This week on the Mad in America podcast I am thrilled to be joined by Dr. Chris van Tulleken. Chris is an Infectious Diseases doctor at the Hospital for Tropical Diseases in London. He trained at Oxford and has a PhD in molecular virology from University College London, where he is an associate professor.
His research focuses on how corporations affect human health, especially in the context of child nutrition, and he works with UNICEF and the World Health Organization on this area. Chris is also one of the BBC’s leading broadcasters for children and adults and his work has won two BAFTAs. In this interview, we talk about Chris’s new book Ultra-Processed People: Why Do We All Eat Stuff That Isn’t Food and Why Can’t We Stop?
The book takes a deep dive into the science, economics, history, and production of ultra-processed food. In particular, we discuss some of the effects of UPF on our brains and bodies and how the food industry positions UPF to dominate our diets.
The transcript below has been edited for length and clarity. Listen to the audio of the interview here.
James Moore: Chris, welcome. Thank you so much for joining me today for the Mad in America podcast. I’m thrilled to have you on.
Chris van Tulleken: It’s a real pleasure to be here. I feel like we’ve been meaning to have some sort of conversation like this for several years, so it’s good that the book has catalyzed the discussion.
Moore: You are well-known for so much, your BBC broadcasting, your work investigating the marketing tactics of baby formula manufacturers, and I know you best from your BBC series, The Doctor Who Gave Up Drugs, where you looked at what could be done about the dramatic rise in the use of prescription drugs in the U.K.
But it’s great to be here today to talk about your brand new book entitled Ultra-Processed People: Why Do We All Eat Stuff That Isn’t Food and Why Can’t We Stop? I have to say it’s a fascinating and worrying examination of the intentional shift in our diet that’s happened over the last 70 years or so.
I wondered what made you interested in writing Ultra-Processed People. Did it follow naturally from your work looking at the infant formula market and the tactics used there?
van Tulleken: I’ve got three answers to that question for different audiences and all of them are true.
One is that I’m an infectious diseases doctor and I do tropical medicine. For a long time I worked in humanitarian emergencies, and I saw a lot of infant death because of the marketing of infant food to people who couldn’t afford it. They were people who had no clean water to make it up, and who couldn’t read the instructions to give it properly. That was my first interaction with what was called, in the 1970s, commerciogenic malnutrition.
A lot of people boycotted some of these companies in the 1970s and 1980s when I was a student and so I assumed the problem had been solved. Yet when I was working in 2008-2010 in these contexts, this marketing was still going on very aggressively.
The second reason is that my identical twin brother has lived with obesity for a very long time, and I’ve had a complex relationship with him about it. I found it very distressing and I’ve stigmatized him and harassed him about it for a long time. So part of the journey of the book was untangling that and realizing how I’ve interacted with him about weight and shame.
Then, as you say, it was a very natural extension of the work I was doing around other commercial determinants of health, including the way that companies affect our health. Companies affect our health in good and bad ways; they employ us, they give us goods and services. But many industries have a very significant negative effect on our health and the pharma industry and the food industry are intimately linked.
Once you start seeing things through this prism, and this is most of my academic work now, you start to realize the effects of the relationships that the medical profession has with either the pharmaceutical or the food industry. So the journey to get there was through all that work.
Moore: Could we talk a little bit about the definition of ultra-processed food because it’s not exactly straightforward, is it?
van Tulleken: Well, there’s a very long formal scientific definition that’s been used to try and delineate and study the category of food that we know is harmful. It’s a working definition of junk food, essentially.
But the shorthand way that’s really effective for people is if it’s wrapped in plastic, and it’s got something in it that you don’t find in the domestic kitchen, it’s ultra-processed food. I spoke earlier today to Marion Nestle, who’s a professor at New York University. She’s done a huge amount of work on the food industry, and her rule of thumb is if you couldn’t make it at home, it’s UPF and that’s a pretty good one too.
The nuance to that is, there’s a lot of lasagna out there and lots of pizza out there that you feel like you might be able to make at home, but it’s in plastic, and it might or might not have something weird in it. So in the U.K., a lot of listeners are going to recognize these kinds of fringe foods. Are they UPF or are they not? They have got a very long list of ingredients, but you might have most of them in a well-stocked kitchen, that’s the sort of stuff around the edges. But broadly, it’s stuff with the additives like emulsifiers, stabilizers, sweeteners, xanthan gum, potassium sorbate, and anything like that. It’s all ultra-processed.
