Two previous short-term studies demonstrated that if you eat a diet based largely on ultra-processed foods, you are likely to consume far more calories than you would eating less processed diets–and not notice that you are overeating.

The big question: why.

Study #1:  Hall K, et al.  Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake .  Cell Metabolism 2019; 30:67–77.

When study subjects ate the ultra-processed diet, they consumed 500 calories a day more than when they were eating the unprocessed diet.  This is a staggering difference.  They seemed to eat the ultra-processed diet faster.

Study #2: Hamano S, Sawada M, Aihara M, Sakurai Y, Sekine R, Usami S, Kubota N, Yamauchi T. Ultra-processed foods cause weight gain and increased energy intake associated with reduced chewing frequency: A randomized, open-label, crossover study. Diabetes Obes Metab. 2024 Nov;26(11):5431-5443. doi: 10.1111/dom.15922.

These investigators reported a difference of 813 calories.  They attributed it to less chewing.

Study #3 (as yet unpublished): Its results appeared as a Tweet (X) from Dr. Hall describing a presentation he gave at a meeting in London (Apparently, X is where science gets discussed these days).  The recording of the entire meeting is now available.  Dr Hall’s presentation begins at minute 38.

The latest result: a difference of 1000 calories a day!

Dr. Hall was kind enough to send me the slides from his presentation.

My translation:

• Blue bar: Minimally processed diet, low in energy density (calories per gram) and low in irresistably delicious (hyper-palatable) foods.
• Red bar: Ultra-processed diet high in energy density and high in hyper-palatable foods.

The big result: Difference between blue (unprocessed) and red (ultra-processed): 1000 calories a day.

• Purple bar: Ultra-processed high in energy density, low in hyper-palatable.
• Green bar: Ultra-processed low in energy density, low in hyper-palatable.

Difference between purple (high, low) and red: 200 calories a day.

Difference between green (low, low) and red: 630 calories a day.

Participants reported no differences in appetite or pleasantness of the meals on the various diets.  There also were no observable differences in eating rate.

Obviously, participants who ate more calories gained more weight.

Comment

My summary: We love and cannot stop eating yummy high-calorie foods.

All of this reminds me of the work of Barbara Rolls, who for years has argued for diets low in energy density, and whose low-energy-dense Volumetrics diet is consistently ranked at the top of diet plans.

It’s great to see all this research coming together.  Whatever the reasons—energy density, hyper-palatability, less chewing—the take-home-message seems utterly obvious: reduce intake of ultra-processed foods.

As Jerry Mande summarized the significance of this study, also in a Tweet (X) :

BREAKING..@KevinH_PhD  presents preliminary data from long awaited (6yrs!) follow-up study. Confirm initial findings. Energy dense, hyper-palatable UPF foods result in 1000 kcal/day greater intake than minimally processed food. Time to regulate UPF #MAHA

Indeed, yes.

[Apologies for sending this out yesterday (in error).  I’ve added a few things.]

Such an odd time we live in, with politics making increasingly strange bedfellows, this time with the American Council on Science and Health, an industry front group if there ever was one.

Yet here it is with two articles on the looming threat of bird flu.

USDA’s Dereliction in Containing Bird Flu Could Cause Calamitous Pandemic (Part 1) An inherent conflict of interest – USDA both regulating and promoting livestock industries – prevents appropriate responses to outbreaks of infectious disease. READ MORE

The government’s inaction has allowed H5N1 to spread with remarkably little attention. The virus has now affected at least 446 dairy herds in 15 states and more than 100 million birds, mostly commercial poultry, in addition to the documented human cases…USDA is the primary culprit in this failure. The department is tasked with two conflicting roles: protecting the health and safety of the nation’s livestock while promoting and protecting the $174.2 billion agriculture industry. Sick cows with a novel strain of bird flu do not bode well for business, especially for a dairy sector that exports millions of tons of milk, cheese, and other products globally each year.

Shortly after the March detection of H5N1, USDA imposed what amounts to a gag order on its employees, according to insiders. State veterinarians began receiving private phone calls from their USDA colleagues, who told them to refrain from discussing the outbreak without prior approval. This information embargo severely hindered the response from the start.

