Feel Better, Live More with Dr Rangan Chatterjee - Why You Can’t Stop Eating Ultra-Processed Foods: Dr Chris Van Tulleken #414

Episode Date: January 3, 2024

Why do we all eat stuff that isn’t food and why can’t we stop? In this episode, Dr Chris van Tulleken, author of Ultra-Processed People explains all. As well as being one of the UK’s leading science broadcasters, Chris is a practising infectious diseases doctor in the NHS. He gained his medical degree at Oxford University and his PhD in molecular virology from University College London, where he is an associate professor. He works closely with the World Health Organization and UNICEF, and his research looks at how corporations affect human health.   In this episode, Chris explores what may be the biggest public health crisis of our time: ultra-processed food, or UPF, for short. Many people these days, certainly most regular listeners to this podcast, will be aware of UPFs. But there’s still a lot of confusion around what they really are. For Chris, it’s simple: if it’s wrapped in plastic and has at least one ingredient you wouldn’t find in a home kitchen, it’s a UPF. If it makes a health claim on the packet? Ironically, it’s even more likely!   A UPF is any food that’s processed industrially and created for big-business profit, rather than to provide nutrients. And here in the UK, UPF makes up 60 percent of the average diet. The trouble is, says Chris, UPFs have been shown to be the leading cause of early death in the world, ahead of tobacco. Even if you remain at what is considered a healthy weight, consuming UPFs still leaves you vulnerable to things like Type 2 Diabetes, heart disease, dementia, anxiety, depression, inflammatory bowel disease, cancer and eating disorders.   In this conversation, Chris provides a clear definition of the difference between processing and ultra-processing, and explains how our toxic food environment is designed to be addictive. We also discuss a whole range of different topics such as the need to see obesity as a condition and not an identity and the seemingly revolutionary idea that re-prioritising food shopping and cooking as a vital, enjoyable part of our day, could be a first step towards the societal change that’s urgently needed.   This podcast episode is not about shame or blame - it’s about education and empowerment. Chris is a brilliant communicator who insists the prevalence and appeal of UPFs is not our fault. I thoroughly enjoyed my conversation with him - I hope you enjoy listening. Support the podcast and enjoy Ad-Free episodes. Try FREE for 7 days on Apple Podcasts https://apple.co/feelbetterlivemore. For other podcast platforms go to https://fblm.supercast.com. Find out more about my NEW Journal here https://drchatterjee.com/journal Thanks to our sponsors: https://zoe.com https://calm.com/livemore https://drinkag1.com/livemore Show notes https://drchatterjee.com/414 DISCLAIMER: The content in the podcast and on this webpage is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified healthcare provider. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

Ultra-processed food is now the leading cause of early death on planet Earth, ahead of tobacco. We have really good data that they drive a huge number of what we kind of euphemistically call negative health outcomes, which is everything from cardiovascular disease to metabolic disease to early death. There is a huge difference between processing, which is ancient and we have to process our food, and ultra-processing, which is new. It's exclusively industrial. And it is about making products that are convenient, easily marketed, addictive, and very, very profitable. Hey guys, how you doing? Hope you're having a good week so far.

My name is Dr. Rangan Chatterjee, and this is my podcast, Feel Better, Live More. Why do we all eat stuff that isn't food? And why can't we stop? That's the subtitle of the book, Ultra Processed People. And the author is this week's guest, Dr. Chris Van Tulleken. As well as being one of the UK's leading science broadcasters, Chris is a practicing infectious diseases doctor in the NHS. He gained his medical degree from Oxford University and his PhD in molecular virology from the University College London, where he is an associate professor. He works closely with the World Health Organization and UNICEF, and his research looks at how corporations affect human health. In Ultra

