Two ultra-processed food experiments, two different outcomes—what’s the truth?
Can a dietitian who struggles to find time for meal preparation and regularly skips lunch offer the best advice?
Teen develops fatty liver disease, type 2 diabetes on a diet of ultra-processed foods
Ultra-processed foods (UPFs) are increasingly coming under attack as people recognize their destructive effects. Recently, a Pennsylvania teen filed lawsuits against several manufacturers that made the food he grew up eating for causing type 2 diabetes and fatty liver disease by the time he turned 16. He alleges in the lawsuits that “the companies intentionally develop addictive food and market it to children.”
The Epoch Times covered the story, quoting Mike Morgan, a partner at Morgan and Morgan, the firm representing the teen:
Ultra-processed foods (UPF) are the result of companies that value profits over people, health, and safety.”
UPFs linked to higher risk of early death
Yale Medicine wrote about UPFs in its article, “Ultraprocessed Foods: Are They Bad for You?” noting a British Medical Journal review that links them to 32 different health problems and a higher risk of dying from any cause.
CNN’s article, “How much ultraprocessed food are you eating?” emphasizes that even though these foods are associated with chronic and fatal conditions, 71% of foods sold in the U.S. contain ingredients manufactured in a lab.
Ultraprocessed foods have been linked to a higher risk of cancer, heart disease, obesity and early death, yet estimates say 71% of the food supply in the United States may contain ingredients created in a laboratory.
According to the Food and Agriculture Organization of the United Nations, ultraprocessed foods contain ingredients “never or rarely used in kitchens, or classes of additives whose function is to make the final product palatable or more appealing.”
Industrial techniques destroy food value
CNN authors Sandee LaMotte and colleagues also made the important point that it’s not just the number or types of ingredients that are in a product. A product with few ingredients can still be ultra-processed because of the industrial techniques used to make them such as “extrusion, molding and prefrying — which some experts say make the food ‘predigested.’”
The industrial techniques thus matter because these processes may fundamentally degrade their nutritional value. Paul A. Sitt, a former insider at a food manufacturer, highlights the detrimental effects of the extrusion process for making cold breakfast cereals in Beating the Food Giants (p. 47), revealing how manufacturers prioritize cost-cutting and marketability, often at the expense of health.
The machine used for making shaped cereals, called an extruder, is a huge pump with a die at one end. The ingredients are mixed together into a thick soup called a slurry. The slurry goes into the extruder, is heated to a very high temperature and pushed through the die at high pressure. A spinning blade slices off each little crown or elephant, which is carried on a stream of hot air past nozzles which spray a coating of oil and sugar on each piece, to seal off the cereal from the ravages of milk and give it crunch. This extrusion process, besides creating a sweet, crunchy cereal, destroys much of the nutrient content of the ingredients. Even the chemical vitamins, added before the extrusion process, are damaged by it. The amino acid lysine, a crucial amino acid, is especially ravaged by extrusion. Yet the only changes made in the dozens of variables in the extrusion process are those which will cut costs or increase sales, regardless of how these changes will alter the nutritive value of the product.
He wrote the book in 1982; this information is not new.
Dietitian argues UPFs can contribute to a healthy diet
Despite the mounting evidence of harm, some argue that ultra-processed foods can still contribute to a healthy diet. Dietician Jessica Wilson recently set out to do just that in her article carried by Slate Magazine titled “Ultraprocessed Foods Have a Terrible Reputation. They Don’t Deserve It.” She claims that ultra-processed foods like protein bars, packaged salad dressings, and frozen meals help her get the nutrition she needs.
