Review of Ultra Processed People by Abby Langer Nutrition

Chris Van Tulleken, the author, is an infectious diseases doctor at the University College Hospital in London for Tropical Diseases and an associate professor at University College London in the division of infection. Chris holds a medical degree from Oxford and a PhD in molecular virology. 

The primary focus of his book Ultra Processed People is the correlation of obesity with Ultra Processed Food (UPF). He offers a blend of analysis and commentary to illustrate the impact of UPFs on the human body and their marketing strategies.

Van Tulleken’s objective is to provide people with information to “equip themselves with the simple and not-so-simple facts that will aid them in making the right choices.”

This evaluation of Ultra Processed People addresses the key aspects covered in the book.

(Photo source: NPR)

As a nutritionist, I believe ultra-processed food has a justified place in our society. Should our diets exclusively consist of it? Ideally not. However, I’m of the opinion that it’s entirely possible to maintain good health while including some UPF in our diets.

Initially, the book’s cover denounces UPF as “food that isn’t food.” Not only are ultra-processed foods actual sustenance, but in some cases, they are the only affordable option for individuals.

While Van Tulleken discusses food deserts and social determinants of health throughout the book, it’s somewhat hypocritical that the book’s cover would stigmatize food even before it’s opened.

According to Van Tulleken, over the last 150 years, we have begun consuming substances created from molecules using various forms of processing. A significant portion of our daily calories come from ingredients like modified starches, invert sugars, hydrolyzed protein isolates, and seed oils, and ultra-processed food now constitutes approximately 60 percent of the average diet in the UK and USA. 

Van Tulleken explains that as time progresses, humans are increasingly consuming more UPF, which can be detrimental to the body.

While this may be accurate, it’s essential to recognize the complexity of food choices and nutrition in general: yes, UPF may elevate the risk of disease if they constitute the entirety of a person’s diet. 

I’m inclined to believe that most individuals on this planet understand that their diet should not solely comprise items like chips and soda; and in cases where this occurs, it’s not because the individual has a choice of what to eat – often, they are struggling to survive on an insufficient food budget.

There are exceptions, of course, but social determinants of health are intimately connected to food choices and ultimately, a person’s health status and results.

(Source: United Way Halifax)

An individual’s ability to make knowledgeable and healthy food choices is greatly influenced by a complex interplay of circumstances. These circumstances encompass inequalities in access to resources such as time, finances, and education. 

No, we don’t all have the same 24 hours in a day. Here’s why.

Additionally, economic factors, including income, education, and living conditions, can exert a substantial influence, frequently compelling people to depend on more convenient and processed food options. 

All these factors can affect the quantity of ultra-processed food an individual consumes, and Van Tulleken acknowledges this in the book.

NOVA classification

Van Tulleken delves into the NOVA classification of UPF. The NOVA classification of foods serves as a standardized method to categorize food, primarily for scientific purposes. 

The NOVA categories include:

Group 1: Unprocessed and minimally processed foods

Group 2: Processed culinary ingredients

Group 3: Processed foods

Group 4: Ultra-processed foods

NOVA is a rather straightforward method of loosely categorizing food, but its practicality in everyday life is debatable. Its accuracy is also somewhat contentious as it’s based on subjective data. It’s quite evident which foods are unprocessed and minimally processed, and thousands of processed foods like hummus, frozen vegetables, canned beans, pasteurized milk, and others are nutritious. 

We don’t particularly require NOVA to inform us of this.

I have discussed NOVA in greater detail in my post about ultra-processed foods here.

Van Tulleken theorizes that UPF are engineered to be addictive, which he claims complicates matters when someone tries to cut these foods to lose weight. The legitimacy of a ‘food addiction’ diagnosis is contested: Some individuals do exhibit symptoms that may resemble addiction, but this isn’t universal. It’s unclear whether these symptoms are a result of a genuine physical addiction. 

He talks about how since the 1980s, the prevalence of obesity has surged, which he attributes to our UPF consumption habits. Similar to many of Van Tulleken’s theories in Ultra Processed People, I find this one to be an oversimplification of a complex issue: how can we ascribe obesity solely to UPF intake?

Here are some other disparities between now and the 80s:

Home Economics isn’t as prevalent in schools anymore

Today, we embrace a culture that glorifies busyness, leading to heightened stress and anxiety

We lead more sedentary lifestyles, particularly with increased screen time and the availability of online services

There’s a wider variety in grocery stores, potentially contributing to increased consumption

Decline in community support

Increased cost of living – The escalating cost of living, encompassing housing, healthcare, and education expenses, can influence people’s capacity to prioritize health and nutrition. When individuals and families face financial constraints, they may opt for cheaper, calorie-dense foods for quick satiety, despite lacking vital nutrients.

The cost of food has risen since the 1980s, with food priced at $10 now equivalent to about $37 in 2023. Food price inflation has risen, impacting the affordability of weekly food purchases for people. 

