Have we bitten off more than we can chew?

Processed foods have been around for a long time, but millions of years, since early humans first cooked meat over open flames. After that, humans learned processing techniques to make food safer, more delicious, and last longer.

However, with the advent of ultra-processed foods (UPFs), we may have reached a tipping point where modern food production methods are taking an unsustainably high toll on our health.

UPF is a more durable and cheaper product, but is often lacking in nutrients and high in calories, sugar, fat, salt, and numerous additives. new evidence It has been suggested that increased UPF intake may increase several non-communicable diseases and associated mortality.

Here we provide an introduction to some of the latest data regarding UPF and its potential negative effects on gastrointestinal (GI) health.

An increasingly mainstream food source

The term UPF appeared in 2009 By Brazilian nutritionist Carlos Monteiro. Founded by Monterio and his colleagues NOVA classification systemdivides foods into four categories: unprocessed or minimally processed foods, processed cooking ingredients, processed foods, and UPF.

Processed foods are produced by minimally changing the natural state of the food, such as adding salt, sugar, or oil. Examples include fruits in syrup and vegetables in vinegar or pickles.

UPF is a highly modified product created through an industrial process. These typically contain multiple additives, preservatives, and artificial ingredients. These foods are designed to have a long shelf life and include sugar-sweetened beverages, highly processed meat products, flavored yogurt, packaged snacks, and breakfast cereals.

However, the NOVA system has its critics.in 2022 debate Sponsored by the American Academy of Nutrition, some experts warned that the system was vague and confusing and included healthy foods such as plant-based burgers.

UPF consumption is Increasing worldwide, the United States (58%) and United Kingdom (57%) have the highest daily energy intake from UPF among adults. Among young people, this number may be even higher.a Large cross-sectional study According to U.S. National Health and Nutrition Examination Survey data, from 1999 to 2018, the share of UPF in total energy expenditure for people aged 2 to 19 years increased from 61.4% to 67%.

The specific components of UPF that contribute to various gastrointestinal diseases are still unknown. but, Preclinical research found that common food additives (such as sweeteners, colorants, emulsifiers, microparticles, or nanoparticles) can have negative effects on the gut, including intestinal permeability, intestinal inflammation, and the microbiome. was shown.

Overweight/Obesity and Metabolic Health Risks

The association between UPF and overweight/obesity has been noted in the following literature: some research. One of the first of its kind was small trial Starting in 2019, participants were randomly assigned to either a UPF diet or a minimally processed diet for two consecutive weeks, then switched to an alternative diet. It was found that during the UPF diet, patients ate about 500 more calories per day and gained about 2 pounds.

The increased risk of weight gain can also be passed on to your child during pregnancy. 2022 survey A study of 19,958 mother-infant pairs found that children of those who consumed the most UPF had a 26% higher risk of being overweight/obese than those who consumed the least.

Children who consume high levels of UPF also have significant changes in their metabolome, potentially leading to decreased metabolic health and increased risk of overweight/obesity. 2021 survey.

The specific UPF is increased risk For type 2 diabetes, therefore May sensitize people Associated with related gastrointestinal diseases, such as metabolic dysfunction associated fatty liver disease (MASLD).Recent review Several prospective studies have found that UPF intake may be a risk factor for MASLD.

Potential link with inflammatory bowel disease (IBD)

The prevalence of IBD is increasing in the United States past 10 years, UPF consumption has been identified as one of the potential causes. This is supported by a recent meta-analysis that reported that ingesting high levels of UPF may increase the risk of IBD. 47% increase For adults.

High UPF intake appears to increase the risk of Crohn's disease (CD) rather than ulcerative colitis (UC). A meta-analysis in 2023 revealed that 71% increased risk For CD, it was associated with higher UPF consumption, but no such association with UC was found. This discrepancy is also evident in several large prospective studies.individual research 245,112 U.S. medical professionals, 187,854 people at the UK Biobank, and 413,590 healthy volunteers Researchers from eight European countries all found a significant association between increased UPF consumption and CD, but not UC. An analysis of medical experts found that the UPFs with the strongest correlation to CD risk included ultra-processed breads and breakfast foods. Ready-to-eat/preheated meals. sauces, cheeses, spreads, gravies, etc.