Critiques media focus on “celebrity” doctor’s book
Wilson, identified by Slate as an MS RDN, a registered dietitian nutritionist in California who specializes in the clinical treatment of eating disorders, said she first started looking at UPFs in the summer of 2023 when a book by U.K. “celebrity” doctor Chris van Tulleken titled, Ultra-Processed People: The Science Behind Food That Isn’t Food“.began capturing attention for an experiment he did for his book.” Van Tulleken, she explained, conducted a 30-day experiment for his book during which 80% of his diet consisted of UPFs, attempting to replicate the average British diet. As he reported, after eating a “variety of fast food, frozen meals, and sugary cereals for 30 days,” he experienced “poor sleep, anxiety, sluggishness, constipation, and feelings of unhappiness.” Wilson claimed that van Tulleken should not have generalized his experience as she disputed the idea that most people eating a diet high in ultra-processed foods would fare as poorly as he did.
Chris van Tulleken wasn’t just a “celebrity” doctor as Wilson referred to him, but a well-credentialed physician. According to his bio in the book:
Chris van Tulleken is an infectious diseases doctor at the Hospital for Tropical Diseases in London. He trained at Oxford and has a PhD in molecular virology from University College London, where he is an Associate Professor. His research focuses on how corporations affect human health, particularly in the context of child nutrition, and he collaborates with UNICEF and the World Health Organization in this area. As one of the BBC’s leading broadcasters for both children and adults, his work has won two BAFTAs. He lives in London with his wife and two children.
She also noted the extensive media attention that van Tulleken and his book received in the U.S. and U.K. Despite her contention that “this all seemed overly dramatized and incredibly reductive,” his book garnered significant acclaim.
According to the listing of his book on Amazon, it was:
a New York Times Bestseller,
an International Bestseller,
a Finalist for the 2024 IACP Award for Food Issues & Matters,
an Economist Best Book of 2023,
one of Smithsonian's Ten Best Books About Food of 2023,
a Financial Times Best Food and Drink Book of 2023,
a New Yorker Best Books of 2023 So Far,
a Goodreads Choice Awards 2023 Nominee, and
an NPR 2023 "Books We Love" Pick.
The Amazon listing also noted that he ate a diet consisting of 80% UPFs “under the supervision of colleagues at University College London,” meant to reflect the typical diet of many children and adults in the United States. He also spoke with a variety of experts from different specialties and the food industry to gather information.
While his body became the subject of scientific scrutiny, he spoke to the world’s leading experts from academia, agriculture, and―most important―the food industry itself.
Replicates van Tulleken’s UPF experiment to confirm its impact
Wilson referenced her patients’ experiences after reading these types of stories, stating that many got “analysis paralysis” trying to integrate the latest urgent health messaging into their diets and started reading labels, questioning the almond milk lattes and veggie burgers they were eating.
She, therefore, decided to try eating a high UPF diet herself for one month to see what would happen.
So I decided to find out for myself what it would look like to eat a diet purposefully loaded with ultraprocessed foods. That September, I set out to replicate van Tulleken’s experiment.
A further impetus for Wilson to embark on her experiment, according to Jamie Duchard, writing about Wilson’s experiment for Time, was Wilson’s belief that the book shamed her patients who are from marginalized populations, as well as those who are food insecure or have limited access to fresh food. Wilson also wondered, she claimed, how an entire category of foods could be considered unhealthy.
Wilson, who specializes in working with clients from marginalized groups, was irked . . . She felt that . . . the news coverage of it shamed people who regularly eat processed foods—in other words, the vast majority of Americans, particularly the millions who are food insecure or have limited access to fresh food; they also tend to be lower income and people of color. Wilson felt the buzz ignored this “food apartheid,” as well as the massive diversity of foods that can be considered ultra-processed: a category that includes everything from vegan meat replacements and nondairy milks to potato chips and candy. “How can this entire category of foods be something we’re supposed to avoid?” Wilson wondered.
Not the same UPF experiment
Wilson met with a chemical engineer involved with food processing at the University of California, Davis to determine, according to the Nova Food Classification System1 (the same system that van Tulleken used), what was and wasn’t UPF. She wrote that it was somewhat difficult to figure that out; she called the categories “squishy.”
