E281: Is ultra-processed food still food?
Lots of talk these days about ultra-processed foods (UPFs). Along with confusion about what in the heck they are or what they're not, how bad they are for us, and what ought to be done about them. A landmark in the discussion of ultra-processed foods has been the publication of a book entitled Ultra-processed People, Why We Can't Stop Eating Food That Isn't Food. The author of that book, Dr. Chris van Tulleken, joins us today. Dr. van Tulleken is a physician and is professor of Infection and Global Health at University College London. He also has a PhD in molecular virology and is an award-winning broadcaster on the BBC. His book on Ultra-processed People is a bestseller. Interview Summary Chris, sometimes somebody comes along that takes a complicated topic and makes it accessible and understandable and brings it to lots of people. You're a very fine scientist and scholar and academic, but you also have that ability to communicate effectively with lots of people, which I very much admire. So, thanks for doing that, and thank you for joining us. Oh, Kelly, it's such a pleasure. You know, I begin some of my talks now with a clipping from the New York Times. And it's a picture of you and an interview you gave in 1995. So exactly three decades ago. And in this article, you just beautifully communicate everything that 30 years later I'm still saying. So, yeah. I wonder if communication, it's necessary, but insufficient. I think we are needing to think of other means to bring about change. I totally agree. Well, thank you by the way. And I hope I've learned something over those 30 years. Tell us, please, what are ultra-processed foods? People hear the term a lot, but I don't think a lot of people know exactly what it means. The most important thing to know, I think, is that it's not a casual term. It's not like 'junk food' or 'fast food.' It is a formal scientific definition. It's been used in hundreds of research studies. The definition is very long. It's 11 paragraphs long. And I would urge anyone who's really interested in this topic, go to the United Nations Food and Agricultural Organization website. You can type in NFAO Ultra and you'll get the full 11 paragraph definition. It's an incredibly sophisticated piece of science. But it boils down to if you as a consumer, someone listening to this podcast, want to know if the thing you are eating right now is ultra-processed, look at the ingredients list. If there are ingredients on that list that you do not normally find in a domestic kitchen like an emulsifier, a coloring, a flavoring, a non-nutritive sweetener, then that product will be ultra-processed. And it's a way of describing this huge range of foods that kind of has taken over the American and the British and in fact diets all over the world. How come the food companies put this stuff in the foods? And the reason I ask is in talks I give I'll show an ingredient list from a food that most people would recognize. And ask people if they can guess what the food is from the ingredient list. And almost nobody can. There are 35 things on the ingredient list. Sugar is in there, four different forms. And then there are all kinds of things that are hard to pronounce. There are lots of strange things in there. They get in there through loopholes and government regulation. Why are they there in the first place? So, when I started looking at this I also noticed this long list of fancy sounding ingredients. And even things like peanut butter will have palm oil and emulsifiers. Cream cheese will have xanthum gum and emulsifiers. And you think, well, wouldn't it just be cheaper to make your peanut butter out of peanuts. In fact, every ingredient is in there to make money in one of two ways. Either it drives down the cost of production or storage. If you imagine using a real strawberry in your strawberry ice cream. Strawberries are expensive. They're not always in season. They rot. You've got to have a whole supply chain. Why would you use a strawberry if you could use ethyl methylphenylglycidate and pink dye and it'll taste the same. It'll look great. You could then put in a little chunky bit of modified corn starch that'll be chewy if you get it in the right gel mix. And there you go. You've got strawberries and you haven't had to deal with strawberry farmers or any supply chain. It's just you just buy bags and bottles of white powder and liquids. The other way is to extend the shelf life. Strawberries as I say, or fresh food, real food - food we might call it rots on shelves. It decays very quickly. If you can store something at room temperature in a warehouse for months and months, that saves enormous amounts of money. So, one thing is production, but the other thing is the additives allow us to consume to excess or encourage us to consume ultra-processed food to excess. So, I interviewed a scientist who was a food industry development scientist. And they said, you know, most ultra-processed food would be gray if it wasn't dyed, for example. So, if you want to make cheap food using these pastes and powders, unless you dye it and you flavor it, it will be inedible. But if you dye it and flavor it and add just the right amount of salt, sugar, flavor enhancers, then you can make these very addictive products. So that's the logic of UPF. Its purpose is to make money. And that's part of the definition. Right. So, a consumer might decide that there's, you know, beneficial trade-off for them at the end of the day. That they get things that have long shelf life. The price goes down because of the companies don't have to deal with the strawberry farmers and things like that. But if there's harm coming in waves from these things, then it changes the equation. And you found out some of that on your own. So as an experiment you did with a single person - you, you ate ultra-processed foods for a month. What did you eat and how did it