UPF intake can also worsen symptoms in people who already have IBD. Recently published research They studied 135 adults with IBD (34.8% with UC and 65.2% with CD) who were getting 45% of their calories from UPF. After 1 year of follow-up, the researchers found that UC patients in the higher tertile of UPF consumption had more active disease (14.2 vs. 6.2) and active inflammation (1.6 vs. 0.6) than those in the lower tertile. ) episodes were found to be significantly higher. Unlike other studies, no such association was found in CD patients.

In a presentation at the annual Crohn's and Colitis conference, James D. Lewis, MD, of the University of Pennsylvania in Philadelphia, said: research summary They cite several food additives, including the emulsifiers carboxymethylcellulose, polysorbate 80, and carrageenan, as potential causes of gastrointestinal inflammation and IBD.

Just recently, the American College of Gastroenterology announced: Latest information on clinical practice We recommend that patients with IBD adopt a diet low in UPF, sugar, and salt, and follow a Mediterranean diet rich in fresh fruits and vegetables, monounsaturated fats, complex carbohydrates, and lean protein, unless contraindicated. I am.

Association with cancer risk

High UPF consumption Increased risk Proportions of total cancer incidence, ovarian cancer, and breast cancer-related mortality.

The opposite effect also appears to be true. the study from lancet planetary health found that replacing 10% of your UPF with minimally processed foods lowers your overall cancer risk by 4%, and reduces your risk of hepatocellular carcinoma and esophageal squamous cell carcinoma by 27% and 20%, respectively. discovered.

Recent meta-analyses have shown mixed results regarding the association between UPF intake and the risk of certain gastrointestinal cancers.

2023 analysis found that high UPF intake was associated with increased risk of colorectal cancer (CRC) and pancreatic cancer. moreover, meta-analysis Of the 13 studies, they cited gastrointestinal cancers, including CRC, as the cancer with the strongest association, but noted that further prospective studies are needed.

results from Three US prospective cohort studies We showed that high UPF intake was associated with an increased risk of colorectal cancer in men. Certain subgroups of UPF were also associated with increased risk of CRC in both men and women.

For patients with pre-existing colorectal cancer, continued intake of UPF may contribute to an increased risk of death. study I found it.

On the other hand, recently published umbrella reviews An epidemiological meta-analysis concluded that the existing evidence linking UPF and CRC is weak.

How can clinicians help patients avoid these addictive foods?

Attempting to resist the gravitational pull of the UPF can put patients at a disadvantage.

The high carbohydrate and fat content in UPF causes a surge of dopamine in the brain. comparable to nicotine.

UPF poisoning is also estimated. occurs in 14% in adults and 12% in children. Certain his UPFs, such as candy and frozen desserts, have been proposed to act as “.gateway food” and encourages other unhealthy eating habits in teens.

some policy changes It is proposed To combat increases in UPF fees, including mandatory taxes and warning labels on UPF.

In recent years, some Medscape Medical News The contributors share their thoughts on UPF, which may help clinicians discuss these increasingly dominant staple foods before discussing them with patients.

in Explanation of 2023Dr. Caroline Apovian advised clinicians to question some common assumptions about UPF consumption. Also in 2023, Travis D. Masterson, Ph.D. Strategies provided Help patients deal with stressors that may lead them to eat certain unhealthy foods. Dr. David Johnson suggested this. beginning They researched the possible causes of the Western diet and recommended that clinicians offer the Mediterranean diet as a healthy and easy alternative to patients with gastrointestinal disorders.

John Watson is a freelance writer living in Philadelphia.