The two of us looked at the printouts and attempted to clearly delineate what made a food Category 4 (ultraprocessed) and not Category 3 (processed). We found the categories to be squishy; placing a food in one or the other was something of a judgment call, with experts often disagreeing about what foods fall into which category.
She and the engineer therefore determined for themselves which foods belonged in the ultra-processed category.
Van Tulleken discusses the Nova Food Classification System extensively in his book, writing that it was the impetus for his experiment. He worked with other researchers to conduct his experiment on the effects of UPFs; the results of his experiment would be used to get funding for a larger study. As such, van Tulleken’s book was a result of his experiment, not the reason for it. He did not conduct the experiment solely to write the book, as Wilson implied.
In the course of researching the impact of UPF, I partnered with colleagues at University College London Hospital (UCLH). I was the first patient in this study. The idea was to get data from me that would help us get funding for a much larger study (one we’re now undertaking). The idea was simple: I would quit UPF for a month, then be weighed and measured in every possible way. Then, the next month I would eat a diet where 80 per cent of my calories came from UPF – the same diet that around one in five people in the UK and the USA eat.
In contrast to van Tulleken’s controlled study, Wilson adopted a more personalized and nutrition-conscious approach.
[W]hile van Tulleken purposefully swapped snacks like nuts for chips, I didn’t make any nutritional compromises with my diet. I ate that cashew yogurt, as well as Aidells Chicken and Apple sausage, soyrizo (a vegetarian dupe of chorizo), protein shakes, gluten-free bread, and countless Trader Joe’s and Costco snacks and premade meals.
How to distinguish between processed and ultra-processed
Understanding what exactly qualifies as ultra-processed can be challenging. Mia de Graff, a Business Insider food editor breaks it down in this video, highlighting even seemingly healthy options that fall into this category.
But the reality is that you can cut these foods out. If you speak to a nutritionist, they will tell you that they eat ultra-processed foods, too. They’re unavoidable. But the key is thinking about eating them in moderation.
Wilson's results: Feeling better by eating lunch—and making nutrient-dense choices
Unlike van Tulleken, Wilson reported feeling much better after a month of eating ultra-processed foods, explaining:
At the end of my experiment, I actually felt better than I had before. I went from skipping lunch during the week, because Sunday Jessica had had no interest in meal prep, to having meals and snacks full of veggies and protein at the ready. I didn’t have decision fatigue over what to cook, because everything took five minutes or less to get onto my plate. What’s more, it all tasted good. It was easy to grab an ultraprocessed main course and add some fruit and vegetables on the side. I didn’t need afternoon naps anymore, and overall, my anxiety was lower. Most important to me, my spouse noticed that I was more pleasant in the evenings.
However, her experience was different because she ate regularly during her experiment. Before, she had struggled with skipping lunch due to a lack of time for meal prep. While Wilson’s diet technically met the criteria for UPFs, it included more nutrient-dense options like cashew yogurt, protein shakes, and meals rich in vegetables and proteins, choices that are far healthier than the chips and sugary cereals that van Tulleken consumed. (This raises the question of whether she took advantage of the "squishiness" in category definitions to make certain choices.)
Wilson’s food choices are not necessarily representative of what most people who consume ultra-processed foods typically choose to eat or have access to. Would her patients with eating disorders be able to incorporate her suggestions easily, or would they experience “analysis paralysis” trying to replicate them? Additionally, this diet does not appear financially practical for her patients who, as Duchard reported, come from marginalized communities, nor for the lower-income and food-insecure populations about whom she was also said to be concerned.
These individuals likely do not live near and cannot afford the convenience of shopping at places like Trader Joe’s, which often carries higher-priced items as compared to other more accessible, budget-friendly options. For many, the UPFs they eat are more like van Tulleken’s, with minimal nutritional value and a greater risk of negative health outcomes.
Processed or ultra-processed?