affect your body, your mood, your sleep? What happened when you did this? So, what's really exciting, actually Kelly, is while it was an n=1, you know, one participant experiment, I was actually the pilot participant in a much larger study that we have published in Nature Medicine. One of the most reputable and high impact scientific journals there is. So, I was the first participant in a randomized control trial. I allowed us to gather the data about what we would then measure in a much larger number. Now we'll come back and talk about that study, which I think was really important. It was great to see it published. So, I was a bit skeptical. Partly it was with my research team at UCL, but we were also filming it for a BBC documentary. And I went into this going I'm going to eat a diet of 80% of my calories will come from ultra-processed food for four weeks. And this is a normal diet. A lifelong diet for a British teenager. We know around 20% of people in the UK and the US eat this as their normal food. They get 80% of their calories from ultra-processed products. I thought, well, nothing is going to happen to me, a middle-aged man, doing this for four weeks. But anyway, we did it kind of as a bit of fun. And we thought, well, if nothing happens, we don't have to do a bigger study. We can just publish this as a case report, and we'll leave it out of the documentary. Three big things happened. I gained a massive amount of weight, so six kilos. And I wasn't force feeding myself. I was just eating when I wanted. In American terms, that's about 15 pounds in four weeks. And that's very consistent with the other published trials that have been done on ultra-processed food. There have been two other RCTs (randomized control trials); ours is the third. There is one in Japan, one done at the NIH. So, people gain a lot of weight. I ate massively more calories. So much so that if I'd continued on the diet, I would've almost doubled my body weight in a year. And that may sound absurd, but I have an identical twin brother who did this natural experiment. He went to Harvard for a year. He did his masters there. During his year at Harvard he gained, let's see, 26 kilos, so almost 60 pounds just living in Cambridge, Massachusetts. But how did you decide how much of it to eat? Did you eat until you just kind of felt naturally full? I did what most people do most of the time, which is I just ate what I wanted when I felt like it. Which actually for me as a physician, I probably took the breaks off a bit because I don't normally have cocoa pops for breakfast. But I ate cocoa pops and if I felt like two bowls, I'd have two bowls. It turned out what I felt like a lot of mornings was four bowls and that was fine. I was barely full. So, I wasn't force feeding myself. It wasn't 'supersize' me. I was eating to appetite, which is how these experiments run. And then what we've done in the trials. So, I gained weight, then we measured my hormone response to a meal. When you eat, I mean, it's absurd to explain this to YOU. But when you eat, you have fullness hormones that go up and hunger hormones that go down, so you feel full and less hungry. And we measured my response to a standard meal at the beginning and at the end of this four-week diet. What we found is that I had a normal response to eating a big meal at the beginning of the diet. At the end of eating ultra-processed foods, the same meal caused a very blunted rise in the satiety hormones. In the 'fullness' hormones. So, I didn't feel as full. And my hunger hormones remained high. And so, the food is altering our response to all meals, not merely within the meal that we're eating. Then we did some MRI scans and again, I thought this would be a huge waste of time. But we saw at four weeks, and then again eight weeks later, very robust changes in the communication between the habit-forming bits at the back of the brain. So, the automatic behavior bits, the cerebellum. Very conscious I'm talking to YOU about this, Kelly. And the kind of addiction reward bits in the middle. Now these changes were physiological, not structural. They're about the two bits of the brain talking to each other. There's not really a new wire going between them. But we think if this kind of communication is happening a lot, that maybe a new pathway would form. And I think no one, I mean we did this with very expert neuroscientists at our National Center for Neuroscience and Neurosurgery, no one really knows what it means. But the general feeling was these are the kind of changes we might expect if we'd given someone, or a person or an animal, an addictive substance for four weeks. They're consistent with, you know, habit formation and addiction. And the fact that they happened so quickly, and they were so robust - they remained the same eight weeks after I stopped the diet, I think is really worrying from a kid's perspective. So, in a period of four weeks, it re-altered the way your brain works. It affected the way your hunger and satiety were working. And then you ended up with this massive weight. And heaven knows what sort of cardiovascular effects or other things like that might have been going on or had the early signs of that over time could have been really pretty severe, I imagine. I think one of the main effects was that I became very empathetic with my patients. Because we did actually a lot of, sort of, psychological testing as well. And there's an experience where, obviously in clinic, I mainly treat patients with infections. But many of my patients are living with other, sort of, disorders of modern life. They live with excess weight and cardiovascular disease and type two diabetes and metabolic problems and so on. And I felt in four weeks like I'd gone from being in my early 30, early 40s at the time, I felt like I'd just gone to my early 50s or 60s. I ached. I felt terrible. My sleep was bad. And it was like, oh! So many of the problems of