Can you construct a healthy diet from ultra-processed foods?
My gut instinct would be a resounding NO!
Why?
I have discussed the challenges with consuming ultra-processed foods many times in the past on this blog. To summarize why regularly consuming ultra-processed foods is not going to be a good idea…
- They are generally calorically dense, meaning they contain a lot of calories for very little food.
- They are hyper-palatable, once you begin eating them, they are very hard to stop eating.
- They are generally nutrient poor, you don’t get the macronutrients, micronutrients, vitamins and minerals you do from whole foods and if you do you may not absorb them as well.
- They tend to be quick digesting, potentially resulting in you being hungrier than if you were eating whole foods.
Now I also realize that some people will point out that you CAN consume ultra-processed foods and still be healthy. I completely agree with this statement. If you can moderate your consumption, and primarily consume whole nutrient dense foods, you certainly can be healthy. But just because something is possible to do, doesn’t mean it is a good idea for everyone, more on this later.
That said, can you consume a diet primarily composed of ultra-processed foods and still be healthy? Can you consume mostly ultra-processed foods and only have a moderate amount of unprocessed foods and still be healthy?
A recent study (Dietary Guidelines Meet NOVA: Developing a Menu for A Healthy Dietary Pattern Using Ultra-Processed Foods, 2023) was published which tried to answer this question.
Researchers took a really interesting approach to this study and people will point out a number of flaws in how it was conducted.
First, a lot of the data was based on nutritional surveys. These can be ripe with inaccuracies because it is hard for people to recall what they ate accurately.
Second the classification of what foods counted as ultra-processed was done based on the NOVA classification system. Of course this is opinionated, so not everyone agrees that NOVA has the definition of ultra-processed correct (Ultra-Processed Foods: How Functional Is the NOVA System?, 2022).
Third, the actual classification of the foods was done by “graders” that were familiar with the NOVA classification system. The potential issue with this approach is that one person may interpret the NOVA guidelines differently than another, which can lead to one grader classifying a food as ulta-processed and another grader saying it’s not ultra-processed.
Fourth, researchers used the 2020 Dietary Guidelines for Americans as their definition of a “healthy diet”. Some people are of the opinion that these guidelines are actually what is causing us to be unhealthy.
While these potential flaws may make you wonder why I even wrote a blog post about this study, as you will soon see I don’t think these flaws actually make much of a difference.
For the purpose of discussing this study it will be useful to know how NOVA defines an ultra-processed food. Below is their definition, along with a couple of examples.
Finally before we dive into the results it is useful to understand how the researchers came up with the list of ultra-processed foods to construct a menu from. There are a couple of figures from the study that I think help clarify how foods were determined to be ultra-processed or not and then how those foods were filtered down to a list of foods that matched the Dietary Guidelines for Americans.
https://www.sciencedirect.com/science/article/pii/S0022316623724346
Now that we have all that background out of the way let’s dive into the results!
After narrowing down a list of ultra-processed foods to construct a menu from, the researchers were able to construct a 7 day meal plan which contained 91% ultra-processed foods that ended up scoring an 86 out of 100 on the Healthy Eating Index (HEI). The HEI score is a way of classifying a diet based on the Dietary Guidelines For Americans, with a score of 100 signifying that the diet matches all the guidelines.
When I first saw these results I thought to myself….
“How is this possible?!?!?”
How could they construct a diet of ultra-processed foods that was able to so closely adhere to the dietary guidelines? I know the dietary guidelines can leave a lot to be desired but they aren’t that bad that a diet composed of ultra-processed foods could score that high!
So I dug deeper into the paper…
The next thing I saw was the menu that the researchers constructed. I have copied it here for your reference.
When I started reading this menu I was taken back…
Where are the cookies?
Where are the donuts?
Where are the sugar sweetened beverages?
Where is the fast food?
Where is the candy?
Where is the boxed cereal?
Where are the alcoholic drinks?
Where are the “healthy snack packs”?
Where is the fried food?
Where are the chips?
It quickly became clear that what I think of when I think of ultra-processed foods and what classifies as an ultra-processed food are two very different things!
Now I was even more curious…what was the list of foods they had to work with? What did these graders classify as ultra-processed foods?
Thankfully the researchers published the whole list, which you can find in the supplementary material from the study.
Did you know that canned spinach is an ultra-processed food?
What?!?!? How bad can that be?
