Scale of Britain's junk food crisis laid bare
Ultra-processed foods – such as ice cream, processed meats such as ham, mass-produced bread, breakfast cereals, ready meals, biscuits, and fizzy drinks – are being increasingly linked to bad health.
The concept of ultra-processed foods (UPFs) has been popularised by figures such as Prof Tim Spector, founder of the wellness project Zoe, and Dr Chris van Tulleken, the TV doctor and author.
UPFs have previously been linked to increasing rates of obesity, heart disease and cancer, and now experts believe they may be behind thousands of early deaths each year.
They often contain high levels of saturated fat, salt and sugar, and typically include additives, preservatives and other ingredients not used in home cooking – such as emulsifiers and artificial colours and flavours – which are added by manufacturers.
They have been the result of society's shift toward buying food that can be eaten quickly or on-the-go, like meal deals and ready meals, combined with extending shelf life of products and what experts say are the addictive characteristics of UPFs.
But concerns are growing about the impact these types of food are having on our health.
Stop signs on food packaging
Researchers from Brazil's scientific institution, the Oswaldo Cruz Foundation, analysed the impact of UPFs on the rates of premature deaths in eight separate countries.
The study, published in the American Journal of Preventative Medicine, found UPFs made up 53 per cent of people's food energy consumption in the UK.
This was the second highest behind only the US at 55 per cent.
Using mathematical modelling, the authors found the proportion of premature deaths attributable to UPFs ranged from 4 per cent in Colombia, where consumption is lower and regulations are stricter, up to 14 per cent of premature deaths in the UK and US.
The researchers said that in 2018-19, some 17,781 premature deaths in the UK could have been linked to UPFs, according to their model.
Many countries in South America require UPFs to have black octagonal stop signs on their packaging so consumers are aware, with proposals for them to be used in the UK put forward by former government food tsar and National Food Strategy author Henry Dimbleby.
Eduardo Nilson, lead investigator of the study from the Oswaldo Cruz Foundation, said the impact of UPFs on health went 'beyond the individual impact' of high levels of salt, fat and sugar.
He suggested this was 'because of the changes in the foods during industrial processing and the use of artificial ingredients, including colourants, artificial flavours and sweeteners, emulsifiers, and many other additives and processing aids'.
'So assessing deaths from all causes associated with UPF consumption allows an overall estimate of the effect of industrial food processing on health,' he said.
Dr Nilson added that the study found 'each 10 per cent increase in the participation of UPFs in the diet increases the risk of death from all causes by 3 per cent.'
The research team also looked at data from Australia, Brazil, Canada, Chile and Mexico.
'Health harms of UPFs'
Scientists are not sure whether the link to poor health and early death is just because of the high content of known risk factors – salt, sugar and fat – or whether there is something additional at play when foods are 'ultra-processed'.
Prof Nita Forouhi, professor of population health and nutrition at the University of Cambridge, said the study had limitations but 'nonetheless, evidence on the health harms of UPFs are accumulating and this paper does add to that body of evidence'.
She said while this study was observational and could not prove a link between the two, it was 'the best we are going to get realistically', adding that 'we should not ignore such findings, especially as the current research has reported consistently similar associations in several countries which increases the degree of confidence'.
Stephen Burgess, statistician at the University of Cambridge, said it was possible the actual cause was a 'related risk factor such as better physical fitness', but the replication of the trend across countries and cultures 'raises suspicion that ultra-processed foods may be more than a bystander'.
Nerys Astbury, associate professor from the University of Oxford, disagreed with the study authors' call for UPFs to be added to national dietary guideline recommendations, such as the suggested limits on daily sugar and salt intake.
' Many UPF tend to be high in these nutrients, and studies to date have been unable to determine with certainty whether the effects of UPF are independent of the already established effects of diets high in foods which are energy dense and contain large amounts of fat and sugar,' she said.
'Rushing to add recommendations on UPF to these recommendations is not warranted based on this study in my opinion.'
