I was a UPF skeptic before I started digging into the literature. Above and beyond KD Hall's excellent and well controlled studies that totally control diet and switch between UPF and "real" food diets in both directions, there's a huge array of other studies with large effect sizes, that generally show a 1.3x - 1.7x all cause mortality hazard ratio. That's roughly a "smoking" size hazard, extremely significant.
Even after controlling for fiber and macros, the top quartile of UPF eaters by percent of diet have a 1.3 - 1.7x all cause mortality Hazard Ratio compared to the bottom quartile, and the amount of UPF eaten follows a direct dose-reponse curve in terms of the incremental all cause mortality.
“But wait,” you might say, “you can’t just control by macros, UPF is eaten by fat poor people, so they have many other negative health confounds!” And you’d be right!
Happily, many researchers thought of this. In fact, a 1.7x all cause mortality HR study (the SUN study in Spain) controlled for education level, SES, obesity, marital status, smoking status and historical smoking, age cohort, and a double handful of specific health conditions. Then because there could still be residual confounding, they did sensitivity analysis and calculated Vanderweele E values to get the minimum strength of association before calculating the final impacts.
A Swedish study with n=27k6 measured actual UPF metabolites in blood and found a 1.23x HR in all cause mortality for each additional sigma of UPF consumption.
They also controlled for BMI, marital status, smoking history and status, educational level, alcohol use, exercise, coffee drinking, familial health history, and more in this analysis. Their finding is in line with several other studies: “Our observed positive association with all-cause mortality was supported by a recent meta-analysis [40] and four subsequent cohort studies [17-19,21]”
I'd be willing to bet most of your readers don't smoke. I think the evidence is probably stronger than you portray it to be in this post, and if the relatively conscientious and health-aware folk in your audience knew the true effect sizes, they might be willing to make some of those major changes in diet, even if difficult.
Sure, at the societal level it's hard to move the needle - but part of the reason to write is to positively influence your readers when you can.
Every food can be part of a healthy diet, or an unhealthy diet. People need to relax and enjoy their food. Even three Big Macs a day — and nothing else — is a pretty decent diet: https://skeptoid.com/episodes/4629
"Historically, the Inuit did perfectly fine on a diet consisting mainly of saturated fat, the Maasai on cow's milk and blood loaded with cholesterol, Paleolithic Europeans on a staple of starchy grains and tubers with a little of everything else sprinkled in."
Is living as long as possible really the best criterion for how we should live our lives? Beyond bacon-versus-muesli debates the human enthusiasm for extreme sports (or even less-extreme sports like skiing) suggests otherwise.
Wasn’t there a study where they kept all macros and calories constant comparing UPF vs non UPF and the UPF still came out worse? I’ve been subsisting mostly on powdered food (Soylent, Huel) for a decade.. This would certainly be classified as UPF yet at 58 I’m down to my high school weight with a respectable lipid panel and still running ultra marathons and Ironman triathlons.. I’d venture to say the powdered food is not harming me. Of course as a red blooded American I do dabble occasionally in blatantly UPF (junk) food.. but the engineer in me really wants to know WHAT it is about UPF (aside from sugar, saturated fat, salt) that is making America fat? I’ve read elsewhere on the interwebs that it may have to do with emulsifiers or other such chemicals that might detrimentally alter the gut biom. Are we any closer to finding out what is doing the most harm?
This is basically false. While the US does have some issues with obesity, the overall picture is far healthier than low-income nations. Many low-income countries - such as Pacific Island nations - have even worse problems with ultra processed foods.
60 percent of american consumption. Is upf. Diabetes is not the only disease that bring on things like cancer, heart disease fatigue and yes obesity are out of control..and while yes some pa fiction island. Countries and portions of India are also on thr upf for our population and wealth we eat considerably worse then most Latin or African countries even food poisoning is on the increase here.
According to this study, the % UPF intake by calories was 53% for both the US and UK. Certainly this is not ideal, but America is not nearly as much of an outlier as people imagine. Most middle-income countries like Brazil are on their way to American levels of UPF consumption as well, for example Mexico with close to 30%.
Hey! I also share the latest health news and tips so that you can become healthier! Please subscribe to get updates weekly! https://healthbyteforyou.substack.com/
It appears that the focus here lies on ‘swapping’ UPF calories for non-UPF calories. One of the take-aways I got from the excellent book ‘Ultra Processed People’ is that a major problem is that these UPF foods are not satiating, hence you tend to over eat easier. Was this taken into account in the study you based this post on I wonder?