Wilson agreed that homemade pasta sauce from vegetables you grow yourself is a healthier choice than the store-bought sauce she used. However, except for the soybean oil, the Trader Joe’s Giotto’s Tomato Basil Marinara she bought, appears to be a wholesome, minimally processed choice, according to this screenshot of the label below:
Her lifestyle, as that of many others, she argues, doesn’t allow for time to prepare food. However, as she mentioned earlier, that’s because she often doesn’t feel like cooking.
But many of us are working far more than 40 hours a week, sometimes in multiple jobs, with long commutes and swing shifts just to pay our bills and manage our student loan debt. The time one has to cook a meal is often infinitesimal, and if we need to wash, cut, season, and cook a vegetable, it simply might not happen.
And that’s where Trader Joe’s Asian Style Vegetables, with the ultraprocessed stir-fry sauce, comes in for me. (I doubt my life would improve if I came home after a hard day at work and ate unseasoned veggies, without help from delicious prepackaged toppings.)
Fooducate gives Trader Joe’s Asian Style Vegetables, with the ultra-processed [Beijing-style] stir-fry sauce a grade of C, primarily because of the sauce. The vegetables are frozen so they, like the pasta sauce, might be considered minimally processed.
However, choosing to avoid ultra-processed soy sauce doesn’t mean she has to settle for unseasoned vegetables. Instead, she could opt for a plain bottle of soy sauce without additives, or even select other frozen vegetables and add seasonings like dried herbs, oil, vinegar, butter, or a different dressing. Once the vegetables are prepared, seasoning them doesn’t take much time.
She could even buy the vegetables fresh rather than frozen at Trader Joe’s, as this screenshot from its website shows.
Taking personal responsibility for our choices
Wilson suggests that her busy schedule leaves her with no choice but to rely on ultra-processed foods, especially since she often lacks the time to prepare meals. But is that the case? Is she better off eating ultra-processed foods rather than making the effort to prepare minimally processed or unprocessed food for herself?
Stephen Covey’s principles, as outlined in The 7 Habits of Highly Effective People (p.21), emphasize starting from the inside out, with one’s paradigms, character, and motives, to build personal and interpersonal effectiveness. Applying this framework to food choices suggests that examining our paradigms about food and the motives behind those choices could help us determine whether they serve us well or need reconsideration.
Similarly, questioning the paradigms and motives behind the messages from media and authority figures can offer insights into their advice and perspectives. Can dietitians like Wilson, who struggle to find time for meal preparation and sometimes skip meals, truly offer the best advice without interjecting personal bias?
By starting from the inside out, and taking personal responsibility for our choices, we are empowered to make decisions that align with our values and well-being, fostering a greater sense of autonomy and freedom in a world where external pressures and others’ opinions too often influence our choices.
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The four Nova Scale categories, as explained by Harvard Health and the Nutrition Therapy Institute, are as follows:
Unprocessed and minimally processed foods are those that include the edible parts of plants, animals, fungi, algae, and water, which are maintained in their natural state or minimally altered to prepare them for use and/or extend shelf life. Vitamins and nutrients are primarily still intact.
Processed culinary ingredients are created from minimally processed food to make products used in home or restaurant kitchens. They are prepared from unprocessed or minimally processed foods that are not to be consumed on their own. These include sugar made from cane or beets, honey, syrup, butter, olive oil, and cornstarch.
Processed foods are simple products made by cooking, preserving, fermenting, or canning ingredients from previous groups. They are designed to be more shelf stable and/or to modify or enhance the sensory qualities of the unadulterated foods. Salt, sugar, oil, or other foods in group 2 are the only additives included in these foods. Examples include canned or jarred beans, vegetables, fruits, meats, fish, salted or smoked meats, cheese, freshly baked bread, beer, and wine.
Ultra-processed foods are foods with added ingredients like artificial colors and flavors, preservatives for shelf stability, and ingredients to preserve texture. Generally, these foods contain substances not normally used in cooking, items you won’t find in a household kitchen or even recognize as food.
Included in the UPF category would also be foods manufactured using industrial techniques like extruded cold breakfast cereals.