We hear a lot of talk about ultra-processed foods (UPFs) these days. Though there is no officially recognized definition of “ultra-processed,” the term is widely used, and it has even become something of a political issue in recent months—-and with good reason.

UPFs have become a dominant feature of the modern diet, accounting for about 60% of all calories consumed in the US (Juul F, et al. Am J Clin Nutr. 2022). These foods, refine or engineered through chemical and industrial processes, and containing ingredients not typically found in traditional kitchens, are now strongly linked to a range of serious health problems. As researchers unravel their impact, it seems clear that reducing UPF intake is essential for long-term personal and public wellness.

UPFs: What Are They?

There’s considerable debate in academic, health policy, and regulatory circles about the precise definition of “ultra-processed.” The FDA is currently working with the US Department of Agriculture to develop an authoritative definition of the term for use by the food industry, food regulators, and policy-makers. In late July, the two agencies issued a public Request for Information to gather data and viewpoints on the issue. To date, the agencies have not yet released a final definition.

For practical purposes, UPFs are industrially formulated products designed for convenience and taste, often at the expense of nutritional value and health. These items are typically produced by taking whole foods apart and reassembling them with added artificial colors, flavors, and preservatives. Approximately 71% of packaged foods in the US fit that general definition (Baldridge AS, et al. Nutrients. 2019).  

In the grocery store, identifying UPFs can be straightforward: if a product’s ingredient list includes items that wouldn’t be found in a home kitchen—things like high-fructose corn syrup, hydrogenated oils, or emulsifiers—the product is likely a UPF. These foods are usually sold in attractive packaging with marketing targeted at children, and promising features such as “ready-to-eat,” “new bold flavor,” or “long shelf life.”

The Role of Chemical Additives

Food manufacturers use more than 10,000 additives, encompassing artificial colors, flavors, emulsifiers such as polysorbate 80 and carboxymethylcellulose, thickeners, sweeteners, and preservatives (Neltner TG, Comp Rev Food Sci & Food Safety. 2011).

Companies use these substances to extend shelf life, preserve or simulate color, modify texture or “mouthfeel,” intensify flavor, render the main ingredients quick to cook, or stimulate appetite. No doubt these additives increase consumer appeal. But as a nation, we are paying a huge health price in exchange for the convenience and the sensory hyperstimulation. 

Health Risks of UPF Consumption

Numerous epidemiological studies, including a comprehensive review of 43 studies, have documented direct, dose-dependent relationships between UPF consumption and various chronic diseases Even additives once considered harmless, such as certain food dyes, have been linked to behavioral issues in children and a range of other adverse effects.

Here’s a quick run-down of the major patterns that researchers have observed:

Obesity: Consuming as little as 30% of daily calories from UPFs increases the risk of obesity by 51% compared to lower intake levels, according to the 2021 43-study review by Melissa Lane and colleagues.

All-cause mortality: That review also concluded that eating UPF products more than five times a day is associated with a 28% increased risk of premature death.

Metabolic syndrome: Every 10% increase in UPF intake raises the risk of metabolic syndrome by 4%, Lane and colleagues report.

Cancer: Each 10% increase in UPF consumption is associated with a 12% higher risk of any type of cancer, a 30% higher risk of death from ovarian cancer, and a 16% increase in breast cancer mortality (Lane M, et al. Obes Rev. 2021. Chang K, et al. EClinicalMedicine, 2023.)

Cardiovascular disease: For every 10% increase in UPF consumption, the risk of coronary heart disease rises by 12%, while stroke risk increases by 11%, according to the Lane paper.

Inflammatory bowel disease (IBD): People who consume one to four servings of UPFs daily, show a 67% increase in Crohn’s and ulcerative colitis risk compared to people who don’t eat UPFs or who eat fewer servings. The risk also increases the more someone eats. Consuming five or more servings daily of UPF is associated with an 82% increased IBD risk (Narula N, et al. BMJ, 2021).

Irritable bowel syndrome (IBS): People who consume more than 20% by weight of UPFs have 25% higher risk of IBS compared with people consuming less than 10%, according to the Lane analysis.

Pregnancy complications: According to a metanalysis of 54 studies, representing a total cohort of 552,686 people, diets high in UPF consumption are associated with disturbing 19% increased risk of gestational diabetes mellitus (GDM) overall. In the subset of ten case-control studies included in this analysis, the rise in GDM was an alarming 206% among highest consumers of UPF.

High UPF intake is also associated with serious increases in risk of preeclampsia. Overall, the risk increase was 28% among high consumers. In a subset of 3 studies that looked specifically at “Western diet patterns,” that risk increase was an alarming 251%!

Low sperm count: A 2024 cross-section study of 200 healthy young men, looking at the impact of UPF on semen quality, showed that sperm counts, sperm motility, and sperm morphology were all diminished among the men in the highest tertile for UPF consumption. The authors state that “Theoretically, replacing 10% of energy from UPF with 10% of energy from unprocessed or minimally processed food consumption was associated with a higher total sperm count, sperm concentration, total motility, progressive motility, and normal sperm forms.”

Cognitive decline: Eating a lot of UPFs is bad for the brain. Among people in whom UPFs account for 20% or more of their total caloric intake, memory loss is speeded up by 28%, and verbal fluency declines by 25, according to a Brazilian prospective cohort study representing nearly 11,000 people (Gomes Gonçalves N, et al. JAMA Neurology. 2023)

Depression and anxiety: People who consume 20% or more of calories from UPF have a 22% increased risk of depression compared to those who eat lower amounts, according to the Lane metanalysis. Another metanalysis of 26 studies, comprising over 260,000 individuals from 12 countries, showed that for every 10% increase in daily UPF calorie consumption, there was an 11% higher depression risk. (Mazloomi SN, et al. Nutr Neurosci. 2023).