Processed People, Chris investigates what may be the biggest public health crisis of our time, ultra processed food, or UPF for short. Many people these days, certainly most regular listeners to this podcast, will be aware of UPFs, but there's still a lot of confusion around what they really are. For Chris, it's simple. If it's wrapped in plastic and has at least one ingredient, you wouldn't find in a home kitchen, it's a UPF. If it makes a health claim on the packet, ironically, it's even more likely. A UPF is any food that's processed industrially and created for big business profit,

rather than to provide nutrients. And here in the UK, UPF makes up 60% of the average diet. The trouble is, says Chris, UPFs have been shown to be the leading cause of early death in the world ahead of tobacco. And even if you remain at what is considered a healthy weight, consuming UPFs still leaves you vulnerable to things like type 2 diabetes, heart disease, dementia, anxiety, depression, inflammatory bowel disease, cancer, and eating disorders. In our conversation, Chris provides a clear definition of the difference

between processing and ultra-processing, and explains how our toxic food environment is designed to be addictive. We also discuss a whole range of different topics, such as the need to see obesity as a condition and not an identity, and the seemingly revolutionary idea that reprioritising food shopping and cooking as a vital, enjoyable part of our day could be a first step towards the societal change that's urgently needed. This podcast episode is not about shame or blame. It's about education and empowerment. Chris is a brilliant communicator who insists that the prevalence and appeal of UPFs is not our fault. I thoroughly enjoyed my conversation with him. I hope you enjoy listening.

I wanted to start off by asking you to lay it out. start off by asking you to lay it out. Why should anyone who's stumbled across this podcast or video care about ultra processed foods and how much they're consuming? Because they are most of what we eat and because we have really good data that they drive a huge number of what we kind of euphemistically call negative health outcomes, which is everything from cardiovascular disease to metabolic disease to early death. So we're pretty sure that ultra-precious food is now the leading cause of early death on planet Earth, ahead of tobacco. Now, when I say pretty sure, according to some data sets in some places, tobacco might still be slightly ahead. In the UK, tobacco might be ahead. But it's really

the leading cause of diet-related disease. And it's the leading cause of environmental destruction, loss of biodiversity, plastic pollution, and the second leading cause of carbon emissions. So you have to care about it. And it's just a way of describing the industrial food that makes up what we eat. I think when a lot of people think about their diet and the foods that they're consuming, they think about it through the lens of weight. So, you know, yeah, Chris, you're talking about ultra processed food, but I'm fine. My weight's completely normal. And one of the really interesting things that you elaborate on in your book is this idea that ultra-processed food consumption is harmful to us or has the potential to be harmful to us,

irrespective of its impact on our weight. So we've got, let's say there are probably over 2000 peer reviewed publications that we could use to bring evidence to this question of, are we sure that ultra-precious food harms us? And that it isn't just food eaten by people who are disadvantaged in other ways. Among those 2000 papers are 70 prospective clinical studies. So these are the kind of studies that we use to prove that tobacco causes lung cancer. And among all that data, the most studied effect is weight gain. But most of the studies on other health outcomes like cardiometabolic disease, dementia, anxiety, depression, inflammatory bowel disease, cancers, early death, they adjust for weight gain. In other words, even if you are at what we probably shouldn't call a healthy weight, but let's say that is the

term we use, even if you live at a healthy weight, if you, like most people in Britain, eat an average of 60% of your calories from ultra-processed food, you're still vulnerable to all those harms. And the other thing about that is that the new weight loss drugs, if you continue eating an ultra-processed diet whilst you take semaglutide, for example, or Bagovi, you might not gain weight, but you'll still be exposed to all the other harms of the food. So this is food that's driving disease in a whole number of different ways. When was it that you thought, this is an issue, I need to explore this a little bit deeper? So in 2014, I made a horizon with my brother, and it was about fat versus sugar. Because we'd had in the 1980s, fat became the

demon molecule. We stripped all the fat out of yogurts and industrially processed food and replaced it with modified cornstarch and gums. And then in 2000, Gary Taubes wrote this piece in the New York Times saying that, no, sugar, we got it wrong. And all the sugar that we've used to replace the fat, that's the problem. And so in 2014, this sort of debate was raging. And Zand and I did this thing where I ate a very high fat diet and he ate a very high sugar diet. And we tried to figure out the difference. And we went and visited a guy called Paul Kenny in New York, who was studying rats. And he had figured out that if you feed rats cheesecake, which is a 50-50 mix of fat and sugar, the rats put on lots of weight. And so where we kind of resolved that

