Modern Day Hunger Games

The connections between what we consume and our health has long been realized and studied.  There is substantial and increasingly robust evidence to show that consumption of a “healthy” diet can have profound impacts on our health and well-being. I don’t think any of us would argue with that.  But just what constitutes healthy?  We have been taught over the years to think about food based on the supposed 4 major groups – carbs, protein, dairy and fruits/vegetables.

This has led to the ever growing barrage of conflicting dietary advice on Insta or tik-tok; should you be paleo or keto; vegan or carnivore; low fat or low carb?  This binary view is, in the words of Fergie from the Black Eyed Peas, “so 2000 and late”.  What all of these eating plans have in common is a myopic focus on the “macros”, as this foursome of food groups is affectionately known.  Similar to modern medicine’s myopic focus on symptoms and diagnoses, this approach to feeding ourselves clearly misses the mark as our waistlines increase and our national health continues to decline despite the ever growing nutraceutical and diet food industries.  

I’m not going to try to debate the virtues of any of those eating patterns, and I’m not going to try to talk any of you into giving up bacon (my husband already railed on me for throwing Cheetos under the bus). Because the honest truth is, with any of those eating patterns, unless you know the science of food, what happened to it before you ate it, and what is happening in you when you do, you can be doing the work of “following a diet” and still not be eating healthy.  

So  while I actually do hope to convince you (in future posts) that there is real science to support eating more plants as a means of good health, I am going to pick on vegetarians for a minute to illustrate a point.  Many would argue, and be correct, that eating a diet of plant foods has many health benefits.  However, a diet of Domino’s Pizza, Oreos and apple juice, while completely vegetarian, is undeniably not healthy. Is it just because these items are full of fat and refined or added sugar, or has something else happened to the food along the way?  

Ironically, even though the US 2010 Dietary Guidelines for Americans report was among the first official reports to advise Americans to reduce our consumption of nutrients commonly found in excess in processed foods (such as free sugars, sodium and trans fats), the report conveniently overlooked the sources of these nutrients.  By focusing only on macros as a way to define food groups, they are putting sugary cereals, granola bars, and whole grains in the same category. Or calling ketchup a vegetable (as defined by the USDA Food and Nutrition Service during the Reagan administration in 1981).  And similarly proclaiming that processed meat such as chicken nuggets or hot dogs count the same as whole meat sources.

In addition, the heavy industrialization of the majority of our food has brought a whole new category onto our plates, and nowhere on the MyPlate graphic are these chemicals represented.  Processes and ingredients used in the majority of foods today are designed to create powerfully branded, highly profitable products that are made from low-cost ingredients with long shelf-life. The convenience of imperishable, hyper-palatable, and ready-to-consume products are what give these foods the ability to displace all other food groups, thereby replacing freshly made regular meals and dishes.  

And believe me, I get it.  In our ever increasingly fast paced worlds, we all need to rely on certain conveniences in the kitchen, especially when it comes to feeding a family and keeping everybody on schedule. Be it the morning rush to get out the door, juggling extra-curriculars, awkwardly timed late night school sports practices, or god forbid your attempts to get to a gym, many of us struggle to find the time or the energy to make our own food.  I am not suggesting that we should go back to milling our own grain for flour, we all need to rely on food processes to eat. 

But there are many who would argue, and the evidence is mounting, that the degree to which our food is now being ultra processed relates directly to declining measures of health.   

In an attempt to look at food and its relation to our health in a novel way, a team of Brazilian researchers, led by Carlos Monteiro, Professor of Nutrition and Public Health at the School of Public Health, University of Sao Paulo, Brazil, developed what is known as the NOVA classification in 2009.   While it was originally conceived as 3, they ultimately modified it to include 4 categories of food based on the extent and purposes of the industrial processes they undergo.  Their feeling is that the processes that involve physical, biological and chemical techniques used before food is consumed is more relevant to health than the actual macro ingredients included. 

Their assertion is not that all processing is bad, but that our over reliance on what they call ultra processed foods has changed the biochemical landscape within us.  By classifying food in this new way, astounding new  links between diet and  health for us as individuals, and on population levels, are being revealed.  In order to really delve into the health effects of food processing, we need to understand the definitions first.

Group 1 – unprocessed or minimally processed: If you can eat it without having to do anything to it but collect it, it is unprocessed – think whole fruit, vegetable, nuts, seeds, eggs.  Anything that you cut, grind, ferment, pasteurize, freeze, dehydrate, cook or vacuum seal to make it more palatable or safe to eat, or to allow for safe short term storage is considered minimally processed.   These are mostly whole foods as well.  The majority of what your grandmother would have identified as food fits here.  

The physiologic distinction between unprocessed and minimally processed is negligible. The macronutrient quantity and nutrient density (amount of calories per gram) varies widely in this group, making any single food unbalanced (ie dairy and meat are high in calcium, amino acids and saturated fat, but have no fiber or vitamins, and plants are high in fiber and many vitamins, but low in caloric density, fat and cholesterol, and it is difficult to get all necessary amino acids from individual plants), but it is precisely this variety that has allowed humans to evolve into the consummate omnivores that we are. When we eat a varied diet, we cover all of our macro and micro nutrient needs with ease.