modern life: waking up to pee in the middle of the night is because you've eaten so much sodium with your dinner. You've drunk all this water, and then you're trying to get rid of it all night. Then you're constipated. It's a low fiber diet, so you develop piles. Pain in your bum. The sleep deprivation then makes you eat more. And so, you get in this vicious cycle where the problem didn't feel like the food until I stopped and I went cold turkey. I virtually have not touched it since. It cured me of wanting UPF. That was the other amazing bit of the experience that I write about in the book is it eating it and understanding it made me not want it. It was like being told to smoke. You know, you get caught smoking as a kid and your parents are like, hey, now you finish the pack. It was that. It was an aversion experience. So, it gave me a lot of empathy with my patients that many of those kinds of things we regard as being normal aging, those symptoms are often to do with the way we are living our lives. Chris, I've talked to a lot of people about ultra-processed foods. You're the first one who's mentioned pain in the bum as one of the problems, so thank you. When I first became a physician, I trained as a surgeon, and I did a year doing colorectal surgery. So, I have a wealth of experience of where a low fiber diet leaves you. And many people listening to this podcast, I mean, look, we're all going to get piles. Everyone gets these, you know, anal fishes and so on. And bum pain it's funny to talk about it. No, not the... it destroys people's lives, so, you know, anyway. Right. I didn't want to make light of it. No, no. Okay. So, your own experiment would suggest that these foods are really bad actors and having this broad range of highly negative effects. But what does research say about these things beyond your own personal experience, including your own research? So, the food industry has been very skillful at portraying this as a kind of fad issue. As ultra-processed food is this sort of niche thing. Or it's a snobby thing. It's not a real classification. I want to be absolutely clear. UPF, the definition is used by the World Health Organization and the United Nations Food and Agricultural Organization to monitor global diet quality, okay? It's a legitimate way of thinking about food. The last time I looked, there are more than 30 meta-analyses - that is reviews of big studies. And the kind of high-quality studies that we use to say cigarettes cause lung cancer. So, we've got this what we call epidemiological evidence, population data. We now have probably more than a hundred of these prospective cohort studies. And they're really powerful tools. They need to be used in conjunction with other evidence, but they now link ultra-processed food to this very wide range of what we euphemistically call negative health outcomes. You know, problems that cause human suffering, mental health problems, anxiety, depression, multiple forms of cancer, inflammatory diseases like Crohn's disease and ulcerative colitis, metabolic disease, cardiovascular disease, Alzheimer's and dementia. Of course, weight gain and obesity. And all cause mortality so you die earlier of all causes. And there are others too. So, the epidemiological evidence is strong and that's very plausible. So, we take that epidemiological evidence, as you well know, and we go, well look, association and causation are different things. You know, do matches cause cancer or does cigarettes cause cancer? Because people who buy lots of matches are also getting the lung cancer. And obviously epidemiologists are very sophisticated at teasing all this out. But we look at it in the context then of other evidence. My group published the third randomized control trial where we put a group of people, in a very controlled way, on a diet of either minimally processed food or ultra-processed food and looked at health outcomes. And we found what the other two trials did. We looked at weight gain as a primary outcome. It was a short trial, eight weeks. And we saw people just eat more calories on the ultra-processed food. This is food that is engineered to be consumed to excess. That's its purpose. So maybe to really understand the effect of it, you have to imagine if you are a food development engineer working in product design at a big food company - if you develop a food that's cheap to make and people will just eat loads of it and enjoy it, and then come back for it again and again and again, and eat it every day and almost become addicted to it, you are going to get promoted. That product is going to do well on the shelves. If you invent a food that's not addictive, it's very healthy, it's very satisfying, people eat it and then they're done for the day. And they don't consume it to excess. You are not going to keep your job. So that's a really important way of understanding the development process of the foods. So let me ask a question about industry and intent. Because one could say that the industry engineers these things to have long shelf life and nice physical properties and the right colors and things like this. And these effects on metabolism and appetite and stuff are unpleasant and difficult side effects, but the foods weren't made to produce those things. They weren't made to produce over consumption and then in turn produce those negative consequences. You're saying something different. That you think that they're intentionally designed to promote over consumption. And in some ways, how could the industry do otherwise? I mean, every industry in the world wants people to over consume or consume as much of their product as they can. The food industry is no different. That is exactly right. The food industry behaves like every other corporation. In my view, they commit evil acts sometimes, but they're not institutionally evil. And I have dear friends who work in big food, who work in big pharma. I have friends