Author Chris Van Tulleken 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 has a medical degree from Oxford and a PhD in molecular virology.
In his book Ultra Processed People, he focuses on the question of obesity with its relation to Ultra Processed Food (UPF). He provides a mix of analysis and commentary to show how UPFs affect the human body, and how they’re marketed.
Van Tulleken’s goal is to give people information to ‘arm yourself with the simple and not-so-simple facts that will help you make the choices that are right for you.’
This Ultra Processed People review addresses the larger points in the book.
(Photo from NPR)
As a dietitian, I think ultra-processed food does have a rightful place in our world. Should our diets be made up solely from it? Not ideally. But, I do believe that it’s entirely possible to be healthy and to eat some UPF.
Starting out, the book’s cover calls UPF ‘food that isn’t food.’ Not only is ultra-processed food actual food, it’s sometimes the only food individuals can afford.
While Van Tulleken talks about food deserts and social determinants of health throughout the book, it’s a bit rich that the book’s cover would food shame people before they even open it.
According to Van Tulleken, over the past 150 years, we have begun to consume substances constructed from molecules using multiple kinds of processing. Many of our calories are coming from ingredients like modified starches, invert sugars, hydrolyzed protein isolates, and seed oils, and ultra-processed food now makes up around 60 per cent of the average diet in the UK and USA.
Van Tulleken outlines that as time goes on, humans are beginning to consume more and more UPF that in turn, can be harmful to the body.
While this may be correct, it’s important to realize the nuance behind food choices and nutrition in general: yes, UPF may increase risk for disease if they’re all people are consuming.
I’m willing to venture that most humans on this planet understand that their entire diets should not consist of foods like chips and soda; and, when this is the case, it’s not because the person has a choice of what to eat – in many cases, they’re trying to survive on a limited food budget.
There are outliers, of course, but social determinants of health are intimately linked to food choices and ultimately, to a person’s health status and outcomes.
An individual’s capacity to make informed and healthy food choices is heavily influenced by a complex interplay of circumstances. These circumstances encompass disparities in access to resources like time, finances, and education.
Additionally, socioeconomic factors, such as income, education, and living conditions, can exert a significant influence, often constraining people to rely on more convenient and processed food options.
All of these things can impact the amount of ultra-processed food someone eats, and Van Tulleken acknowledges this in the book.
Van Tulleken talks about the NOVA classification of UPF. NOVA classification of foods is a standardized method for categorization of food, mostly for scientific purposes.
NOVA categories are:
Group 1: Unprocessed and minimally processed foods
Group 2: Processed culinary ingredients
Group 3: Processed foods
Group 4: Ultra-processed foods
NOVA is a fairly basic way of putting food into loose categories, but its usefulness in everyday life is questionable. Its accuracy is also somewhat controversial, since it’s built on subjective data. It’s fairly obvious 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 really need NOVA to tell us this.
Van Tulleken hypothesizes that UPF are engineered to be addictive, which he says complicates matters when someone is trying to cut these foods to lose weight. The validity of a ‘food addiction’ diagnosis is controversial: Some people do have symptoms that may mimic addiction but this doesn’t happen with everyone. It’s unknown if these symptoms are due to an actual physical addiction.
He talks about how since the 1980’s, the prevalence of obesity has skyrocketed, which he believes is because of our UPF habit. Like a lot of Van Tulleken’s theories in Ultra Processed People, I find this one to be an oversimplification of a complex issue: how can we say that obesity is directly due to UPF intakes?
Here are some other differences between now and the 80’s:
Home Economics isn’t much of a thing in schools anymore
Today, we have a culture where being busy is praised, leading to increased stress and anxiety
We’re more sedentary, especially with screen time and the availability of online…everything
There’s a greater choice in grocery stores, which can lead to increased intake
Decreased community supports
Increased cost of living – The rising cost of living, including expenses related to housing, healthcare, and education, can impact people’s ability to prioritize health and nutrition.When individuals and families face financial constraints, they may opt for cheaper, calorie-dense foods that provide short-term satiety but lack essential nutrients.
The cost of food has gone up since the 1980s, food priced at $10 is now worth about $37 in 2023. Food price inflation has increased, and this has an impact in the food that people are able to afford each week.
Health care – Changes in healthcare costs and access can affect individuals’ ability to manage their health. High healthcare expenses and limited access to affordable healthcare services can hinder obesity prevention and management efforts.
What happens when we eat a lot of ultra-processed food?