Healthcare – Shifts in healthcare expenses and accessibility can affect individuals’ ability to manage their health. Substantial healthcare costs and limited access to affordable healthcare services can impede obesity prevention and management efforts.

Ramifications of excessive UPF consumption

Van Tulleken is justified in highlighting that a diet predominantly comprising UPF is linked to poor health outcomes.

Concurrently, recent research affirms that we tend to consume more calories and gain more weight when our diet is largely UPF-based, even when calories and macronutrients are matched. A less stringent trial than the aforementioned one, but one utilized by Fernanda Rauber, whose work Van Tulleken references, suggests similar findings.

There is substantial research indicating that a diet high in ultra-processed foods correlates with cancer and obesity.

Van Tulleken places great emphasis on emulsifiers and their adverse effects on our gut bacteria, yet there is insufficient compelling research to support this.that contention. It’s simply another hypothesis, as per the writer.

Ultra Processed People makes several assertions, backed only by preliminary studies, although it seems to be presented as a disclaimer for readers. However, Van Tulleken appears to oversimplify intricate matters in doing so, which I consider to be unjust.

For instance, in his ‘research’ for the book, Van Tulleken subjected himself to a diet composed of 80% ultra-processed foods. By the third week, he experienced constipation, fatigue, irritability, and despair. This led him to delve deeper into the impact of UPF on the body.

He then underwent brain scans. The physician who conducted the scans purportedly observed that ‘the structure of his brain hadn’t altered, but the information coursing through the neural pathways had.’ She also mentioned that such changes don’t occur unless there has been a significant physiological change in the brain.

Regrettably, Van Tulleken didn’t make an effort to elaborate further on what the scans actually detected and the potential clinical significance for individuals consuming such a high amount of UPF.

Outside of the brain scans, nothing he encountered astonishes me. He transitioned from consuming minimal ultra-processed food to virtually all UPF, which would undeniably impact his well-being and his emotional state – even within a few weeks.

Ultra-processed foods often lack vital nutrients like fiber, vitamins, and minerals. They are frequently heavily processed. Depending on the specific foods Van Tulleken consumed, it’s entirely predictable that he would experience variations in his bodily functions and mood.

He asserts that ultra-processed foods are generally soft and readily digestible. According to research, this can lead to overconsumption because the food is easy to consume rapidly and is more readily absorbed by the body.

Van Tulleken delves into additives and the sensory aspects of ultra-processed food, particularly focusing on the use of aroma to stimulate the brain’s dopamine pleasure system when unwrapping UPF packaging.

The concept is that the aroma makes ultra-processed food appear more enticing, which can lead to cravings once the package is opened. He believes that this phenomena could disrupt the body’s ability to form accurate connections between nutrients and food.

It’s important to highlight that Van Tulleken doesn’t explicitly offer proof to substantiate this contention.

In the USA, companies are authorized to self-declare substances, and this tends to occur more frequently in smaller enterprises. He goes on to suggest that substances like the corn oil in our kitchens might have been produced using a method that leaves it containing unapproved additives and antibiotics.

The writer’s intention appears to be to spotlight the lack of openness and potential hazards associated with the FDA and its oversight of the food system. This is unquestionably a significant discussion that we should engage in.

FYI: Green powders and protein powders are also considered ultra-processed foods.

Van Tulleken stretches the point when he talks about how individuals may develop a strong inclination for ultra-processed foods over traditional, locally sourced, more nutritious foods. This change in preference can lead to a notable departure from traditional diets, which may have previously offered a more balanced and wholesome source of nourishment.

I’m not an anthropologist, but I’d argue that if people are no longer consuming their traditional foods, there are other causes beyond a McDonald’s opening nearby.

Review of Ultra-Processed People, in brief:

The Ultra Processed People book presents a blend of existing knowledge (a diet abundant in UPF isn’t ideal), speculations by the author, and assertions made without credible evidence to support them.

Van Tulleken does get a lot right in Ultra-Processed People. I appreciated that he recognized the influence of social factors on our dietary choices and that he opposes categorizing food as ‘good’ and ‘bad’.

He raises concerns about the FDA’s regulatory processes for food. Although I believe this is a crucial topic, the language used by Van Tulleken in that section and others seems to sensationalize the subject deliberately. Always keep in mind that the dosage determines the poison.

The book contains a lot of conjecture, anecdotes, and unsubstantiated claims.

That being said, he is absolutely correct that ultra-processed foods are easier to consume and digest, and their appeal is undeniable.

No one here is arguing that ultra-processed food should dominate our diet; quite the opposite, in fact. However, UPF can indeed play a role in a nutritious diet with their accessibility, convenience, flavor, and yes – nutrients.

Addressing the quantity of ultra-processed food we consume, alongside disparities in nutrition and health, necessitates addressing the underlying inequalities in society to ensure that everyone, irrespective of their circumstances, has an equitable chance to make healthy choices for themselves and their families.