Nearly 60% of the average adult diet and nearly 70% of children's diets in the United States contain hundreds of new ingredients that human physiology has never been exposed to. From soda drinks to cereals, packaged snacks to processed meats, ultra-processed foods are packed with additives. Oils, fats, sugars, starches and sodium, as well as emulsifiers such as carrageenan, mono- and diglycerides, carboxymethylcellulose, polysorbates and soy lecithin, continue to strip foods of healthy nutrients while introducing other ingredients that may be harmful to human health.
While obesity and physical inactivity are recognized contributors to avoidable morbidity and mortality in the United States, another emerging hazard is the unprecedented intake of these ultra-processed foods in the standard American diet. This could be a new "silent" killer, like high blood pressure that went undetected in previous decades.
Physicians at Florida Atlantic University's Schmidt College of Medicine explore this hypothesis and provide important insights for health care providers in this battle to align the entertainment industry, the food industry and public policy with patient needs. Their findings were published in a review article in the American Journal of Medicine.
Declining life expectancy and dietary guidelines
"Today, those of us who practice medicine in the United States find ourselves in the ingloriously unique position of being the first health care professionals in 100 years to preside over a decline in life expectancy," said corresponding author Dawn H. Sherling, MD, associate director of the Internal Medicine Residency Training Program and associate professor of medicine at the FAUS Schmidt College of Medicine. "Our life expectancy is lower than other countries with similar economic power. When we look at the growth in non-communicable disease rates in less developed countries, we can see that the trajectory of this growth is linked to the growth in the consumption of ultra-processed foods in their diets."
Although professional organizations such as the American College of Cardiology caution patients to "try to choose processed foods rather than ultra-processed foods" in their 2021 Dietary Guidelines, one thing to note is that "there is no generally accepted definition of ultra-processed foods, and some healthy foods may fall into the category of ultra-processed foods."
The health effects of ultra-processed foods
"When food components are contained in a natural, whole food matrix, they are digested more slowly and less efficiently, resulting in reduced caloric intake, a general lower glycemic load, and a lower rise in triglyceride-rich lipoproteins after eating, which can contribute to atherosclerotic plaque," said senior author Allison H. Ferris, MD, associate professor and chair of the Department of Medicine and director of the Internal Medicine Residency Program at FAUS Schmidt College of Medicine. "So even if troublesome additives are removed from ultra-processed foods, there will still be concerns that overconsumption of these products may lead to obesity, diabetes and heart disease."
The authors add that public health organizations are increasingly using the NOVA classification system, which divides foods into four categories - whole foods, cooking ingredients (such as butter, oil and salt), conventionally processed foods (such as bread and yogurt made with few ingredients) and ultra-processed foods - or those that are industrially produced and use ingredients not typically found in home kitchens.
One plausible mechanism to explain this hazard is that ultra-processed foods contain emulsifiers and other additives that are mostly not digested by the mammalian gastrointestinal tract. They may serve as a food source for our microbiota and therefore may contribute to dysbiosis of the microbiota, promoting disease in the appropriate host.
The role of additives in disease
"Additives, such as maltodextrin, may make the mucus layer more friendly to certain types of bacteria that are more abundant in people with inflammatory bowel disease," Sherling said. "When the mucus layer is not properly maintained, the epithelial cell layer can become vulnerable, as shown in feeding studies in humans using carrageenan and other studies in mouse models using polysorbate-80 and cellulose gum, where it can trigger an immune response in the host."
The authors added that the incidence of colorectal cancer has increased significantly in the United States, especially among younger adults. They believe that increased consumption of ultra-processed foods may be a contributor to several other gastrointestinal diseases.
"Whether ultra-processed foods contribute to our current rising rates of non-communicable diseases needs to be directly tested in a priori designed analytical studies," said co-author Charles H. Hennekens, MD, FACPM, first Sir Richard Dole Professor of Medicine and senior academic advisor at FAU's Schmidt College of Medicine. "At the same time, we believe all healthcare professionals have a responsibility to discuss with their patients the benefits of increasing consumption of whole-fat foods and decreasing consumption of ultra-processed foods."
The authors also argue that just as the dangers of tobacco began to emerge in the middle of the last century, decades later, overwhelming evidence and the efforts of forward-thinking health officials prompted policy changes that began to consciously discourage cigarette consumption. Ultra-processed foods are likely to follow a similar path, they say.
"The multinational corporations that produce ultra-processed foods are as powerful, if not more powerful, than the tobacco companies of the last century, and it is impossible for governments to quickly enact policies to promote wholesome foods and discourage the consumption of ultra-processed foods," Sherling said. It is important that healthcare providers also continue to recognize that many of our patients struggle to afford and find healthier options, which requires a broader public health response.
Compiled source: ScitechDaily