who work in tobacco. These are not evil people. They're constrained by commercial incentives, right? So, when I say I think the food is engineered, I don't think it. I know it because I've gone and interviewed loads of people in product development at big food companies. I put some of these interviewees in a BBC documentary called Irresistible. So rather than me in the documentary going, oh, ultra-processed food is bad. And everyone going, well, you are, you're a public health bore. I just got industry insiders to say, yes, this is how we make the food. And going back to Howard Moskovitz, in the 1970s, I think he was working for the Campbell Soup Company. And Howard, who was a psychologist by training, outlined the development process. And what he said was then underlined by many other people I've spoken to. You develop two different products. This one's a little bit saltier than the next, and you test them on a bunch of people. People like the saltier ones. So now you keep the saltier one and you develop a third product and this one's got a bit more sugar in it. And if this one does better, well you keep this one and you keep AB testing until you get people buying and eating lots. And one of the crucial things that food companies measure in product development is how fast do people eat and how quickly do they eat. And these kind of development tools were pioneered by the tobacco industry. I mean, Laura Schmidt has done a huge amount of the work on this. She's at University of California, San Francisco (UCSF), in California. And we know the tobacco industry bought the food industry and for a while in the '80s and '90s, the biggest food companies in the world were also the biggest tobacco companies in the world. And they used their flavor molecules and their marketing techniques and their distribution systems. You know, they've got a set of convenience tools selling cigarettes all over the country. Well, why don't we sell long shelf-life food marketed in the same way? And one thing that the tobacco industry was extremely good at was figuring out how to get the most rapid delivery of the drug possible into the human body when people smoke. Do you think that some of that same thing is true for food, rapid delivery of sugar, let's say? How close does the drug parallel fit, do you think? So, that's part of the reason the speed of consumption is important. Now, I think Ashley Gearhardt has done some of the most incredible work on this. And what Ashley says is we think of addictive drugs as like it's the molecule that's addictive. It's nicotine, it's caffeine, cocaine, diamorphine, heroin, the amphetamines. What we get addicted to is the molecule. And that Ashley says no. The processing of that molecule is crucially important. If you have slow-release nicotine in a chewing gum, that can actually treat your nicotine addiction. It's not very addictive. Slow-release amphetamine we use to treat children with attention and behavioral problems. Slow-release cocaine is an anesthetic. You use it for dentistry. No one ever gets addicted to dental anesthetics. And the food is the same. The rewarding molecules in the food we think are mainly the fat and the sugar. And food that requires a lot of chewing and is slow eaten slowly, you don't deliver the reward as quickly. And it tends not to be very addictive. Very soft foods or liquid foods with particular fat sugar ratios, if you deliver the nutrients into the gut fast, that seems to be really important for driving excessive consumption. And I think the growing evidence around addiction is very persuasive. I mean, my patients report feeling addicted to the food. And I don't feel it's legitimate to question their experience. Chris, a little interesting story about that concept of food and addiction. So going back several decades I was a professor at Yale, and I was teaching a graduate course. Ashley Gerhardt was a student in that course. And, she was there to study addiction, not in the context of food, but I brought up the issue of, you know, could food be addictive? There's some interesting research on this. It's consistent with what we're hearing from people, and that seems a really interesting topic. And Ashley, I give her credit, took this on as her life's work and now she's like the leading expert in the world on this very important topic. And what's nice for me to recall that story is that how fast the science on this is developed. And now something's coming out on this almost every day. It's some new research on the neuroscience of food and addiction and how the food is hijacking in the brain. And that whole concept of addiction seems really important in this context. And I know you've talked a lot about that yourself. She has reframed, I think, this idea about the way that addictive substances and behaviors really work. I mean it turns everything on its head to go the processing is important. The thing the food companies have always been able to say is, look, you can't say food is addictive. It doesn't contain any addictive molecules. And with Ashley's work you go, no, but the thing is it contains rewarding molecules and actually the spectrum of molecules that we can find rewarding and we can deliver fast is much, much broader than the traditionally addictive substances. For policy, it's vital because part of regulating the tobacco industry was about showing they know they are making addictive products. And I think this is where Ashley's work and Laura Schmidt's work are coming together. With Laura's digging in the tobacco archive, Ashley's doing the science on addiction, and I think these two things are going to come together. And I think it's just going to be a really exciting space to watch. I completely agree. You know when most people think about the word addiction, they basically kind of default to thinking about how much you want something. How much, you know, you desire something. But there are other parts