Luckily, the researchers not only included the food item but the brand and ingredients so we can look it up. In the case of canned spinach it was Glory Canned Spinach. It obviously contained spinach but also Less than 2% of: Salt, Hydrolyzed Soy Protein, Caramel Color, Dried Onion, Brown Sugar, Natural Smoke Flavor, Disodium Inosinate and Guanylate, Spice, Dried Garlic, Natural Hickory Smoke Flavor.
OK so I can see how this meets the NOVA classification of an ultra-processed food, but it’s vastly different from a donut! If I saw canned spinach on a client’s food log, I honestly wouldn’t even think twice about it.
Other items on the ultra-processed food list are canned tomatoes, canned lentils, canned sliced carrots, water chestnuts, brown rice, plain yogurt, canned sardines, dried shrimp, catfish filets, chicken apple sausage, chicken, liver sausage, and dried venison bar.
Now it is becoming clear how constructing a diet from these “ultra-processed foods” can result in a decent diet, certainly far better than the average American’s diet. In fact the researchers say this much in the paper by illustrating how the HEI score of their ultra-processed food diet compares to the HEI score of the average American’s diet.
Here is what a perfect HEI score looks like.
https://www.sciencedirect.com/science/article/pii/S0022316623724346
Here is a visualization of the HEI score from the researcher’s constructed ultra-processed foods diet. It is not perfect and falls short on meeting the guidelines sodium and whole grains requirements.
https://www.sciencedirect.com/science/article/pii/S0022316623724346
Now compare that to the HEI score of the average American’s diet.
https://www.sciencedirect.com/science/article/pii/S0022316623724346
As you can see the average American’s diet is far worse (at least according to the Dietary Guidelines for Americans) than the constructed ultra-processed foods diet from this study.
Does this study change my stance that you should consume mostly unprocessed whole foods?
No.
I still think the goal should be to eat as many whole unprocessed foods as possible. If you have the choice between canned spinach and fresh spinach, choose the fresh spinach. At the same time like I said above I would not say you should avoid canned spinach purely based on the fact it is labeled “ultra-processed”.
Like everything we need to apply some common sense.
Is an Epic Venison bar the same as a donut?
Is canned spinach the same as a candy bar?
Both are considered ultra-processed, but they are not even comparable from a health perspective. We don’t need a classification system to tell us which food better serves our health.
Labeling and categorizing foods provide some useful guidelines and general recommendations to help you decide what foods to choose. When we say things like avoid ultra-processed foods or anything that comes in a box or a wrapper, that is a good rule of thumb, but it doesn’t mean you should avoid canned sardines.
If you find this all frustrating and confusing, I can completely understand. As much as we want nutrition to be black and white, it’s not that simple, there are all kinds of gray areas. Rather than try to enumerate all the gray areas, the better approach is to follow exactly what I have said in the past…
Eat mostly minimally processed whole foods. Fruits, vegetables, meat, fish, eggs, fowl, nuts, and seeds. If you want and tolerate it, throw in some dairy and whole grains.
There is no gray area when it comes to minimally processed whole foods, they are almost universally beneficial. You don’t need to try and decipher if this processed food contains ingredients that are detrimental or if they are hyperpalatable, or if they are calorically dense.
If your diet mostly consists of those foods and you happen to have a small amount of ultra-processed foods it won’t be a big deal. If you instead try and make a diet mostly of ultra-processed foods you are likely to run into all kinds of gray areas that will be quite frustrating and take a lot of mental effort to navigate. If I am going to consume canned spinach I will need to pay attention to what else is in that can besides spinach. If however, I pick up a bunch of fresh spinach from the grocery store I don’t need to worry about what’s in it, I know it’s going to be OK to consume.
Ultra-processed foods are not going to disappear from our food environment, they are here to stay. And clearly, depending on your definition, ultra-processed foods could be used to construct a diet that is not half bad. Like I said above though, just because it is possible to construct a diet from ultra-processed foods doesn’t mean it’s a great idea. For most people the effort to construct such a diet would be quite high and can eventually be much more work than it is worth.
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References
Dietary Guidelines Meet NOVA: Developing a Menu for A Healthy Dietary Pattern Using Ultra-Processed Foods. (2023, June 24). PubMed. Retrieved January 9, 2024, from https://pubmed.ncbi.nlm.nih.gov/37356502/
Ultra-processed foods: how functional is the NOVA system? (2022, March 21). PubMed. Retrieved January 9, 2024, from https://pubmed.ncbi.nlm.nih.gov/35314769/