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'There's a feeling that if it's a drink, it doesn't count, but of course it does. Just be aware of it and adjust other things in your diet to maintain balance.' Dietary advice in many countries is to drink no more than 125-150ml of fruit juice, vegetable juice or smoothie daily – a small glass. The Australian study concluded you can be a little more generous: 'The multiple potential beneficial effects detected at low to moderate levels (50-240 ml/day) of 100% juice consumption can provide exposure to beneficial nutrients and bioactive compounds, without the risks associated with excess consumption of free sugars and calories.' Gill says that consuming anything in excess can be harmful to health. 'Enjoy a glass of fruit juice or smoothie, but don't rely on it to hydrate you throughout the day. It shouldn't be your default drink … Think of it this way: it takes three to four oranges to make one glass of juice. You wouldn't eat four oranges in one sitting.' No. Even a green juice containing five different vegetables, or a smoothie made from five kinds of fruit, counts for only one of your five a day, because of the free sugars and lack of fibre. Hobson goes further. 'Juice is an extra – you should still eat at least five fruits and vegetables in whole form,' he says. 'You shouldn't get into the habit of drinking your nutrition. We should be chewing, not sipping!' As well as prioritising vegetables, include lower-sugar fruits such as berries, stone fruits, citrus fruits, kiwi and avocado. Consider diluting juices and smoothies with still or sparkling water, or ice – Benelam says juice should always be diluted half and half with water when given to children. The NHS advises drinking juices and smoothies at mealtimes, not as a between-meal snack, to reduce the risk of tooth decay. This may have an added benefit, says Hobson – especially for vegetarians and vegans. 'Vitamin C helps the body absorb iron from plant-based sources such as dark green leafy vegetables, tofu, seeds, beans and lentils.' 'Always choose a pure 100% fruit juice, ideally with pulp,' says Gill. Avoid 'fruit nectars' and products labelled 'juice drinks': 'They are bulked out with other ingredients such as sweeteners, colours and flavourings.' 'It depends what you can afford,' points out Hobson. 'Buy fresh juice if you can – pasteurised juice loses vitamin C. You'll still get some vitamin C from juice that is made from concentrate, but avoid any with added sugar or syrup.' 'Vitamin C is sensitive to oxidisation and levels do decline, so freshly made juices at a juice bar may contain more,' says Benelam. 'But portions tend to be very large – go for a small size.' Gill says there is evidence to show that ginger can help with nausea and that turmeric has anti-inflammatory effects. 'There is no harm in taking a daily shot if you enjoy it,' she says. 'At the same time, they are often expensive, can contain added sugars and different brands contain different amounts of ginger.' She notes that supplementing with ginger can interact with medications such as blood thinners; seek advice from a pharmacist if necessary. Hobson is more sceptical. 'I'm not sold on fruit shots,' he says. 'A lot of them are apple juice with a bit of ginger.' It's probably better – and certainly cheaper – to use ginger and turmeric in cooking instead. 'Juice fasts are unsustainable and unrealistic for most people,' says Gill. 'While fruit and vegetables are a rich source of many nutrients, including fibre and vitamin C, they are limited in other nutrients – such as vitamin B12, iron, omega 3 and protein. They cannot provide the body with all its nutritional needs. Food diversity is what's needed for optimal health.' There is no need to 'detox', adds Benelam. 'Our bodies are very good at getting rid of toxins.' And Hobson is unequivocal: 'Avoid juice fasts at all costs. There are no health benefits whatsoever.' 'We should get most of our hydration from water,' says Benelam – but it doesn't have to be plain. Gill suggests flavouring still or sparkling water with chopped fruit or berries; a squeeze of lemon or lime; herbs such as mint, basil or rosemary; or slices of cucumber. She says other drink options include kombucha – 'Just check the amount of sugar, which can vary from brand to brand' – and herbal and fruit teas (hot or iced). Gill suggests Greek yoghurt topped with banana or berries, chia seeds and honey. Benelam keeps it simple: 'A glass of milk – cow's or plant-based – is a good alternative before or after the gym. It contains protein, nutrients and electrolytes.' In an ideal world, we'd get our vitamins, minerals and bioactive compounds (such as polyphenols, flavonoids and carotenoids) from whole fruits and vegetables, rather than juices and smoothies. However, most of us don't eat enough of them. As the Australian review points out, juices and smoothies are an 'affordable, accessible and palatable' addition to the diet. You're not better off with Cola-Cola – but you should stick to one small glass a day. Do you have an opinion on the issues raised in this article? If you would like to submit a response of up to 300 words by email to be considered for publication in our letters section, please click here.
