Ultra-Processed People: The Science Behind Food That Isn’t Food

Book Title: Ultra-Processed People: The Science Behind Food That Isn’t Food

Author: Chris van Tulleken

Publication Details: W.W. Norton, 2023, 416 pps, $18.99 paperback

In Ultra-Processed People, Chris van Tulleken argues that the ultra-processing of foods is the primary reason that today’s food intake results in many health problems, such as metabolic dysfunction and most chronic diseases. Van Tulleken is an infectious diseases physician at the Hospital for Tropical Diseases in London. He trained at Oxford and has a PhD in molecular virology from University College London. He is best known in England for his interest in food science and the harms caused by corporations making ultra-processed food. He is a frequent broadcaster on the BBC (British Broadcasting Corporation), covering how ultra-processed food affects children and adults. He has won two BAFTA (British Academy of Film and Television Arts) awards.

A difficulty with this topic is a clear definition of ultra-processed food. “Foods with five or more ingredients” is often used, but that is lacking in specifics about the ingredients. Van Tulleken recommends use of the NOVA Food Classification System designed by the Center for Epidemiological Studies in Health and Nutrition at the School of Public Health in Sao Paulo, Brazil. Here food is divided into four groups. Group 1 is unprocessed or minimally processed food such as vegetables, fruits, and meat. Group 2 is processed culinary ingredients such as natural oils, butter, sugar, salt, vinegar, and honey. Group 3 is processed food such as ready-made mixtures of Groups 1 and 2 that are processed for preservation or taste such as cans of beans, salted nuts, smoked meat, canned fish, freshly made bread, and chunks of fruit in syrup. Group 4 is ultra-processed food defined as “formulations of ingredients, mostly of exclusive industrial use and made by a series of industrial processes.”¹ Ultra-processed food has ingredients that you would not find in your kitchen. These ingredients are foreign to our body and cause harm.

In the book, van Tulleken describes a dialogue he had with Gary Taubes, the science writer who exposed that excess sugar and refined carbohydrates, and not fat, are the cause of insulin resistance, metabolic dysfunction, and chronic diseases such as overweight, obesity, and type 2 diabetes. ^{2, 3} The carbohydrate/insulin axis leading to visceral fat storage is now widely accepted as the primary cause of overweight, obesity, and its many comorbidities such as fatty liver and dementia. ⁴ Van Tulleken disagrees and has a chapter arguing “Why it isn’t about sugar.” I find this binary argument lacking because both are right. Most ultra-processed food is loaded with refined carbohydrates. Van Tulleken does not discuss the epidemic of type 2 diabetes and how insulin resistance leads to it.

Another possibility is that the harm caused by ultra-processed food is related to the ubiquitous manufactured seed oils used in food processing. Family physician Catherine Shanahan has covered this topic in her recent book Dark Calories. ⁵

Ultra-Processed People is a useful and informative book that should be widely read by family medicine teachers, learners, and patients. Readers will be challenged to reflect on what foods they are consuming have health consequences. After reading Ultra-Processed People, I threw away a bag of dark chocolates that were marketed as healthy but were over-processed. Eating real foods found in nature continues to be good advice. Humans evolved over many years to do this.