of it that are really relevant here too. I mean one is how do you feel if you don't have it and sort of classic withdrawal. And people talk about, for example, being on high sugar drinks and stopping them and having withdrawal symptoms and things like that. And the other part of it that I think is really interesting here is tolerance. You know whether you need more of the substance over time in order to get the same reward benefit. And that hasn't been studied as much as the other part of addiction. But there's a lot to the picture other than just kind of craving things. And I would say that the thing I like about this is it chimes with my. Personal experience, which is, I have tried alcohol and cigarettes and I should probably end that list there. But I've never had any real desire for more of them. They aren't the things that tickle my brain. Whereas the food is a thing that I continue to struggle with. I would say in some senses, although I no longer like ultra-processed food at some level, I still want it. And I think of myself to some degree, without trivializing anyone's experience, to some degree I think I'm in sort of recovery from it. And it remains that tussle. I mean I don't know what you think about the difference between the kind of wanting and liking of different substances. Some scientists think those two things are quite, quite different. That you can like things you don't want, and you can want things you don't like. Well, that's exactly right. In the context of food and traditional substances of abuse, for many of them, people start consuming because they produce some sort of desired effect. But that pretty quickly goes away, and people then need the substance because if they don't have it, they feel terrible. So, you know, morphine or heroin or something like that always produces positive effects. But that initial part of the equation where you just take it because you like it turns into this needing it and having to have it. And whether that same thing exists with food is an interesting topic. I think the other really important part of the addiction argument in policy terms is that one counterargument by industrial scientists and advocates is by raising awareness around ultra-processed food we are at risk of driving, eating disorders. You know? The phenomenon of orthorexia, food avoidance, anorexia. Because all food is good food. There should be no moral value attached to food and we mustn't drive any food anxiety. And I think there are some really strong voices in the United Kingdom Eating Disorder scientists. People like Agnes Ayton, who are starting to say, look, when food is engineered, using brain scanners and using scientific development techniques to be consumed to excess, is it any wonder that people develop a disordered relationship with the food? And there may be a way of thinking about the rise of eating disorders, which is parallel to the rise of our consumption of ultra-processed food, that eating disorders are a reasonable response to a disordered food environment. And I think that's where I say all that somewhat tentatively. I feel like this is a safe space where you will correct me if I go off piste. But I think it's important to at least explore that question and go, you know, this is food with which it is very hard, I would say, to have a healthy relationship. That's my experience. And I think the early research is bearing that out. Tell us how these foods affect your hunger, how full you feel, your microbiome. That whole sort of interactive set of signals that might put people in harmony with food in a normal environment but gets thrown off when the foods get processed like this. Oh, I love that question. At some level as I'm understanding that question, one way of trying to answer that question is to go, well, what is the normal physiological response to food? Or maybe how do wild animals find, consume, and then interpret metabolically the food that they eat. And it is staggering how little we know about how we learn what food is safe and what food nourishes us. What's very clear is that wild mammals, and in fact all wild animals, are able to maintain near perfect energy balance. Obesity is basically unheard of in the wild. And, perfect nutritional intake, I mean, obviously there are famines in wild animals, but broadly, animals can do this without being literate, without being given packaging, without any nutritional advice at all. So, if you imagine an ungulate, an herbivore on the plains of the Serengeti, it has a huge difficulty. The carnivore turning herbivore into carnivore is fairly easy. They're made of the same stuff. Turning plant material into mammal is really complicated. And somehow the herbivore can do this without gaining weight, whilst maintaining total precision over its selenium intake, its manganese, its cobalt, its iron, all of which are terrible if you have too little and also terrible if you have too much. We understand there's some work done in a few wild animals, goats, and rats about how this works. Clearly, we have an ability to sense the nutrition we want. What we understand much more about is the sort of quantities needed. And so, we've ended up with a system of nutritional advice that says, well, just eat these numbers. And if you can stick to the numbers, 2,500 calories a day, 2300 milligrams of sodium, no more than 5% of your calories from free sugar or 10%, whatever it is, you know, you stick to these numbers, you'll be okay. And also, these many milligrams of cobalt, manganese, selenium, iron, zinc, all the rest of it. And obviously people can't really do that even with the packaging. This is a very long-winded answer. So, there's this system that is exquisitely sensitive at regulating micronutrient and energy intake. And what we understand, what the Academy understands about how ultra-processed food subverts this is, I would say there are sort of three or four big things that