Moore: When I was reading the book, I couldn’t help but think that if food labels showed how the food was manufactured, extruded or mechanically recovered or emulsified or whatever, a lot of what we eat might suddenly become less appetizing.
van Tulleken: Palm oil is an interesting example because you’ll see that on many ingredient lists and of course, it is a traditional food. I’ve worked a lot in West and Central Africa, and if you crush a palm nut and eat it, you get this extraordinary spicy bright red oil.
The palm oil that’s in our chocolate spreads, in our peanut butter, in our bread and biscuits is refined, bleached, deodorized, hydrogenated and inter-esterified, in order to take it from that spicy red flavorful oil that spoils quite quickly into an absolutely solid commodity fat that’s interchangeable with anything from chicken fat to beef, soy to butter to any of the other solid fats that we can make out of palm oils. So, yes, we don’t label food accurately. I think that’s fair to say.
Moore: And perhaps even more, there are some pretty unbelievable health claims on the packaging of UPF aren’t there?
van Tulleken: I think it’s a good rule of thumb that if a food has a health claim anywhere written on it, it’s probably ultra-processed. If it’s associated with weight loss or it’s high in fiber or it’s vitamin enriched or has 30% less sugar or will support weight loss as part of a balanced diet that is almost guaranteed to be ultra-processed food.
What’s important to say is that my interest is not in demonizing individual products. In the U.K. and the U.S., 60% of our calories on average come from ultra-processed food. It’s normal for children to eat 80-90% of their calories from ultra-processed food. So having a bit of palm oil in your peanut butter misses the point. Our entire diet is built around these foods that are really about extracting money from us, and many of them are quite addictive, that’s the issue. Worrying about any one thing is to slightly miss the point, in my view.
Moore: Perhaps we could turn to the relationship between mental health and consuming UPF. So, there is some evidence that consumption of ultra-processed food could be linked to issues such as ADHD, autism and depression. We know that UPF affects the microbiome, and it’s not too much of a leap to believe that it could affect our mental health too. So what do we know about that? Does eating UPF change the brain?
van Tulleken: We’re pretty sure it does. So the way the evidence works is that we’ve got some laboratory science about the individual macronutrients and some of the additives that are there, and also to do with the texture of the food.
So we’ve got a lot of really good science on very soft food, dry food and energy-dense food, and that’s typically ultra-processed food. It’s soft, dry and energy-dense because it’s palatable, it drives consumption and it keeps for a long time. So we’ve got this lab data saying that there are lots of qualities and additives in this food that are in these experiments associated with things that might be problems.
Then we’ve got epidemiological data. So we look at population studies, and the great problem for the epidemiologist to solve has been to ask is this just fatty, salty, sugary food? Is this just what we think of classically as junk food? Is the processing important and by processing, I mean not just the additives and the physical and thermal and chemical processing, but also the marketing which certainly drives excess consumption.
So we’ve got loads of epidemiological data now, which makes all these statistical adjustments for salt, sugar, fat, fiber, and dietary pattern. When you control for all those things in your big regression analysis, what you see is the effect remains unchanged in magnitude and significance in almost all of the outcomes.
So the population data associates ultra-processed food with weight gain and most of the research is around that. But we’re also sure it’s associated with all cancers, including some specific cancers, heart attacks, strokes or cardiovascular disease, metabolic disease, like type 2 diabetes, inflammatory bowel disease like Crohn’s disease, dementia, anxiety, depression, and early death. The ADHD links are a bit weak, there is more work to be done there.
How does it drive all this? We’ve got lots of clues and instincts. So it might be molecules like acrylamide, which we think drives brain inflammation, it might be migratory molecules from the plastics, it might be some of the additives directly like some of the colors and the flavorings, or it might be that it affects our brain because it subverts our body’s evolved systems that guide nutritional intake. And it might be it affects our brain because it gives us piles, forces us to overeat, and takes away our control and agency from our diet because we become addicted to it and that leads us into a spiral of anxiety and depression. Or it might be all of the above. I personally suspect it is all of the above.
Moore: There was a fascinating experiment you describe in the book where children were allowed to choose food according to their wishes and they were guided by their bodies to fill in the nutritional gaps in their diet without them even being aware of it.
van Tulleken: This was an amazing study done in the 1920s by a woman called Clara Davis. She set up a nutritional institute with very young children, and they were allowed to choose their diet from 34 different little dishes. So each child at any one meal would get 12 of these dishes, and it included things like raw beef and bone marrow and lactic milk, which is basically thin yogurt. They’d get a little dish of salt, so they could dip things in salt if they wanted, some of the food was raw, and some of it was cooked.
