processed foods,” he said. “For children it’s even higher, sadly, with 67% of children’s daily calories from ultra-processed foods which are relatively empty.

“These alarming statistics go a long way to the prevalence of obesity, type 2 diabetes, and all the adverse health consequences that follow,” he said. “Ultra-processed foods are the perfect storm to promote overconsumption and weight gain: They’re engineered in the lab for maximum appeal, they’re calorie dense, and they have little or no fiber or other healthy nutrients have any.”

“The problems are even more acute for individuals who are food insecure, as the constraints of limited access and affordability of nutritious food lead to very high consumption of ultra-processed foods,” said Dr. Devries.

“The food label tells the story. Ultra-processed foods typically have a long list of ingredients, most of which are not used in home cooking and would be more familiar in a chemistry lab,” said Dr. Devries. “Many types of packaged snacks, breakfast cereals, prepared meals and sugary drinks are examples.”

“Looking at a nutrition label will give you an idea if a food is ultra-processed,” said Dr. Sachdev. “If you don’t recognize many of the ingredients listed, that’s a sign that there was a lot of processing involved.”

“High amounts of added fat and sugar added to ultra-processed creations make them much more calorie dense than most whole foods,” Dr Devries said.

“It is important to point out that all calories are not created equal,” said Dr. Sachdev. “So the same calories you might get from eating an apple, for example, are very different than the calories you might get from eating an apple fruit bar.

“These may be equal in number, but the amount of ultra-processed calories and the nutrition they provide to your body is different,” she said.

“There are many foods that can be marketed or thought to be healthy, but are actually quite processed,” said Dr. Sachdev. That means “it’s important to be aware of the foods you eat regularly and how processed these foods are.”

“The best options are meals made from whole foods, often easier to put together in one skillet,” said Dr. Devries. “When you’re running, a salad is a great option with healthy protein. And for a snack, it’s hard to beat fresh fruit and nuts.”

“Having home-cooked meals using whole foods is key,” said Dr. Sachdev. “That means you’re buying things like fresh fruit and vegetables, then preparing them at home.”

“The best advice is to choose foods that don’t have and don’t need labels: fresh vegetables, fruit, dried beans and whole grains,” said Dr. Devries. “Among packaged foods, focus on those with as few added ingredients as possible in a whole food, such as frozen vegetables and fruit, canned beans and canned fish.”

“A lot of grocery stores are set up with fresh items on the outer ring and then the center aisles are where you’ll find a lot of the processed and ultra-processed items,” said Dr. Sachdev. “Shop the perimeter of the grocery store to get those fresh, whole fruits and vegetables and those healthy proteins.”

In addition, “the perimeter of the supermarket generally includes the produce section, and that’s a great place to load up,” said Dr. Devries. “But other parts of the perimeter, including the deli counter and the bakery, are not necessarily priority areas.

“It’s best to focus primarily on buying unlabeled whole foods and a few carefully selected packaged foods that contain mostly single whole food ingredients,” he said.

“It’s probably not practical to eliminate all processed or ultra-processed food. Everyone is different, so think about where you can start to make changes. Talk to your doctor or health care team about the changes that would be most beneficial to your health,” said Dr. Sachdev, noting the value of ‘being pragmatic about what works for you.’

“What you eat is very personal and the best diet is the one you can follow,” she said.

“Ask yourself: What are some small steps you can take to change your habits and follow a healthier diet with less ultra-processed and processed foods?” Dr. Sachdev said. “Small changes add up and once you’ve established one habit, you can work on changing another.”

“The best plan is to make ultra-processed foods the rare exception rather than the rule,” said Dr. Devries. “There are many forces at work that encourage us to make less healthy choices, including product placement.

“It’s no wonder why candy bars are placed near check-out counters and even, unfortunately, in some hospital cafeterias,” he said. “But we are starting to see some positive changes, including some vending machines – traditionally bastions of junk food – now offering gourmet salads.”

When it comes to ultra-processed food, “talk to your doctor and health care team. Together, you can come up with some specific and actionable goals,” said Dr. Sachdev. “Your doctor may be able to refer you to resources that can help you make and maintain lifestyle changes.”