ultra-processed does that real food doesn't. It's generally very soft. And it's generally very energy dense. And that is true of even the foods that we think of as being healthy. That's like your supermarket whole grain bread. It's incredibly energy dense. It's incredibly soft. You eat calories very fast, and this research was done in the '90s, you know we've known that that kind of food promotes excessive intake. I guess in simple terms, and you would finesse this, you consume calories before your body has time to go, well, you've eaten enough. You can consume an excess. Then there's the ratios of fat, salt, and sugar and the way you can balance them, and any good cook knows if you can get the acid, fat, salt, sugar ratios right, you can make incredibly delicious food. That's kind of what I would call hyper palatability. And a lot of that work's being done in the states (US) by some incredible people. Then the food may be that because it's low in fiber and low in protein, quite often it's not satiating. And there may be, because it's also low in micronutrients and general nutrition, it may be that, and this is a little bit theoretical, but there's some evidence for this. Part of what drives the excess consumption is you're kind of searching for the nutrients. The nutrients are so dilute that you have to eat loads of it in order to get enough. Do you think, does that, is that how you understand it? It does, it makes perfect sense. In fact, I'm glad you brought up one particular issue because part of the ultra-processing that makes foods difficult for the body to deal with involves what gets put in, but also what gets taken out. And there was a study that got published recently that I think you and I might have discussed earlier on American breakfast cereals. And this study looked at how the formulation of them had changed over a period of about 20 years. And what they found is that the industry had systematically removed the protein and the fiber and then put in more things like sugar. So there, there's both what goes in and what gets taken out of foods that affects the body in this way. You know, what I hear you saying, and what I, you know, believe myself from the science, is the body's pretty capable of handling the food environment if food comes from the natural environment. You know, if you sit down to a meal of baked chicken and some beans and some leafy greens and maybe a little fruit or something, you're not going to overdo it. Over time you'd end up with the right mix of nutrients and things like that and you'd be pretty healthy. But all bets are off when these foods get processed and engineered, so you over consume them. You found that out in the experiment that you did on yourself. And then that's what science shows too. So, it's not like these things are sort of benign. People overeat them and they ought to just push away from the table. There's a lot more going on here in terms of hijacking the brain chemistry. Overriding the body signals. Really thwarting normal biology. Do you think it's important to add that we think of obesity as being the kind of dominant public health problem? That's the thing we all worry about. But the obesity is going hand in hand with stunting, for example. So, height as you reach adulthood in the US, at 19 US adults are something like eight or nine centimeters shorter than their counterparts in Northern Europe, Scandinavia, where people still eat more whole food. And we should come back to that evidence around harms, because I think the really important thing to say around the evidence is it has now reached the threshold for causality. So, we can say a dietary pattern high in ultra-processed food causes all of these negative health outcomes. That doesn't mean that any one product is going to kill you. It just means if this is the way you get your food, it's going to be harmful. And if all the evidence says, I mean, we've known this for decades. If you can cook the kind of meal, you just described at home, which is more or less the way that high income people eat, you are likely to have way better health outcomes across the board. Let me ask you about the title of your book. So, the subtitle of your book is Why We Can't Stop Eating Food That Isn't Food. So, what is it? The ultra-processed definition is something I want to pay credit for. It's really important to pay a bit of credit here. Carlos Montero was the scientist in Brazil who led a team who together came up with this definition. And, I was speaking to Fernanda Rauber who was on that team, and we were trying to discuss some research we were doing. And every time I said food, she'd correct me and go, it is not, it's not food, Chris. It's an industrially produced edible substance. And that was a really helpful thing for me personally, it's something it went into my brain, and I sat down that night. I was actually on the UPF diet, and I sat down to eat some fried chicken wings from a popular chain that many people will know. And was unable to finish them. I think our shared understanding of the purpose of food is surely that its purpose is to nourish us. Whether it's, you know, sold by someone for this purpose, or whether it's made by someone at home. You know it should nourish us spiritually, socially, culturally, and of course physically and mentally. And ultra-processed food nourishes us in no dimension whatsoever. It destroys traditional knowledge, traditional land, food culture. You don't sit down with your family and break, you know, ultra-processed, you know, crisps together. You know, you break bread. To me that's a kind of very obvious distortion of what it's become. So, I don't think it is food. You know, I think it's not too hard of a stretch to see a time when people might consider these things non-food. Because if you think of food, what's edible and whether it's food or not is completely socially constructed. I mean, some parts of the world, people eat