Doctor: “Ultra-processed foods are to blame for the state of more than half the patients I see”

The paper, published in the BMJ, showed conclusively that people who ate the most ultra-processed food had a 21 per cent higher risk of death from any cause. (Shutterstock/ShotPrime Studio via Daily Mail)

Last night, I got back late from work and, feeling stressed and tired, I raided the kitchen cupboards and scoffed a bowl of Coco pops, two pieces of toast and all the Tunnock’s Milk Chocolate Caramel Wafers in the biscuit tin.

I knew what I was eating was highly processed and unhealthy — but the temptation of the short-term hit was too great to worry about any of the health implications.

As a doctor, I’m always handing out advice about eating this or that, exercising, quitting smoking, cutting down on booze and such like. I give this advice to my patients, my family and in this very column.

But following the advice is so much harder than giving it.

I’d be lying if I said those caramel biscuits weren’t delicious — but however mouth-watering, we all really do need to make a greater effort when it comes to ultra-processed foods (UPFs).

Essentially, these are processed foods packed with sugars and fat, with lots of additives — such as artificial sweeteners, emulsifiers and similar additives.

In the past few years, the noise about UPFs has become much louder. But I was never sure how much was hype and how much was actually fact.

However, unlike with my previous late-night scoffing, this time I’m feeling more worried about it. For last week a study published in the BMJ by world-leading epidemiologists from across the continents changed everything.

In future, it will be regarded as one of those landmark studies that alters the advice we give to patients. Once and for all, it confirms the truth about the risks of ultra-processed food — it’s literally killing us.

This paper showed conclusively that people who ate the most ultra-processed food had a 21 per cent higher risk of death from any cause, a 66 per cent higher chance of dying from heart disease and a 12 per cent higher chance of getting cancer.

There were also increased risks for obesity — 36 per cent — and type 2 diabetes — 40 per cent.

But the greatest impact was on mental health — with a 48 per cent higher risk of anxiety and a 22 per cent higher risk of depression over the study period.

Previous research has demonstrated that there might be a link, but this review of studies brought together many smaller studies comprising data from over nine million patients. With these numbers, the links between UPF and ill-health could be proved beyond doubt and with near statistical certainty.

And working in A&E, I see UPFs’ impact. I’d estimate that over 50 per cent of the patients would not have become ill if it were not for a diet full of UPFs, strokes, cancers, heart attacks and diabetic complications are all so much more common in those who have more UPFs in their diet.

Groundbreaking, pioneering, landmark, whatever we call this paper, you can be sure that the food manufacturers are not going to take this lying down.

This industry is a multi-trillion-pound business and companies with vested interests will try every trick to delay the reforms that we need.

We only have to look into the history of smoking to see the playbook of what will happen.

Many doctors 100 years ago backed smoking and even claimed it was beneficial. They were paid handsomely to take part in tobacco marketing campaigns.

However, in the 1950s, two now famous British epidemiologists Sir Richard Doll and Sir Austin Bradford Hill, published a landmark study showing that smoking was associated with cancer.

The tobacco industry spent the next 50 years questioning the validity of the study, saying it was not proof and arguing that ‘being associated’ with cancer does not mean it caused it. The manufacturers argued that the only way to answer the question of whether smoking was dangerous was through a randomised controlled study. Half of the trial volunteers would smoke cigarettes and the other half wouldn’t — research that was plainly unethical and also undoable.

The effect was to delay the introduction of public health measures, such as bans on smoking in the workplace and elsewhere. Meanwhile, tobacco companies continued to make a profit, while millions around the world died from smoking-related disease.

I see similar arguments about the research on ultra-processed food. For instance, that people who eat UPFs do die younger and get more cancer but there are other factors, such as lack of exercise.

Just because something is marketed as healthy, doesn’t mean it is. (Shutterstock/kurhan via Daily Mail)

But as their tobacco research showed, there were other ways to prove smoking caused cancer — crucially by showing a strong statistical association. in the case of UPFs, the researchers found a 12 per cent increased risk of cancer, proving beyond doubt that UPFs directly affect health.

There also needs to be a ‘biological gradient’ — in other words, the more UPFs you eat, the more unwell you become.

The new study showed this too — for example, with every 10 per cent increase in the consumption of UPFs, there was a 12 per cent increase in the risk of developing type 2 diabetes.

There also needs to be consistency in the results, which there was with the results coming from over nine million people from multiple studies, each one providing the same results: UPFs are linked to ill-health. But, crucially, in order to prove the cause, there needs to be a scientific explanation for the findings. And we now have it.

It won’t surprise you to learn that ultra-processed food is nutrient-deficient but high in added sugars and unhealthy (but tasty) fats. Lacking in protein, they often don’t fill you up and so you eat more calories. But that’s only one half of the problem.

The foods often contain what are in effect edible chemicals, the like of which our bodies have never experienced before in human evolution.

Studies have shown that chemicals, such as emulsifiers and artificial flavourings, can cause inflammation which triggers a whole host of ill effects. These include increasing damage to DNA that can lead to cancer and helping to create plaques in arteries that lead to heart attacks.

But it’s the disruption to the gut bacteria which I think is the most worrying and can explain the effects on mental health.

The gut-brain axis is a two-way communication system between the brain and the gut — changes in bacteria in our gut caused by UPFs disrupt the signalling from the gut to the brain via the vagus nerve (as well as changing hormones created by the gut). This is how UPFs can raise the risk of depression and anxiety.

The problem is that it’s not easy to make changes, firstly, because these foods are so addictive and, secondly, because it’s sometimes hard to tell exactly what an ultra-processed food is.

A rough rule of thumb is if you had all the time in the world, could you personally grow the ingredients, or use an animal, to make the food in front of you? If not, it’s a UPF.

This includes breakfast cereals and snacks I used to think were healthy — protein bars, frozen meals and ready-meals (even low-fat, low-sugar versions), mass-produced bread, baked goods and margarine.

Just because something is marketed as healthy, doesn’t mean it is: the coco pops I had were labelled as ‘rice with added goodness, no artificial colours or flavours and 30 per cent less sugar’, and the health ‘traffic lights’ were mainly green.

But the cereal also contains 16 different ingredients, including glucose syrup, malt extract and cocoa mass.

Tackling UPFs is partly about individual responsibility, but also legislation and policies. Like they did with smoking, the Government has to take responsibility to nudge us into eating foods which won’t harm us.

For example, with taxes on ultra-processed food, with subsidies to make non-ultra-processed food affordable; and, crucially, ensuring that public venues such as leisure centres, hospitals and schools serve and sell healthy dishes.

The question for me is: will my late-night snack choices end up killing me? The answer, based on this new study, is very possibly yes. And that should set the alarm bells ringing not just for me, but for all of us.

Source: Daily Mail, UK (4 March 2024)