I'm still skeptical about whether there is anything special nutritionally about UPF beyond having excess fat, sugar, salt and too little fibre. However, they are often designed to be very "moreish" and convenient. A lot of food tech expertise goes into giving potato chips the right mouthfeel and colour, which along with the mix of fat, carbs and salt (a blend that doesn't occur often in fresh food), makes it hard to open a packet and not finish it. The excess calories from that factor alone would be considerable.
So is bakery refined wheat bread(processed) claimed to be healthier than Pepperidge Farm 100% whole grain bread (prepackaged, ultraprocessed) by anti ultraprocessed food people?
Too many chemicals interfere with health. Salt and sugar! Too much. Even cooking has negative health consequences. See Price’s and Pottenger’s basic research on processed foods.
I also do not believe that saturated fat is bad for us as uncovered by Nina Teicholz in The Big Fat Surprise. Are you aware of or have thoughts on her work?
I find Teicholz's work incredibly unconvincing. Saturated fat is worse than other forms of fat, all things being equal. This doesn't mean that diets high in sat fats are always bad, but if you can substitute it's generally an improvement.
Do you have resources that demonstrate the potential harms that are not confounded by other possible causes? That seems to me to be one of her major points.
In this case we can directly link lower cholesterol levels with less deaths through RCTs, which makes it a very strong case. There's proof that saturated fats increase cholesterol more than unsaturated, and while the observational evidence likely overstates the benefits I don't think there's much question in a scientific sense that sat fat => higher cholesterol => greater risk of cardiovascular disease long-term.
I know that Teicholz is a very big proponent of ketogenic diets, and I don't disagree that these can be useful, but I think the claims about saturated fats are not well evidenced and seem more contrarian than scientific to me.
Okay, thank you. I have gone on a low carbohydrate diet that is also low on processed foods and have lost 40 pounds since 2021 and kept it off. I feel better and exercise more. And at almost 81 years old work many hours researching and doing my WW II Baby podcast series. So I am happy.
But you know, it's not just this one study.
I was a UPF skeptic before I started digging into the literature. Above and beyond KD Hall's excellent and well controlled studies that totally control diet and switch between UPF and "real" food diets in both directions, there's a huge array of other studies with large effect sizes, that generally show a 1.3x - 1.7x all cause mortality hazard ratio. That's roughly a "smoking" size hazard, extremely significant.
Even after controlling for fiber and macros, the top quartile of UPF eaters by percent of diet have a 1.3 - 1.7x all cause mortality Hazard Ratio compared to the bottom quartile, and the amount of UPF eaten follows a direct dose-reponse curve in terms of the incremental all cause mortality.
“But wait,” you might say, “you can’t just control by macros, UPF is eaten by fat poor people, so they have many other negative health confounds!” And you’d be right!
Happily, many researchers thought of this. In fact, a 1.7x all cause mortality HR study (the SUN study in Spain) controlled for education level, SES, obesity, marital status, smoking status and historical smoking, age cohort, and a double handful of specific health conditions. Then because there could still be residual confounding, they did sensitivity analysis and calculated Vanderweele E values to get the minimum strength of association before calculating the final impacts.
A Swedish study with n=27k6 measured actual UPF metabolites in blood and found a 1.23x HR in all cause mortality for each additional sigma of UPF consumption.
They also controlled for BMI, marital status, smoking history and status, educational level, alcohol use, exercise, coffee drinking, familial health history, and more in this analysis. Their finding is in line with several other studies: “Our observed positive association with all-cause mortality was supported by a recent meta-analysis [40] and four subsequent cohort studies [17-19,21]”
I've left out another snippet I could have put here that literally runs down 10 additional studies, all with N in the tens to hundreds of thousands, showing similarly large effect sizes. I actually wrote a whole post about this here: https://performativebafflement.substack.com/p/processed-food-followup-ultra-processed?r=17hw9h
I'd be willing to bet most of your readers don't smoke. I think the evidence is probably stronger than you portray it to be in this post, and if the relatively conscientious and health-aware folk in your audience knew the true effect sizes, they might be willing to make some of those major changes in diet, even if difficult.
Sure, at the societal level it's hard to move the needle - but part of the reason to write is to positively influence your readers when you can.
Every food can be part of a healthy diet, or an unhealthy diet. People need to relax and enjoy their food. Even three Big Macs a day — and nothing else — is a pretty decent diet: https://skeptoid.com/episodes/4629
"Historically, the Inuit did perfectly fine on a diet consisting mainly of saturated fat, the Maasai on cow's milk and blood loaded with cholesterol, Paleolithic Europeans on a staple of starchy grains and tubers with a little of everything else sprinkled in."
However the life expectancy of the inuit or the massai is a couple of decades less than the average person in the west. Just saying..