Van Tulleken isn’t wrong when he writes that a diet full of UPF is associated with poor health outcomes.
Along a similar line, recent research confirms that we tend to consume more calories and gain more weight when we consume a diet that’s predominantly UPF, even when calories and macronutrients are matched. A less rigorous trial than the one above but one by Fernanda Rauber, whose work Van Tulleken used for the book, suggests the same findings.
Van Tulleken makes a huge deal about emulsifiers and how they negatively impact our gut bacteria, but there’s really no persuasive research to back that claim up. It’s just another theory, courtesy of the author.
Ultra Processed People makes a lot of claims that are supported only by preliminary research, although I feel as though this is stated as a caveat for readers. But in doing this, Van Tulleken seems to oversimplify complex issues, which I think is unfair.
For example, for his book ‘research,’ Van Tulleken put himself on a diet comprised of 80% ultra-processed foods. By week three, he became constipated, exhausted, angry, and miserable. This is when he started to dive deeper into the effects UPF has on the body.
He then got brain scans done. The doctor who did the scans apparently noticed that ‘the wiring of his brain hadn’t changed, but the information flowing through the wires had.’ She also told him that these changes don’t occur unless something significant has occurred in the physiology of the brain.
Frustratingly, Van Tulleken didn’t bother to go further to explain what the scans actually picked up on, and what the clinical relevance would be for people eating this much UPF.
Aside from the brain scans, nothing he experienced really shocks me. He went from consuming minimal ultra-processed food to eating almost all UPF, which would obviously impact his health and the way he felt – even in a matter of weeks.
Ultra-processed foods are often low in essential nutrients like fibre, vitamins and minerals. It’s often highly processed. Depending on which foods Van Tulleken ate, it’s completely unsurprising that he would have changes in his bodily functions and his mood.
He says that ultra processed foods are generally soft and easily digested. According to research, this can lead to overconsumption because the food is easy to eat quickly, and is easer for the body to absorb.
Van Tulleken delves into additives and the sensory aspects of ultra-processed food, specifically focusing on the use of scent to trigger the brain’s dopamine reward system when opening UPF packaging.
The idea is that the scent makes ultra-processed food seem more appealing, which can lead to cravings once the package is opened. He believes that this phenomenon has the potential to disrupt the body’s ability to form accurate associations between nutrients and food.
It’s important to note that Van Tulleken doesn’t explicitly provide evidence to support this claim.
In the USA, companies are allowed to self-determine substances this tends to happen in smaller companies. He goes into saying that things like the corn oil in our kitchens could have been produced using a technology that leaves it full of unlicensed additives and antibiotics.
The author’s aim seems to be to spotlight the lack of transparency and potential risks associated with the FDA and its regulation of the food system. This is definitely an important conversation that we should be having.
FYI: Greens powders and protein powders are ultra-processed foods, too.
Van Tulleken reaches far when he talks about how individuals may develop a strong preference for ultra-processed foods over traditional, locally sourced, more nutritious foods. This shift in preference can lead to a significant departure from traditional diets, which may have once provided a more balanced and wholesome source of nutrition.
I’m not an anthropologist, but I’d argue that if people aren’t eating their traditional foods, there’s other reasons besides a McDonald’s moving in down the block.
Ultra Processed People review, in short:
The Ultra Processed People book is a mixed bag of things we already know (a diet full of UPF isn’t ideal), things that the author is speculating about, and things he’s asserting but not backing up with credible evidence.
Van Tulleken gets quite a bit right in Ultra-Processed People. I liked that he acknowledged that social determinants of health affect our food choices, and that he is against ‘good’ and ‘bad’ labels for food.
He asks questions about the FDA’s regulatory processes for food. While I think this is an important topic, the verbiage Van Tulleken uses in that section and others seems to intentionally sensationalize the subject matter. Always remember that the dose makes the poison.
There’s a lot of reaching, anecdotes, and unsubstantiated claims in the book.
That being said, he’s absolutely correct that ultra-processed foods are easier to eat and absorb, and that their palatability is undeniable.
Nobody here is arguing that ultra-processed food should comprise the majority of our diet. Exactly the opposite, actually. But UPF can and do play a role in a healthy diet with their accessibility, convenience, taste, and yes – nutrients.
Addressing how much ultra processed food we eat, along with disparities in nutrition and health, requires fixing of society’s underlying inequalities to ensure that everyone, regardless of their circumstances, has an equitable opportunity to make nutritious choices for themselves and their families.