How Bureaucratic Infighting, Dairy Industry Lobbying Have Worsened H5N1 Bird Flu Outbreak (Part 2): There is an inherent conflict of interest – and the potential for injury to public health – when a federal department both regulates and promotes an industry. Nowhere is this more evident than at USDA. READ MORE

While the White House pushed for a response focused on public health, the USDA and the Food and Drug Administration (FDA), which share jurisdiction over the production, transportation, and storage of eggs, seemed more concerned with protecting the interests of the dairy industry. Dairy representatives worried that the virus and subsequent restrictions could cripple their business…According to a former USDA official, dairy industry insiders were alarmed that White House staff were contacting them directly, bypassing the usual channels through the USDA. State veterinarians reported they were told to discontinue routine calls with the USDA’s veterinary services. This exacerbated the communication rift between the White House and the USDA.

The USDA had historically relied on the cooperation of farmers and industry stakeholders, and the bureaucrats feared losing that trust. In contrast, the White House’s OPPR and its public health allies grew increasingly frustrated as the USDA dragged its feet and adopted an approach that seemed to be, “If you don’t test, you don’t know.” This tension and communication failures have come to define the fractured nature of the government’s response to the H5N1 outbreak.

Comment: much of this sounds familiar.  As with any food safety issue, testing protects the public but puts companies at risk.  If testing finds something, companies have to do something: recall products, cull animals, or other things that will cut into profits.  Bird flu is a looming threat to humans; only 55 cases have been detected so far, but as the disease spreads among cattle, cases could increase.  Federal agencies should be doing everything they can to stop this threat.  Let’s hope.

In the meantime, the USDA says it is taking action: USDA Builds on Actions to Protect Livestock and Public Health from H5N1 Avian Influenza.

Since this disease was first detected in dairy cattle in March 2024, the USDA and state and federal partners have taken several steps to better understand the virus and work to eliminate it from dairy herds. In May 2024, USDA implemented a Federal Order to require the testing of cattle before interstate movement, which has helped to limit H5N1’s spread to new states; in the past 30 days, the number of states with known avian influenza detections in dairy herds has dropped from 14 to two. However, USDA believes that additional steps are needed to proactively support effective biosecurity measures, which are key for states and farmers to contain and eliminate H5N1 infections from their livestock.

From the report’s introduction

THE UK’S FOOD SYSTEM ISN’T WORKING. It is unsustainable, unhealthy, and unfair. Deep rooted power imbalances mean that profits and power are concentrated in the middle of the food chain, leaving farmers and citizens feeling the squeeze. Among the poorest fifth of the population, households with children would need to spend 70% of their disposable income on food just to afford the government’s recommended healthy diet….

Diet, overweight and obesity are now the biggest risk factor for preventable death and disability in the UK…growing numbers of farmers and growers are struggling to make a living, with 61% of British farmers saying they are likely to give up their farm in the next 18 months….This is arguably an example of market failure – a predictable outcome of a food system where the governing rules mean there is currently little incentive for companies to sell healthy and sustainable foods.

It makes these points with  data.

I like this one too.

Resources

• Read the full report here
• Technical Report
• Annex

Well, only a little.

First, what this dinner is going to cost you: less than last year but more than before the pandemic.

And how about some agricultural statistics for turkeys?

And some key facts:

• The rise and fall of turkey production in the U.S.: Since 1960, per capita turkey production rose sharply and peaked in 1996 at 26.8 pounds per person. However, in 2022, annual production had dropped to just 20 pounds per person—a decline of approximately 25%.
• Rising prices and shifting consumer demand: Health concerns and changing dietary preferences play a significant role, with more Americans choosing plant-based diets and reducing meat consumption. Rising turkey prices, which increased from $0.80 per pound in 2018 to $1.40 per pound in 2023, also impact consumption.
• Larger birds soften the decline: The average size of turkeys raised in the U.S. has nearly doubled since the 1960s—averaging 32 pounds per bird compared to around 18 pounds in the 1960s. This trend has helped maintain relatively high production levels even as the total number of turkeys raised has declined (a peak of approximately 303 million birds annually in 1996, but an estimated 218 million birds in 2023).