UPFs are real mood-wreckers, too. According to a paper by David Wiss and Erica LaFata, high UPF intake is strongly associated with feelings of boredom, crying, fear, loneliness, unhappiness, poor sleep, and sadness. Of course, this is a negative feedback loop. People in negative mood states often seek temporary comfort in binge-eating, usually on unhealthy UPFs, and these foods, in turn, perpetuate the unhappy moods.

The Mechanisms Behind the Damage

The epidemiological data paint a grim picture: high intake of UPFs is detrimental to nearly all of the body’s organ systems. There are multiple mechanisms by which these fast, convenient, hyper-tasty foods do their damage. These include:

Nutritional imbalances: UPFs lack many essential nutrients. High consumption of them displaces nutrient-rich whole foods. The result is reduced intake of protein, fiber, vitamins, minerals, and beneficial plant compounds. They contribute “empty calories,” increasing caloric intake without providing real nutrition (Mambrini SP, et al. Nutrients. 2023, Monteiro CA, et al. Report from UN Food & Agriculture Organization, 2019).

Overeating & appetite dysregulation: Many UPFs are soft and easy to consume quickly. They encourage faster eating and excessive calorie intake. A landmark NIH trial involving 20 healthy weight-stable adults showed that when the subjects were put on experimental diets high in UPFs for 2 weeks, they ate on average 459 more calories per day than when they were on diets low in UPFs (and given the same amount of presented foods from which they could freely eat). They also gained weight (0.9 kg on average) while on the high UPF diet, but lost roughly the same amount of weight during the non-UPF period.

The authors note that high UPF intake lowers endogenous glucagon-like peptide-1 (GLP-1), leading to appetite dysregulation which further promotes overeating.

Gut microbiome disruption: Emulsifiers, such as polysorbate 80 and carboxymethylcellulose (CMC), commonly found in UPFs, disrupt the balance of the gut microbiota, leading to dysbiosis. Human studies have shown that the frequent consumption of emulsifier-laden UPFs leads to reduced microbiome diversity and worsened gut health (Naimi S, et al. Microbiome. 2021). Emulsifiers can also be damaging to the gut mucosal lining.

Chronic Inflammation: Polysorbate 80, CMC, and carrageenan promote low-grade inflammation in the gut, which may contribute to the development of obesity, metabolic syndrome, and exacerbation of colitis and other inflammatory diseases (Chassaing B, et al. Gut, 2017). Carrageenan, a sulfated polysaccharide derived from red seaweed, is a widely used food additive, especially in dairy and plant-based products. Though it comes from a natural source, it is not necessarily healthy; it triggers the production of pro-inflammatory chemicals and may activate pathways linked to IBD. (Bhattacharyya S, et al, J Biol Chem, 2010; Borthakur A, et al. Am J Physiol Gastrointest Liver Physiol, 2007).

Marketing Manipulates Choices

The packaging and advertising strategies used for UPFs have a pronounced influence on peoples’ eating habits—especially among children. Bright colorful packaging, cartoon characters or cultural heroes, and “healthier-than-competitors” language work together to create desire, drive product purchases, and boost consumption.

Experiments have shown that children tend to eat more when food comes in branded packaging and prefer foods featuring cartoon characters, regardless of their actual nutritional quality (DeCosta P, et al. Appetite, 2017).

The fix for the problem of UPF-related disease is simple, though not easy. We need to teach our patients how to recognize and refuse these alluring, ubiquitous health-wreckers. We might not be able to completely eliminate UPF consumption, but with a bit of education we can help our patients minimize their intake. It comes down to a few basic steps:

• Read ingredient labels: Avoid products with ingredients not typically found in an ordinary home kitchen, or long lists of compounds that sound synthetic.Be especially wary of “health claims,” flashy designs, hyperbolic language. Stay away from products that deliberately target children.
• Assess the nutrient content: Foods that are high in added sugars, fats, and salt, but low in real nutrients and fiber, should be considered UPFs—even if they are “natural” or come from plant sources. There are a lot of unhealthy products marketed as “healthy” alternatives. This includes low-nutrient, carb-heavy gluten-free foods, and highly processed but minimally nutritious vegan substitutes for meats or cheeses.
• Prioritize whole foods: Choose fresh, minimally processed fruits, vegetables, protein sources, and grains whenever possible.

The epidemiological trends clearly implicate ultra-processed foods as major culprits in the rising rates of chronic disease, from obesity and diabetes to cancer and mental health disorders. Their convenience and sensory appeal mask the dangers they contain. Helping our patients to recognize UPFs and reduce their consumption of them is one of the best things we can do to support them in their quest for better health.

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John Neustadt, ND, is Founder and President of the dietary supplement company Nutritional Biochemistry, Inc. (NBI, nbihealth.com) and NBI Pharmaceuticals. Dr. Neustadt started NBI in 2006 when he couldn’t find products with the doses of nutrients he needed for his patients. He received numerous US FDA Orphan Drug Designations for potentially treating rare diseases using natural products through his company, NBI Pharmaceuticals. Dr. Neustadt hosts the “Delivering Health” podcast. He is a Bone Health and Osteoporosis Foundation Corporate Advisory Roundtable member, was North American Medical Advisor to the international JCCA Maccabi Games, and was Vice President and Treasurer of the California Naturopathic Doctors Association (CNDA). Dr. Neustadt has written four books and over 100 research reviews and was recognized by Elsevier as a Top Ten Cited Author in the world for his work. His latest book is Fracture-Proof Your Bones: A Comprehensive Guide to Osteoporosis.