Group 2 – processed culinary ingredient: This group consists of ingredients, such as salt, oil, spices and even sugar, used to prepare foods from Group 1 into palatable and enjoyable dishes.  While the original methods of processing involved traditional hand labor of grinding, milling or pressing, many of these ingredients today are processed industrially.  The ingredients in this group are typically ones that you would find in your own kitchen, and would use to make a wide assortment of dishes more enjoyable, culturally appealing or nutritionally diverse, such as sauces, baked items, salads, stews, dips and desserts. 

These culinary ingredients are very unbalanced, typically having a lot of calories per gram, and very little nutritional benefit if any. But as they are just ingredients, not foods in and of themselves, when consumed in small quantities, there is little compounding risk.  However, because some of these ingredients are cheap byproducts of other industrial processes, they have increasingly been creeping into our diets without any significant recognition.

Group 3- processed foods: These are foods made from blending ingredients from Group 2 with foods from Group 1 to increase their durability, or enhance their qualities in some way.  Typically foods in Group 3 will have fewer than 5 ingredients, all from Groups 1 or 2, and the finished product will still retain some recognizable characteristics of the original source ingredients.  Examples include canned or bottled vegetables, fruits, or fish, processed meat, like bacon, cheeses, many baked breads and crackers.   As with Group 2, historically the processes were done by hand, and can still be done artisanally, but unfortunately, the great majority of these foods are industrially processed.  In general, many of the foods in this group are nutritionally balanced, but when excess oil, sugar or salt are used in industrial quantities, they can tip the balance into unhealthy.

Group 4 – ultra processed food products and drink products: These are made almost exclusively from industrial ingredients, (meaning you don’t have these in your home kitchen) and they are created by a series of industrial techniques and processes with the intention of creating highly palatable, but shelf stable food.  The great majority of the food in this category is made from one of five cheap but high yield plant crops (corn, wheat, soy, cane or beet), or from pureeing or grinding animal carcasses to extract protein.  These substances are easily fractionated, hydrolyzed, or hydrogenated, which strips away the nutritive but perishable qualities of the food.  They are  then combined with modified or unmodified starches, as well as colors, flavors, emulsifiers and other additives that are of “no culinary use”.

Instead, Carlos Monteiro and his team state that these chemical additives are there to “disguise unpleasant sensory properties created by the ingredients, processes or packaging used in the manufacture of ultra-processed foods, or give the final product intense sensory properties especially attractive to see, taste, smell and/or touch, or both.”  The sole function of these additives is to make the final product palatable (and often hyper-palatable) and sellable.  Examples of food substances employed in the manufacture of ultra-processed foods, include varieties of sugars (fructose, high-fructose corn syrup, ‘fruit juice concentrates’, invert sugar, maltodextrin, dextrose, lactose), modified oils (hydrogenated or interesterified oils) and sources of protein (hydrolysed proteins, soya protein isolate, gluten, casein, whey protein, and ‘mechanically separated meat’).

So why should we care about food processing?  Is it just because ultra-processed foods are typically very nutritionally unbalanced, high in sugars, salt and fats?  Or because we are consuming more of them than we think?  Or because the rapid rise in chemicals in our foods is killing off our gut microbes and the resulting dysbiosis is wreaking havoc on us? 

Or should we care because the evidence is mounting that the increase in ultra-processed food consumption, independent of its effects on weight gain, is linked to the rising tide of non-communicable (meaning you can’t catch it from someone else) diseases we see in this country?  In our societal attempts at restraint, have we made a deal with the devil by trading sugar for non-caloric sweeteners? 

Earlier this year, the World Health Organization (WHO)  produced an advisory cautioning against the use of non calorie sweeteners as a method of weight control.  And just yesterday, the International Agency for Research on Cancer, a branch of the WHO, put out a statement indicating that aspartame may be possibly carcinogenic in humans.  While the FDA and the beverage companies lobby that the evidence isn’t strong enough to change recommendations regarding their use, it is becoming more clear that the ubiquitous non-calorie sweeteners are not doing us any favors, and may actively be harming us. 

I am not advocating for giving up everything that comes in a box, or even every sweet treat – life is to be lived, and food to be enjoyed.  There are modern conveniences that I would not want to live without, and I do love dessert.  But, I want to know when I am eating it and make the choice for how much.  I do think we need to understand the rules of the game that Big Food is playing with us.  They  have made everything a dessert  (why is it so hard to find yogurt or peanut butter without added high fructose corn syrup or artificial sweeteners, and emulsifiers for example?).  And the rapid replacement of food in our diet with chemicals has out-paced our ability to evolve to handle them. 

I think complete elimination of Group 2 or 3 foods is frankly unrealistic, and occasional ingestion of Group 4 foods is probably ok, but it is the creep of ultra-processed ingredients into our everyday food that is problematic.  I do think it is high time we all knew how to better identify what we are eating, lest we find ourselves with only a few left standing as in some horrid version of the Hunger Games.

Stay tuned for future posts where I will delve into the science of how ultra-processed foods interact with our gut microbes and affect our physiology.