They also got a cup of cod liver oil and this was the nicest detail. There was a kid called Earl, who had been raised in terrible poverty and as he was weaned from his mother’s breast he was essentially adopted by Clara Davis. He came in with rickets, so there are X-rays of him in the scientific papers and a photograph of him. He had bowed legs and really bad bone damage.
He drank a little cup of cod liver oil, of his own volition, even though the kids could choose what they wanted, every single day until his X-rays improved and his bones regained density and his rickets went away. At that point, he stopped choosing to drink cod liver oil and never touched it again.
So if we look at the animal kingdom, animals eat without labels, without instructions, without nutritional guidance, and they do pretty well. They build their bodies very effectively and have done so for millennia. So we have these systems inside us.
There’s a risk in talking about all this that people think that I’m saying that we need to return to a raw diet and eat an attempted paleo diet. Processing of food is really important. So, we’ve talked so far about ultra-processed food. Processed food is fine. We’ve been processing food for well over a million years.
Humans are the only obligate processivores, we have to process our food. Our jaws and our guts are much smaller than other animals of our size. That’s because we digest our food essentially outside of our bodies. We chop it up with knives, we digest it with cooking. So processing is fine and if we eat processed food, most of us should be pretty good at regulating our nutritional intake without an instruction manual. The difficulty that’s been reported since the 1920s is if we eat ultra-processed food, it has been designed in a way that gets around our satiety mechanisms particularly.
Moore: In reading the book, I couldn’t help but be struck by similarities in the way that Big Food operates like Big Oil and Big Pharma. It’s hugely wealthy, it engages in massive marketing spend. It influences consumer groups and even sponsors research that shows its product in the best possible light. So how can we, as mere consumers, make a stand against that?
van Tulleken: Almost the biggest problem that needs to be solved is not one single regulatory action. So, we should, for example, limit the marketing of this food in the way that we limit the marketing of drugs of abuse and tobacco products. But the main thing we need to change is our culture around how we relate to the industry.
So with the pharmaceutical industry, there is at least some understanding that these conflicts of interest within the research drive bias to corrupt outcomes. Now, it still happens and pharma is very skillful at controlling the way we think about our bodies and the treatments for when we get ill.
With food, the food industry has captured everything from the basic research to the charities that inform government policy. So if you think of any charity about human health and diet, particularly some of the activism ones, some of the ones associated with particular diseases, whether it’s cancer or diabetes, they are often funded by the manufacturers of UPF. Many of my media colleagues are funded by these companies, their research is funded and they’re paid directly. Until we disentangle ourselves from those conflicts, we will never solve the problem.
If people get only one thing from reading my book, it’s to understand that all diet-related disease but particularly obesity is commerciogenic. It’s caused by the interests of industry. The pharma industry, we’ve known for a long time, is what we call financialized. So part of the work of activists of the kind that you work with has been to demonstrate that the primary and almost sole interest of these companies is delivering value to shareholders. And yet they pretend to be stakeholders, they say “We’re interested in patients, of course, shareholders need some money, but our primary focus is the treatment of disease and the patient.”
We’ve shown very clearly now that that is not the case with the pharmaceutical industry, the way they price gouge and market drugs and the way that drugs dominate our treatment for illness, the primacy of that biomedical model of disease that all your listeners will be familiar with.
With food, it’s the same, they dominate the ecosphere. We know that they’re financialized in the sense that they are paying less and less tax, spending less and less on advertising, and doing less that contributes to the economy. They don’t build the infrastructure and they employ fewer and fewer people. What they do is they rent seek off their brands, they do share buybacks, they buy cheap debt and pay it to shareholders.
According to some of the ex-industry experts and insiders that I spoke to, they function more like banks that specialize in food and ingredients than they do as food producers. The big bit of the book is my journey to understand that the food supply system isn’t really a food supply system. It’s an inverted money supply system, we are the source of money and our health is commodified in order to extract that money.
It’s not a very complicated hypothesis and it is very testable. If you can make an addictive product at a rock-bottom price, that’s what you should do if you’re a transnational food corporation. The idea is that food made by transnational food corporations, and the scientists that work for them, might interact with our physiology somewhat differently from the food that a parent or a community member would make because they love us and want to nourish us. I mean, it’s not rocket science, is it?