Is living as long as possible really the best criterion for how we should live our lives? Beyond bacon-versus-muesli debates the human enthusiasm for extreme sports (or even less-extreme sports like skiing) suggests otherwise.
Wasn’t there a study where they kept all macros and calories constant comparing UPF vs non UPF and the UPF still came out worse? I’ve been subsisting mostly on powdered food (Soylent, Huel) for a decade.. This would certainly be classified as UPF yet at 58 I’m down to my high school weight with a respectable lipid panel and still running ultra marathons and Ironman triathlons.. I’d venture to say the powdered food is not harming me. Of course as a red blooded American I do dabble occasionally in blatantly UPF (junk) food.. but the engineer in me really wants to know WHAT it is about UPF (aside from sugar, saturated fat, salt) that is making America fat? I’ve read elsewhere on the interwebs that it may have to do with emulsifiers or other such chemicals that might detrimentally alter the gut biom. Are we any closer to finding out what is doing the most harm?
Americans as a whole lead the charge in killing people with their food most " undeveloped countires" wayy healthier then us
This is basically false. While the US does have some issues with obesity, the overall picture is far healthier than low-income nations. Many low-income countries - such as Pacific Island nations - have even worse problems with ultra processed foods.
60 percent of american consumption. Is upf. Diabetes is not the only disease that bring on things like cancer, heart disease fatigue and yes obesity are out of control..and while yes some pa fiction island. Countries and portions of India are also on thr upf for our population and wealth we eat considerably worse then most Latin or African countries even food poisoning is on the increase here.
According to this study, the % UPF intake by calories was 53% for both the US and UK. Certainly this is not ideal, but America is not nearly as much of an outlier as people imagine. Most middle-income countries like Brazil are on their way to American levels of UPF consumption as well, for example Mexico with close to 30%.
Oh how I envy the Europeans who get fresh cooked bread at the market everyday... So delicious!
Hey! I also share the latest health news and tips so that you can become healthier! Please subscribe to get updates weekly! https://healthbyteforyou.substack.com/
It appears that the focus here lies on ‘swapping’ UPF calories for non-UPF calories. One of the take-aways I got from the excellent book ‘Ultra Processed People’ is that a major problem is that these UPF foods are not satiating, hence you tend to over eat easier. Was this taken into account in the study you based this post on I wonder?
I'm still skeptical about whether there is anything special nutritionally about UPF beyond having excess fat, sugar, salt and too little fibre. However, they are often designed to be very "moreish" and convenient. A lot of food tech expertise goes into giving potato chips the right mouthfeel and colour, which along with the mix of fat, carbs and salt (a blend that doesn't occur often in fresh food), makes it hard to open a packet and not finish it. The excess calories from that factor alone would be considerable.
And you can’t ignore cost.
It’s too simplistic. Correlation or causation? What about other confounders?
https://research.tees.ac.uk/ws/portalfiles/portal/57339668/UPF_manuscript_05.04.23_Accepted.docx
So is bakery refined wheat bread(processed) claimed to be healthier than Pepperidge Farm 100% whole grain bread (prepackaged, ultraprocessed) by anti ultraprocessed food people?
Damn. Now I want to go out and get a Double Bypass burger.
Too many chemicals interfere with health. Salt and sugar! Too much. Even cooking has negative health consequences. See Price’s and Pottenger’s basic research on processed foods.
I also do not believe that saturated fat is bad for us as uncovered by Nina Teicholz in The Big Fat Surprise. Are you aware of or have thoughts on her work?
I find Teicholz's work incredibly unconvincing. Saturated fat is worse than other forms of fat, all things being equal. This doesn't mean that diets high in sat fats are always bad, but if you can substitute it's generally an improvement.
Do you have resources that demonstrate the potential harms that are not confounded by other possible causes? That seems to me to be one of her major points.
In this case we can directly link lower cholesterol levels with less deaths through RCTs, which makes it a very strong case. There's proof that saturated fats increase cholesterol more than unsaturated, and while the observational evidence likely overstates the benefits I don't think there's much question in a scientific sense that sat fat => higher cholesterol => greater risk of cardiovascular disease long-term.
I know that Teicholz is a very big proponent of ketogenic diets, and I don't disagree that these can be useful, but I think the claims about saturated fats are not well evidenced and seem more contrarian than scientific to me.
Okay, thank you. I have gone on a low carbohydrate diet that is also low on processed foods and have lost 40 pounds since 2021 and kept it off. I feel better and exercise more. And at almost 81 years old work many hours researching and doing my WW II Baby podcast series. So I am happy.