"A Potato Chip a Day..."

Three weeks ago, I wrote and spoke about the matka of adding adequate fruits and vegetables to our daily food routine (see how I try and avoid the word “diet”) and how 5 portions of fruits and vegetables a day reduce mortality and increase longevity [1].

Earlier this week Dr. Filippa Juul and her colleagues [2] published a paper that studies the impact of  ultra-processed foods (UPFs) on our health, showing that the more UPFs we have in our diet, the greater is the incidence of cardiovascular disease and associated mortality (Fig. 1).

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Fig. 1: The chart on the left adapted from the article by Juul et al [2], shows an increasing rate of hard cardiovascular disease (CVD), which includes sudden and non-sudden coronary death, myocardial infarction and fatal/nonfatal stroke with increasing intake of UPFs per day. One serving is defined as one cup of cereal, one ounce of chips, etc. The chart on the right is from the article by Wang D at al [1] that I spoke and wrote about two weeks ago, showing how with up to 5 servings of fruits and vegetables, there is reduction in mortality.

See the difference between the two curves. With increasing portions of unhealthy food, there is increasing incidence of cardiovascular disease and death, while with increasing portions of healthy food, there is reduction in disease and mortality.

So what are UPFs? UPFs constitute Group 4 of the NOVA classification of food groups, first proposed by Dr. Carlos Monteiro. He defined UPFs as follows [3]. ‘The term “ultra-processed” was coined to refer to industrial formulations manufactured from substances derived from foods or synthesized from other organic sources. They typically contain little or no whole foods, are ready-to-consume or heat up, and are fatty, salty or sugary and depleted in dietary fibre, protein, various micronutrients and other bioactive compounds. Examples include: sweet, fatty or salty packaged snack products, ice cream, sugar-sweetened beverages, chocolates, confectionery, French fries, burgers and hot dogs, and poultry and fish nuggets.’

UPFs in India include Oreos, Jim-Jams, Doritos, Pringles, Lays, Mad Angles, and all those Rs. 5 and Rs. 10 packs of snacks that are sold not just in the supermarkets but also at the “panwala” and corner stores…basically all foods that are inherently “tasty” but impossible to stop at just one. In fact, this statement “betcha can’t just eat one” was a slogan used to advertise Lays chips at one time. If you are ever confused about whether a particular packaged food item is UPF or not, you can check out this site (world.openfoodfacts.org), which already has more than 80,000 food product listings.

For those interested in more in-depth reading, the Food and Agriculture Organization (FAO) [4] of the United Nations (UN) has published a white paper, headed by Dr. Carlos Monteiro that goes into the details of the food groups and compiles the various studies that show the harmful effects of UPFs. To add to these largely observational and epidemiological studies, Dr. Kevin Hall and his colleagues performed a randomized controlled trial by giving either UPF rich or un-processed food to their test subjects and showed that UPF rich diets cause weight gain [5].

All this is not new. At least two decades or so ago, when I started eating healthy, my afternoon lunch tiffin would come from Ms. Vijaya Venkat, who used to run The Health Awareness Centre, with her daughter Ms. Anju Venkat, who incidentally still runs it successfully. Ms. Vijaya Venkat advocated fruits for breakfast, a healthy lunch without the 5 white poisons (salt, sugar, oil, milk and maida or “white flour”) and a dinner without any rules, with the assumption that we would also eat healthy at dinner-time. I followed this for many years until I started time-restricted eating (TRE), but more about that, some other time.

Michael Moss in his book “Salt, Sugar, Fat” describes how the food industry has used three of those 5 white poisons to “hook” people to eat more and more of these “unhealthy” foods, fueling the rising obesity epidemic, not just in the US, but worldwide. This has prompted the Indian Academy of Pediatrics to come out with guidelines [6] related to “JUNCS” food for under-18 children given our unique paradox of having a high rate of malnutrition coupled with a high rate of childhood obesity.

If you’ve ever eaten food at Indian weddings, that is what the caterers do…add generous dollops of salt, sugar and oil, to make everything taste delicious, no matter how unhealthy the dishes may be. After all, if the food is appreciated, then the wedding is considered good, which in turn means the couple is well-blessed. Even restaurants add just that little extra salt, sugar and oil to make their dishes just that little more delicious, something we wouldn’t do at home, which is why our home-cooked food rarely tastes the same as restaurant food.