cockroaches or ants or other insects. And in other parts of the world that's considered non-food. So just because something's edible doesn't mean that it's food. And I wonder if at some point we might start to think of these things as, oh my God, these are awful. They're really bad for us. The companies are preying on us, and it's just not food. And yeah, totally your book helps push us in that direction. I love your optimism. The consumer facing marketing budget of a big food company is often in excess of $10 billion a year. And depends how you calculate it. I'll give you a quick quiz on this. So, for a while, the Robert Wood Johnson Foundation was by far the biggest funder of research in the world on childhood obesity. And they were spending $500 million a year to address this problem. Just by which day of the year the food industry has already spent $500 million just advertising just junk food just to children. Okay, so the Robert V. Wood Foundation is spending it and they were spending that annually. Annually, right. So, what's, by what day of the year is the food industry already spent that amount? Just junk food advertising just to kids. I'm going to say by somewhere in early spring. No. January 4th. I mean, it's hysterical, but it's also horrifying. So, this is the genius of ultra-processed food, of the definition and the science, is that it creates this category which is discretionary. And so at least in theory, of course, for many people in the US it's not discretionary at all. It's the only stuff they can afford. But this is why the food industry hate it so much is because it offers the possibility of going, we can redefine food. And there is all this real food over there. And there is this UPF stuff that isn't food over here. But industry's very sophisticated, you know. I mean, they push back very hard against me in many different ways and forms. And they're very good at going, well, you're a snob. How dare you say that families with low incomes, that they're not eating food. Are you calling them dupes? Are you calling them stupid? You know, they're very, very sophisticated at positioning. Isn't it nice how concerned they are about the wellbeing of people without means? I mean they have created a pricing structure and a food subsidy environment and a tax environment where essentially people with low incomes in your country, in my country, are forced to eat food that harms them. So, one of the tells I think is if you're hearing someone criticize ultra-processed food, and you'll read them in the New York Times. And often their conflicts of interest won't be reported. They may be quite hidden. The clue is, are they demanding to seriously improve the food environment in a very clear way, or are they only criticizing the evidence around ultra-processed food? And if they're only criticizing that evidence? I'll bet you a pound to a pinch of salt they'll be food-industry funded. Let's talk about that. Let's talk about that a little more. So, there's a clear pattern of scientists who take money from industry finding things that favor industry. Otherwise, industry wouldn't pay that money. They're not stupid in the way they invest. And, you and I have talked about this before, but we did a study some years ago where we looked at industry and non-industry funded study on the health effects of consuming sugar sweetened beverages. And it's like the ocean parted. It's one of my favorites. And it was something like 98 or 99% of the independently funded studies found that sugar sweetened beverages do cause harm. And 98 or 99% of the industry funded studies funded by Snapple and Coke and a whole bunch of other companies found that they did not cause harm. It was that stark, was it? It was. And so you and I pay attention to the little print in these scientific studies about who's funded them and who might have conflicts of interest. And maybe you and I and other people who follow science closely might be able to dismiss those conflicted studies. But they have a big impact out there in the world, don't they? I had a meeting in London with someone recently, that they themselves were conflicted and they said, look, if a health study's funded by a big sugary drink company, if it's good science, that's fine. We should publish it and we should take it at face value. And in the discussion with them, I kind of accepted that, we were talking about other things. And afterwards I was like, no. If a study on human health is funded by a sugary drink corporation, in my opinion, we could just tear that up. None of that should be published. No journals should publish those studies and scientists should not really call themselves scientists who are doing it. It is better thought of as marketing and food industry-funded scientists who study human health, in my opinion, are better thought of as really an extension of the marketing division of the companies. You know, it's interesting when you talk to scientists, and you ask them do people who take money from industry is their work influenced by that money? They'll say yes. Yeah, but if you say, but if you take money from industry, will your work be influenced? They'll always say no. Oh yeah. There's this tremendous arrogance, blind spot, whatever it is that. I can remain untarnished. I can remain objective, and I can help change the industry from within. In the meantime, I'm having enough money to buy a house in the mountains, you know, from what they're paying me, and it's really pretty striking. Well, the money is a huge issue. You know, science, modern science it's not a very lucrative career compared to if someone like you went and worked in industry, you would add a zero to the end of your salary, possibly more. And the same is true of me. I think one of the things that adds real heft to the independent science is that the scientists are taking a pay cut to do it. So how do children figure in? Do you think children are being groomed