Medical Perspectives | Others

September 20, 2020



Dr. Gwen Y. Reyes-Amurao, M.D.

Everyone knows about it. Eating processed food, whatever type it is, will always have deleterious effects on the body. Backed up by clinical studies and medical evidence; a diet rich in ultra-processed food or anything processed, for that matter, will lead to an increased risk of having cancer. One wonders the extent to which ultra-processed can be defined; and if it leads to illness, which types can it really cause?

 

Ultra-Processed Food Defined   

Technically speaking, food that undergoes any type of handling can already be classified as processed food. Blanching vegetables, freezing meat, mixing flour and butter to a dish are just some of the processing techniques applied daily. The creation of ultra-processed food goes far beyond simple cooking techniques and food handling. In a study published in the British Medical Journal (BMJ) in 2016, ultra-processed foods were defined as industrial formulations which, aside from salt, sugar, oils and fats, include substances not used in ordinary cooking preparations. These formulations, additives in particular, are used to imitate sensorial qualities of minimally processed food in their culinary preparations. The BMJ also defined food types according to the extent to which they were processed:

 

  • Unprocessed or minimally processed foods include fresh, dried, ground, chilled, frozen, pasteurized, or fermented staple food such as fruits, vegetables, rice, pasta, eggs, meat, fish or milk.
  • Examples of processed culinary ingredients are salt, vegetable oils, butter, sugar, and other substances extracted from food and those used in the kitchen that transform unprocessed or minimally processed foods into culinary preparations.
  • Processed or ultra-processed food includes canned vegetables with added salt, sugar coated dried fruits, meat products preserved by salting, cheese, and other products manufactured with the addition of salt, sugar, or other substances of the “processed culinary ingredients” group, sugary products and drinks, and starchy food

 

The definition may sound a bit technical. Citing specific examples of ultra-processed food may help recognize them and these are some:

  • carbonated drinks, sweet and savory packaged snacks, and confectionary, mass-produced breads.
  • margarines and spreads, cookies, biscuits, cakes and pastries, breakfast cereals and energy bars.
  • some infant formulas, powdered and fortified meals, and meal substitutes.
  • ready-to-eat food such as pies, pizza, chicken and fish nuggets, sausages, burgers, hotdogs, and other reconstituted meat products, powdered and packaged instant soups, noodles and desserts.

 

Researchers found that those who consume a diet rich in ultra-processed food were getting a large amount of added preservatives, as well as an oversupply of sugar. So much so that sugar made up more than 20% of the total calories provided by the ultra-processed food, which was 10% more than the recommended sugar intake in the USDA dietary guidelines.

 

The Food and Nutrition Research Institute (FNRI) of the Philippines in its survey discovered that majority of Filipino households had the following products in their kitchen: rice, coconut oil, salt, egg, garlic, chicken, 3-in-1 instant coffee, soy sauce, monosodium glutamate (MSG), sugar (both brown and white), tomatoes, eggplants, powdered milk, vinegar, bread, carrots, and instant food mixes (like sinigang and coconut powder). If we take into consideration the definitions mentioned above, more than half of the items in this list would fall under the category of ultra-processed food. This suggests that Filipinos consume processed food almost every day, which have made them a household staple.  

            Because of the busy and fast-paced lives Filipinos have nowadays, quick and easy to prepare meals and instant food plans can sometimes be the only options. This is the reason why canned goods and ultra-processed meats like bacon, sausages, ham and easy-open food packs have now fallen at the top of most Filipino grocery. In a demographic survey conducted by Nielsen in 2014, they discovered that 25% of consumers eat out at fast food restaurants at least once a week (14% increase from 2013) with most of them turning to convenience stores that offer prepared meals and ready-to-eat meal options.  