Coincidentally, this week, Michael Moss has come out with a new book called “Hooked”, which goes one step further to say that UPFs are known to be highly addictive, perhaps sometimes more than tobacco, and the food industry, aware of this, continues to sell these foods, irrespective. If you have ever eaten one Doritos chip, you know the intense pleasure you get the moment you’ve taken one bite…it is this “bliss” that is exploited by these food products and the companies that make them. These “foods” generally don’t make us full and this lack of satiety makes us eat more and more, which is one of the reasons we pack on all those extra kilograms and land up with an increased incidence of cardiovascular and other diseases.

To fight this addiction, we need hacks in our lives to avoid situations that make us eat UPFs.

Imagine a Saturday or Sunday night situation where we sit down to watch a movie. There is a glass of wine on the table and something to munch. This combination of watching a movie, having a drink and eating a snack is perhaps among the worst situations for self-control. Most of us will pretty much mindlessly eat whatever is in front of us…whether it is a bowl of fruits, a packet of Doritos, a jar of nuts…it doesn’t matter. The way to avoid bingeing on UPFs like Doritos or Lays is to not have those packets in the house in the first place, which would ensure they don’t make their way to the table when we watch TV and in turn don’t find our way into our stomachs. Self-control at the end of the day is tough when faced with a cylinder of Pringles, so it is best not to have the Pringles in the house in the first place.

What is your matka here?

It is fine to indulge in UPFs once in a rare while. But if they form a significant part of your daily food habit, then you perhaps need to rethink your food habits, given the increasingly overwhelming data that shows how UPFs increase the incidence of cardiovascular and related disease including some cancers and reduce longevity and may often be addictive.

And if you are still confused about what constitutes a UPF, use the Michael Pollan rule “Don’t eat anything your great-great-great grandmother wouldn’t recognize as food”.

Footnotes:

1. Wang DD, Li Y, Bhupathiraju SN, Rosner BA, Sun Q, Giovannucci EL, et al. Fruit and Vegetable Intake and Mortality: Results From 2 Prospective Cohort Studies of US Men and Women and a Meta-Analysis of 26 Cohort Studies. Circulation. 2021 Mar;CIRCULATIONAHA.120.048996.

2. Juul F, Vaidean G, Lin Y, Deierlein AL, Parekh N. Ultra-Processed Foods and Incident Cardiovascular Disease in the Framingham Offspring Study. J Am Coll Cardiol. 2021 Mar 30;77(12):1520-1531. doi: 10.1016/j.jacc.2021.01.047. PMID: 33766258.

3. Monteiro CA, Cannon G, Moubarac JC, Levy RB, Louzada MLC, Jaime PC. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr. 2018 Jan;21(1):5-17. doi: 10.1017/S1368980017000234. Epub 2017 Mar 21. PMID: 28322183.

4. Monteiro CA et al. Ultra-processed foods, diet quality, and health using the NOVA classification system. FAO 2019

5. Hall KD, Ayuketah A, Brychta R, Cai H, Cassimatis T, Chen KY, Chung ST, Costa E, Courville A, Darcey V, Fletcher LA, Forde CG, Gharib AM, Guo J, Howard R, Joseph PV, McGehee S, Ouwerkerk R, Raisinger K, Rozga I, Stagliano M, Walter M, Walter PJ, Yang S, Zhou M. Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake. Cell Metab. 2019 Jul 2;30(1):67-77.e3.

6. Gupta P, Shah D, Kumar P, Bedi N, Mittal HG, Mishra K, Khalil S, Elizabeth KE, Dalal R, Harish R, Kinjawadekar U, Indumathi K, Gandhi SS, Dadhich JP, Mohanty N, Gaur A, Rawat AK, Basu S, Singh R, Kumar RR, Parekh BJ, Soans ST, Shastri D, Sachdev HPS; Pediatric And Adolescent Nutrition Society (Nutrition Chapter) Of Indian Academy Of Pediatrics. Indian Academy of Pediatrics Guidelines on the Fast and Junk Foods, Sugar Sweetened Beverages, Fruit Juices, and Energy Drinks. Indian Pediatr. 2019 Oct 15;56(10):849-863. Epub 2019 Aug 10. PMID: 31441436.