by the industry to eat these foods? A senator, I think in Chile, got in hot water for comparing big food companies to kind of sex offenders. He made, in my view, a fairly legitimate comparison. I mean, the companies are knowingly selling harmful products that have addictive properties using the language of addiction to children who even if they could read warning labels, the warning labels aren't on the packs. So, I mean, we have breakfast cereals called Crave. We have slogans like, once you stop, once you pop, you can't stop. Bet you can't just eat one. Yeah, I think it is predatory and children are the most vulnerable group in our society. And you can't just blame the parents. Once kids get to 10, they have a little bit of money. They get their pocket money, they're walking to school, they walk past stores. You know, you have to rely on them making decisions. And at the moment, they're in a very poor environment to make good decisions. Perhaps the most important question of all what can be done. So, I'm speaking to you at a kind of funny moment because I've been feeling that a lot of my research and advocacy, broadcasting... you know, I've made documentaries, podcasts, I've written a book, I've published these papers. I've been in most of the major newspapers and during the time I've been doing this, you know, a little under 10 years I've been really focused on food. Much less time than you. Everything has got worse. Everything I've done has really failed totally. And I think this is a discussion about power, about unregulated corporate power. And the one glimmer of hope is this complaint that's been filed in Pennsylvania by a big US law firm. It's a very detailed complaint and some lawyers on behalf of a young person called Bryce Martinez are suing the food industry for causing kidney problems and type two diabetes. And I think that in the end is what's going to be needed. Strategic litigation. That's the only thing that worked with tobacco. All of the science, it eventually was useful, but the science on its own and the advocacy and the campaigning and all of it did no good until the lawyers said we would like billions and billions of dollars in compensation please. You know, this is an exciting moment, but there were a great many failed lawsuits for tobacco before the master settlement agreement in the '90s really sort of changed the game. You know, I agree with you. Are you, are you optimistic? I mean, what do you think? I am, and for exactly the same reason you are. You know, the poor people that worked on public health and tobacco labored for decades without anything happening long, long after the health consequences of cigarette smoking were well known. And we've done the same thing. I mean, those us who have been working in the field for all these years have seen precious little in the ways of policy advances. Now tobacco has undergone a complete transformation with high taxes on cigarettes, and marketing restrictions, and non-smoking in public places, laws, and things like that, that really have completely driven down the consumption of cigarettes, which has been a great public health victory. But what made those policies possible was the litigation that occurred by the state attorneys general, less so the private litigating attorneys. But the state attorneys general in the US that had discovery documents released. People began to understand more fully the duplicity of the tobacco companies. That gave cover for the politicians to start passing the policies that ultimately made the big difference. I think that same history is playing out here. The state attorneys general, as we both know, are starting to get interested in this. I say hurray to that. There is the private lawsuit that you mentioned, and there's some others in the mix as well. I think those things will bring a lot of propel the release of internal documents that will show people what the industry has been doing and how much of this they've known all along. And then all of a sudden some of these policy things like taxes, for example, on sugared beverages, might come in and really make a difference. That's my hope. But it makes me optimistic. Well, I'm really pleased to hear that because I think in your position it would be possible. You know, I'm still, two decades behind where I might be in my pessimism. One of the kind of engines of this problem to me is these conflicts of interest where people who say, I'm a physician, I'm a scientist, I believe all this. And they're quietly paid by the food industry. This was the major way the tobacco industry had a kind of social license. They were respectable. And I do hope the lawsuits, one of their functions is it becomes a little bit embarrassing to say my research institute is funded [by a company that keeps making headlines every day because more documents are coming out in court, and they're being sued by more and more people. So, I hope that this will diminish the conflict, particularly between scientists and physicians in the food industry. Because that to me, those are my biggest opponents. The food industry is really nice. They throw money at me. But it's the conflicted scientists that are really hard to argue with because they appear so respectable. Bio Dr. Chris van Tulleken is a physician and a professor of Infection and Global Health at University College London. He trained at Oxford and earned his PhD in molecular virology from University College London. His research focuses on how corporations affect human health especially in the context of child nutrition and he works with UNICEF and The World Health Organization on this area. He is the author of a book entitled Ultraprocessed People: Why We Can’t Stop Eating Food That Isn’t Food. As one of the BBC's leading broadcasters for children and adults his work has won two BAFTAs. He lives in London with his wife and two children.
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