So this is a hypothesis that our grandparents would have been very familiar with. Our grandparents did worry about this, and my mum worried about this. The team in Brazil, who came up with the idea of ultra processing and defined it, all they did was create a definition that we could generate evidence around and kind of prove our grandparents right when they said—emulsifiers in bread, that seems a bit weird.
Moore: There’s a brilliant example in the book of profit over nutritional value where you describe your daughter’s experience with an ice cream in a park where the ice cream doesn’t melt in the heat. Of course, that’s because it’s more commercially viable for these companies to transport this stuff all around the globe if they don’t need to chill it.
van Tulleken: If you leave ice cream in a bowl, it retains its ball shape, there will be a bit of liquid that comes out of it, but it will stay a warm ball of foam.
Now, in my book, weirdly, and I wonder if I feel a bit like this about the pharmaceutical industry, to some extent, they aren’t really the bad guys. We are allowing them to do this. Now, of course, they are campaigning and bringing legal actions and creating the environment in which they can create these monopolies and dominate the discourse and cause all these externalized costs and health problems. But really, it’s the failure of government and doctors and scientists to act as regulators. They are the baddies in my book, the charities that accept the money and launder the reputations and dilute all the activism. They’re the people who could make a different choice.
When you talk to people in the food industry and the pharma industry as well, a lot of the people that informed this book did work for the pharmaceutical industry. Because it was safe to go to my contacts in pharma and say, “Hey, I’m talking about food. Can you just tell me how your company works?” Whereas if you tackle people in the food industry, there’s a sort of dissonance where they feel ill at ease. People in the pharmaceutical industry love slagging off the people who work in the food industry, they feel comfortable doing that. Of course, when you say, “But are you guys doing the same thing? They’ll go, “Yeah, we sort of do do the same thing.”
So when you’re in these companies, many of the people at the companies want to do things differently. And I give an example of Emmanuel Faber at Danone who I believe sincerely wanted to make Danone a company that was better for the environment and better for people’s health. He was removed very rapidly by activist investors.
Activist investors, of course, are not all trying to get oil companies to leave oil in the ground, activist investors are also saying, “We want our money.” And I have some sympathy with the activist investors because they are answerable to me and my pension. My NHS pension will be partly in the transnational food corporations.
So there’s this trap, this loop of kind of late capitalism, where huge asset funds own these companies and drive these behaviors that generate profit at the expense of everything else. The people who can make a choice aren’t the people in the food companies, they’re not in control. Governments can and doctors can choose. We have signed up to obligations to our patients and the population in general, we’re very clear, we are paid not by those people. I make good money working as a doctor, I can pay all my bills, and so we do have the freedom to say, “I’m not actually going to take money from tobacco, alcohol, food or Pharma” and yet we do.
Moore: There’s a neat coming together of the food and the pharmaceutical industry. In the news recently a lot has been jabs for obesity. So you’ve got a food industry that is blaming inactivity, not the sugar content, for people struggling with their weight. Then along comes pharma and says, “Well, we’ve got a jab for that, now.”
van Tulleken: It’s the “Eat me-Drink me” approach to modern life where we say, “We’ve got all this diet-related disease, let’s invent drugs to fix it.” I’m a fan of weight loss drugs, I should say. We should be able to celebrate treatments for lung cancer, while simultaneously saying “Let’s also invest in some smoking prevention and tobacco control strategies.” What we are doing with food is thinking let’s invest billions in drugs that won’t work nearly as well as the celebrities say they do or as the initial trial said they will. No drug in history has ever worked that well.
They do help some people for a period of time lose quite a significant amount of weight. They probably won’t work nearly as well in people who live in food deserts, with very low-income levels, and no financial or geographical ability to buy actual food. These are displaced people and people of color and indigenous communities across North America and in fact, around the world. So, yes, we’ve been so willing to buy these drugs and spend those billions and yet we are paralyzed when it comes to any kind of food corporation regulation. Like zero, there is almost no regulation and until we disentangle the conflicts of interest, we won’t have any regulation.
Moore: I like the fact that the book isn’t telling people how to live their lives or giving a particular diet to follow. It’s more of an informed consent approach, I think, in terms of giving people the information they need to make the best choices for themselves and their family’s health. But, if people listening wanted to start to make changes to reduce their consumption of UPF, are there some small, simple things that they could start with?
van Tulleken: I essentially refuse to give anyone any advice almost about anything. I know nothing about the lives of your individual listeners, I know very little about the lives of my patients, and I barely understand my own life.