Aren’t you happy to know all this?

Enjoy your dinner!

What are healthy diets? Joint statement by the Food and Agriculture Organization of the United Nations and the World Health Organization

What this is about:

Healthy diets promote health, growth and development, support active lifestyles, prevent nutrient deficiencies and excesses, communicable and noncommunicable diseases, foodborne diseases and promote wellbeing. The exact make-up of a diet will vary depending on individual characteristics, preferences and beliefs, cultural context, locally available foods and dietary customs. However, the basic principles of what constitutes healthy diets remain the same.

The guiding principles: Adequate, Balanced, Moderate, Diverse.

Here’s what they mean by Balance:

The actual guidelines are discussed under the Moderate principle.

• Sodium: restrict to 2 grams/d (5 g table salt)
• Sugars: restrict to 10% or less of daily calories.
• Saturated fat: restrict to 10% of calories, with no more than 1% from trans fat

FAO and WHO duck making a clear statement about the next two issues, although their implications are clear.

• Red and processed meat: even low levels may have negative health consequences
• Ultra-processed foods: these have negative health consequences

I wish they had stated these recommendations more clearly.  Yes they are controversial with big industries lobbying against any suggestion to eat less of these foods, but these agencies, or at least WHO, should put public health first.

I recognize that these agencies have constituencies of nearly 200 countries, many with strong meat and ultra-processed food industries.  I also recognize that the agencies have no power other than leadership to get any of those countries to do anything.

They at least stated what they thought.  It’s up to country governments to take action.  I hope they do.

It’s a slow-news holiday week so I’m going to use it to catch up on reports.  The first:

FAO: The State of Food and Agriculture 2024: Value-Driven Transformation of Agrifood Systems

FAO uses true cost accounting (TCA) to analyze global food systems.

• ➔ By improving on the hidden costs quantified in The State of Food and Agriculture 2023, this report unpacks the health hidden costs associated with unhealthy dietary patterns linked to an increased risk of non-communicable diseases (NCDs).
• ➔ Case studies show how targeted TCA assessments conducted across multiple agrifood systems categories provide more nuanced insights into the requisite agrifood systems transformation and potential actions moving forward.

Here is an example of the kinds of analyses presented here.

And here are the resources:

• Read the full digital report
• Read the In Brief
• Read the interactive story: Beyond the price tag
• Watch the video: State of Food and Agriculture 2024. Value-driven transformation of agrifood systems
• Read the press release: Unhealthy dietary patterns drive $8 trillion in annual hidden costs of global agrifood systems
• Read The State of Food and Agriculture 2023

Read the background papers:

• Navigating the distributional challenges of agrifood systems transformation
• The hidden costs of coffee production in the Eastern African value chains
• A typology for agrifood systems
• Potential of crop diversification to address the hidden costs of major crop value chains in Central Asia
• Refining national true cost accounting for agrifood systems
• Hidden costs of agrifood systems
• How to reduce agrifood systems’ future hidden costs? A multi-country case study

Plant-Based Meat Analogs and Their Effects on Cardiometabolic Health: An 8-Week Randomized Controlled Trial Comparing Plant-Based Meat Analogs With Their Corresponding Animal-Based Foods. Toh DWK, Fu AS, Mehta KA, Lam NYL, Haldar S, Henry CJ. Am J Clin Nutr. 2024 Jun;119(6):1405-1416. doi: 10.1016/j.ajcnut.2024.04.006. Epub 2024 Apr 8.

Erratum in: Am J Clin Nutr. 2024 Aug;120(2):459. doi: 10.1016/j.ajcnut.2024.06.012.

This study compared effects on cardiometabolic health among people eating meat or plan-based alternatives for 8 weeks.

Conclusion: An 8-wk PBMA (plant-based) diet did not show widespread cardiometabolic health benefits compared with a corresponding meat based diet.

Funding: This study was supported by Pinduoduo Incorporated (HongKong Walnut Street Limited). Pinduoduo Incorporated had no role in study design, study conduct, laboratory analyses, data collection, management and interpretation or the writing, reviewing and approval of the manuscript.