Dining out in good traditional restaurants may be a healthier option for some especially when the ingredients used are fresh, organic or are minimally processed, and the manner of which the food was prepared is actually healthy. When eating in fast food joints though, food preparation and sources are never guaranteed and will most likely be rich in saturated fat (such as burgers, fries and fried chicken) or filled with additives and preservatives that make them taste like minimally processed food. Sadly, Filipinos aren’t the only ones turning to fast food, quick meals and instant food sources. Studies show that consumption of ultra-processed food has now become a trend in many diets all over the world.

 

Ultra-Processed Food, Illness and Cancer  

A comprehensive research by the BMJ analyzed the diet of 105,000 middle-aged individuals in the NutriNet-Sante Cohort Study. It has been found that a mere 10% increase in the proportion of ultra-processed foods in the diet was associated with a significant increase of 12% in the risk of overall cancer. With this large group studied within a span of a few years, there was noted increased risk in breast cancer in postmenopausal women, prostate cancer in men less than 40 years of age, and colorectal cancer in both men and women. These risks were associated with the following important factors:

 

  • Ultra-processed foods often have a higher content of total fat, saturated fat, added sugar, and salt. It also contains less fiber and vitamins. This is especially true in heat-treated processed foods, which contain chemicals (like acrylamide) that have been found to possess carcinogenic properties.  According to the US National Cancer Institute, major sources of acrylamide are cigarette smoke and food, specifically potato chips, crackers, cookies, breakfast cereals, and other preserved juices, all of which are ultra-processed. In some studies, they discovered that acrylamide exposure increased the risk of several types of cancer when converted into a compound because of its capacity to damage and cause mutations in one’s DNA.
  • The packaging of ultra-processed food may contain harmful materials that can be passed on to the food itself and ingested by the consumer later on. Bisphenol A or BPA is found in the plastic wrapper of processed food and in inner coatings of cans and jars.  This material has been shown to disrupt normal functioning of the endocrine system and cause problems such as infertility, precocious puberty, and metabolic disorders like Polycystic Ovarian Syndrome (PCOS). Because ultra-processed food affects endocrine and hormone function, ingestion of it has been associated with breast and prostate malignancies, according to the National Institute of Health.
  • Ultra-processed food contains additives such as sodium nitrite in processed meat or titanium dioxide, both of which are known to have carcinogenic effects.   A study by the Cancer Research Center of Hawaii and the University of Southern California followed up the diet of 200,000 people between the ages of 45 and 75 for a period of seven years. They were observed to have high levels of sodium nitrite in their diet because of the high consumption rate of processed meats. Furthermore, they were noted to have a 67% higher risk of cancer, specifically pancreatic cancer than those who consumed minimally processed meats.

 

With the three factors mentioned, significant increase in overall cancer risk was observed. Needless to say, there are other illnesses that can actually arise when large quantities of processed food are found in the diet. Aside from malignancies, ultra-processed food intake was also associated with a higher incidence of dyslipidemia, obesity, and hypertension. This was mainly because of the high salt, sugar, fat, and the low fiber and micronutrient content found in processed food.

 

High sodium diets are associated with increased risk of gastric illness which can eventually lead to stomach cancer. With these ultra-processed types of food, large amounts are often required in order to feel satisfied or full because most of them lack water or fiber that leads to early satiety. This is why more calories are consumed in the diet, leading to weight gain, obesity, and cardiovascular problems. Sugar also immediately shoots up a few minutes after consumption, increasing the risk of high blood sugar or diabetes.

 

Healthy Lifestyle Choices  

According to the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research, about a third of the most common malignancies can be avoided by simply changing lifestyle and dietary habits. Incidentally, in the same study mentioned earlier, consumption of minimally or unprocessed foods was associated with lower risks of overall cancer. Eating healthy, exercising regularly, and avoiding alcohol and tobacco are just some of the lifestyle changes often recommended.