My proposal in the book is a fairly straightforward one. You’re part of an experiment you didn’t volunteer for. New molecules and new combinations of molecules are being tried in your food the whole time. You take all the risks in these experiments, the companies get all the benefits. While you read the book, if you’re someone who struggles with this food, continue to eat the foods you struggle with, the foods you want, and the foods you enjoy.
I didn’t realize until I had the experience of eating an ultra-processed food diet for the book. About three-quarters of the way through the diet, I spoke to a scientist in Brazil, Fernanda Rauber, and she just kept saying, “It’s not food, it’s an industrially produced edible substance.” And that night, it was like I’d fallen out of love, and I just couldn’t eat my fried chicken dinner.
That’s sort of what I want to do to the reader is bring them on that journey and say, “Look, speak to the people I’ve spoken to, through me in the book, keep eating the food, and you may find yourself released from the addiction by the end of it.” That method works very well there’s lots of evidence, the Allen Carr and the World Health Organization recommend it as a smoking cessation strategy. Lots of people who have read the book so far, my editors, and my family, have all had this experience of thinking I just can’t eat it anymore. So the book is trying to disgust the reader, I hope, without stigma.
In terms of advice, you’ve got to become a philosopher of your food. I passionately believe if you’re listening to this and you struggle with binges with overeating, with weight, and with control, all I can give you is some love and support and ask you to become a philosopher of your own diet. Eat the food, think about the food as you taste the low-fat mayonnaise, start to wonder about the fact that the gum has replaced the oil and there’s a bacterial exudate in there that’s kind of snotty. And it’s a bit like mayonnaise but it’s also not quite like mayonnaise.
You know, you should enter this sort of uncanny valley of finding your food a bit ghoulish.
I can’t promise it’s going to happen, I certainly can’t promise you’re going to lose weight, if that’s what you want to do. I don’t think really that anyone should lose weight, I don’t even think that anyone should eat less ultra-processed food. My suspicion is if we reduce poverty and inequality, people would eat less. And that most people when they start to engage with the idea of emulsifiers, and artificial sweeteners and what they do to the body, most people think “I probably don’t want to eat this.”
But I’m allergic to telling people what to do because it just never works. Every therapist knows this, if someone wants to change, it’s down to them. The tragedy is that so many of us are trapped by circumstance and bad fortune.
I dodged that question, didn’t I? But I hope it’s useful to someone. Writing the book changed my life. It sounds corny, but it did and it changed Xand’s life particularly. Xand, as he read the manuscript and as I stopped bullying him, lost about 25 kilos. I’m not celebrating that because he doesn’t look better. I’m not even convinced he’s very much healthier. But he’s done something for him that he’s happy with, and so that I am happy about.
Moore: Chris, is there anything that we didn’t cover that you think is important to share?
van Tulleken: I hate framing these things as a problem. All the way through the book, I’ve struggled with the idea of “an obesity crisis,” “an obesity pandemic,” or “the problem of obesity.”
It is a problem in the sense it causes colossal suffering and it does hurt children particularly who have no agency over what they eat. But I do want to acknowledge that if someone is listening and they are living with obesity, I think using that phrase is quite important. Framing it as “living with” in the same way we do now with HIV, cancer, epilepsy or with diabetes. We don’t say, “You are a diabetic or an epileptic”, we don’t say, “You are cancerous.”
So I think if someone’s living with this, the whole conversation is just suppurating with shame, guilt and blame. I would like people to understand that it really isn’t them. It is the food and you should feel angry, and you are a victim. And the journey out of victimhood I think is activism. I had this sort of moment of “I’ve been duped and I’m the victim of these predatory corporations and the people who fail to regulate them.” Victimhood is not a very useful emotion, so you sort of turn that into real rage.
Moore: Chris, it’s just been fantastic to talk to you today. I do encourage people listening to read the book. It is so packed with science, describing the important research going on in corners of the world that we probably wouldn’t hear about in mainstream journals. The book is funny at points, it’s poignant at others. I think I referred to it as stomach-churning and gut-wrenching, it makes you think about what you’re putting into your body and the bodies of your families. I hope the book does well because it’s something people need to read.
van Tulleken: Well, I really appreciate your kind words on that. I don’t know what to say that isn’t going to be immodest, but I appreciate it and it’s been an absolute pleasure talking to you.
Chris van Tulleken—Ultra-Processed People: Why Do We All Eat Stuff That Isn't Food and Why Can't We Stop? - Mad in America
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