Comment

This study was sent to me by a reader, who viewed it as a rare example of an industry-funded study with results unfavorable to the sponsor’s interests.  He thought the “Walnut” in the company’s name indicated a plant-based bias.

I wasn’t so sure and wondered what Pinduoduo did, exactly.

According to Wikipedia, “Pinduoduo Inc. (Chinese: 拼多多; Pinyin: Pīn duōduō) is a Chinese online retailer with a focus on the traditional agriculture industry. The business is the largest product of PDD Holdings, which also owns the online marketplace Temu.”

But it gets even better.  The American Journal of Clinical Nutrition published a correction to the paper:

The original funding statement was insufficiently elaborated and has been revised for greater clarity: Christiani Jeyakumar Henry [the senior investigator on this study] reports partial financial support provided by Pinduoduo Incorporated (HongKong Walnut Street Limited) which is an agricultural research firm.

This, then, is a standard example of an industry-funded—and conducted—study producing just the results wanted.  Another example of marketing research, alas.

Charlotte Bilekoff.  Real Food, Real Facts: Processed Food and the Politics of Knowledge.  University of California Press, 2024.  267 pages.

Food processing is a big issue these days (witness RFK Jr’s pledge to get ultra-processed foods out of school meals) and I was interested to see what food studies scholar Charlotte Biltekoff had to say about it.

Her thesis: When people say they want to eat “real food” rather than highly processed food, the food industry responds with “real facts,” science-based discussions of the benefits of food processing (“food scientism”).

The industry’s response is based on the idea that if you could only correct public ignorance and misperceptions, you could sell your products more easily.

But public concerns are about politics, not science.  And food scientism is a form of antipolitics.

She cites as an example, the FDA’s ongoing inability to define the term “natural.”

Concerned about health, sustainability, and risk and wanting change in the food system, the public sought to act on its values and aspirations in the marketplace.  Narrowly reframing those concerns as demands that could be met through product reformulations and new approaches to marketing—but without serious, systemic engagement with the broader issues they reflected—the food industry produced products that appeared to be more natural, less processed, and therefore better…articles in the industry press and comments to the FDA show that many perceived the consumers of “real food” as irrational and misinformed.  Seen through the lens of food scientism of the Real Facts frame, consumer perceptions of processing and what “natural” meant, or should mean, were further proof that the public lacked the skills and understanding to meaningfully participate in the regulatory processess, let alone act as knowledgeable participants in the governance of technology and the shaping of the food system. (p. 143)

What Biltekoff has done here is to translate the classic two-culture risk communication problem to food.

Her book made me go back and look at what I wrote about the two-culture problem in Safe Food: The Politics of Food Safety.  The book contrasts the differing perceptions of industry and the public about the potential harm of microbial foodborne illness versus GMOs.

These differences in approaching questions of risk were understood long before anyone invented the techniques for genetically modifying foods. In 1959, for example, the scientist and writer C. P. Snow characterized the ways in which people trained in science tend to think about the world—as opposed to those without such training—as representing two distinct cultures separated from one another by a “gulf of mutual incomprehension” [1]. Much more recently, the anthropologist Clifford Geertz wrote, “The ways in which we try to understand and deal with the physical world and those in which we try to understand and deal with the social one are not altogether the same. The methods of research, the aims of inquiry, and the standards of judgment all differ, and nothing but confusion, scorn, and accusation—relativism! Platonism! reductionism! verbalism!—results from failing to see this” [2].  [1. Snow CP. Two Cultures and the Scientific Revolution: The Rede Lecture. London: Cambridge University Press, 1959; 2. Geertz C. Empowering Aristotle (book review). Science 2001;293:53].

Science-based approaches to food safety, I pointed out, count cases and estimate costs, whereas what I called “value-based” approaches, are about feelings of dread and outrage.

Biltekoff’s analysis applies the two-culture framework to public responses to food processing and to the ways the food industry deals with those responses.

Her analysis explains much about the current pushback against the concept of ultra-processed foods from the food industry and some nutritionists.  If you want to understand why the Dietary Guidelines Advisory Committee has chosen not to recommend reducing intake of ulra-processed foods, read this book.

And, amazingly, the book is available as open source.  Read the book online here.

Read Charlotte Biltekoff’s interview with UC Press here.