 

For those who love meat, who simply cannot do away with red meat or processed meats, the FDA recommends limiting the amount found in the diet. They recommend eating no more than 16 ounces of cooked red and/or processed meat per week, which is roughly the size of a deck of cards weekly. Consumption of processed meats is associated with the high risk of developing colorectal cancer. The WCRF suggests these simple ways in order to reduce processed meat consumption:

  • Incorporate fish and poultry into your weekly diet
  • Color your plate by consuming more bright-colored fruits and vegetables.
  • Include protein-rich dairies such as eggs and cheese

 

Tips to Avoid Processed Food  

To avoid ultra-processed food, it is important to first know what or which ones they are. With the definition and examples mentioned earlier, it would be much easier to identify which foods are processed and which are not. The following are simple, yet helpful tips that will surely help decrease processed food consumption, and ultimately decrease risk for illness and cancer.

  • Be a label reader. Read the ingredients and know which substances or chemicals should be avoided. High fructose corn syrup, modified starch, xanthan gum and dextrose are just some of the common ones to look out for.
  • Identify and avoid additives and preservatives like sodium nitrite.
  • Avoid food that contains too many ingredients. The simpler they are, the better and healthier.
  • Eat homemade snacks. This guarantees that the type of ingredients and cooking technique used contains no preservatives and is more on the healthier side.
  • Prepare meals in advance and make a weekly meal plan. This makes it easier to prepare something healthy and allows time to look for organic or healthier sources of produce. Meal planning helps avoid running out to get fast food or heating up something that’s ready-to-eat or straight out of a can.
  • Go local and organic. Getting fresh and organic produce doesn’t have to be expensive. Local produce providers are everywhere and are always available in weekend gourmet and organic markets.
  • Choose whole grains.
  • Buy bread from a bakery instead of the grocery.
  • Eat more whole foods like fruits and vegetables and eat them every day.

 

Although easier said than done, all it really takes is a conscious decision to eat healthy and live a healthy life even before showing any signs of illness. Avoid smoking or drinking too much alcohol. Make small dietary changes. Choose healthier options like eating chicken instead of steak or snack on an apple instead of chips.  Beginning is always the hardest part, so making a few lifestyle changes as early as now is always a good start.

 

 

References:

  • Touvier M, Julia C, Lavalette C, Hercberg S, Beslay M, Latino-Martel P, Fassier P, Deschasaux M, Mejean C, Alles B, Kesse-Guyot Em Sellem L, Srour B, Fiolet T. Consumption of Ultra-processed Foods and Cancer Risk: Results from NutriNet-Santé Prospective Cohort. British Medical Journal. 2018, 360 doi: https://doi.org/10.1136/bmj.k322
  • Fardet A, Rock E, Bassama J, Bohuon P, Prabhansankar P, Monteiro C, Moubarac JC, Achir N. Current Food Classifications in Epidemiological Studies do not Enable Solid Nutritional Recommendations for Preventing Diet-related Chronic Diseases: The Impact of Food Processing. Advances in Nutrition. 2015; 6(6):629-638. doi: 0.3945/an.115.008789
  •  Ludwig DS, MD, PhD. Technology, Diet and the Burden of Chronic Disease. JAMA. 2011; 305(13):1352-1353. doi:10.1001/jama.2011.380
  • Filipinos Flock to Fastfood Restaurants and Convenience Stores to Get Their Meals. Nielsen. 19 December 2014. http://www.nielsen.com/ph/en/insights/news/2014/filipinos-flock-to-fastfood-convenience-stores-to-get-meals.html. Accessed April 2018.
  • Konieczna A, Rutwoska A, Rachon D. Health Risk of Exposure to Bisphenol A (BPA). Rocz Panstw Zaki Hig. 2015; 66(1):5-11. PMID: 25813067.
  • The Link between Sodium Nitrates and Cancer. 13 May 2013. Retrieved from Cancer Treatment Centers of America website. https://www.cancercenter.com/discussions/blog/the-link-between-sodium-nitrites-and-cancer/ in April 2018.
  • Acrylamide and Cancer Risk. 5 December 2017. Retrieved from National Cancer Institute.https://www.cancer.gov/about-cancer/causes-prevention/risk/diet/acrylamide-fact-sheet in April 2018.

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