program was, it seems to be mixtures of fat and sugar that are driving excess consumption. And there was a famous donut at the time, the glazed ring from, I can't remember if it was Dunkin' Donuts or Krispy Kreme, one of the big donuts, had this perfect mix of fat versus sugar. And so we almost got there in 2014 going, as sugar. And so we almost got there in 2014 going, oh, it's combining fat and sugar together that makes them delicious. And that's what drives excess consumption. And then I kind of ignored it. And then someone showed me these two papers. In fact, it was a television producer showed me these two papers. We were doing a big series on child obesity. And one was from the team in Brazil

that developed the definition of ultra processed food in 2009. And the other was a clinical trial by a skeptic, Kevin Hall from the NIH in the States. And reading those papers, I was like, oh, this explains all of the missing links about the way we understand diet and nutrition. And now we've got this mountain of evidence that UPF is the problem. Yeah. I definitely want us to get to the definition of what UPF is. At some point, we should cover that. You could probably do a three-hour podcast alone just on the nuances of that definition. I know you've got a really simple one, which is very, very practical and very useful. Before we get to that though, Chris, I really want to pause on this point about ultra processed

foods and the relationship between us consuming them and other health problems beyond our weight. Because I really want people to understand that, that it's not just about your weights because I do see a lot of people, whether it was patients or the public or friends, frankly, who will have large volumes of ultra processed food, no blame or no judgment at all because it's what you're surrounded by, right?

And we'll, of course, we're going to talk about that. But they think it's okay because they're of normal weights. They're like, yeah, but it's fine. You know, I'm naturally slim they think it's okay because they're of normal weight. They're like, yeah, but it's fine. I'm naturally slim, so it's not a problem. But you have powerfully, there's a section near the introduction, I think, where you show early death, cancer, inflammatory bowel disease, heart attacks, strokes, metabolic problems, mental health, dementia, all of these conditions are linked with that

consumption. I think in the book, you outlined some research showing that there's a dose-dependent relationship between UPFs that we eat and our risk of getting cancer. What's going on? Well, when you do the big population studies, one of the things you have to ask, you have to meet these criteria to say, are we sure that people who eat ultra-processed food don't just drink loads and smoke loads? Because that's always a risk. And this was the problem with all the smoking data.

So there are this set of criteria where you say, is there a dose-dependent relationship? The more you eat, the worse the effects get. Yes, there is. Is this biologically plausible? Well, yeah, we actually have loads and loads of evidence about all the different ways that ultra processed foods and their additives and their processing methods might be driving this. So, um, and then we look, is it prospective? Does it, does, are we sure that the effect happens after the cause? And yeah, we are, cause we follow people over time. Um, and so we've, we've,

and do we have other experimental evidence? So these are the criteria we use to go, yeah, we are because we follow people over time. And so we've, and do we have other experimental evidence? So these are the criteria we use to go, yeah, no, we're sure this isn't just an association. This is causation and we've met that threshold now. And in fact, we've met it for all those other health problems before we've met it for obesity. You know, obesity is not arguably, I'm an author on a big series we're publishing with The Lancet

on ultra-processed food, and we'll publish it early next year. And I've always said obesity is the most well-evidenced outcome. In fact, probably cardiometabolic disease has even more evidence controlled for obesity. You're very careful in the book with your language around obesity. That was the lawyers. That was the lawyers. That was the lawyers. When I say language,

I mean more living with obesity rather than an obese person. And I was really pleased to see that because I think it is such an important distinction, isn't it? You've led a lot of the charge on this. And I think you and I would agree, I suspect that probably the main harm

that comes to people who live with excess weight is not actually from the excess weight on their bodies. It's from bad treatment by our profession. And we have lots of data that doctors don't like seeing patients who live with excess weight. We treat them badly. They get fewer investigations. They get less time and less treatment

than patients who live at a normal way and so when we we've seen this move we don't talk about epileptics or cancerous people we don't even say diabetics anymore so much you know we've moved to people who live with problems you live with HIV you live with diabetes so it's it's not an identity it's a thing that it's up to the patient to pick up or put down when they want. And I think that is, if the book does only one thing, it's try to reduce the stigma around diet-related disease, but especially obesity. You know, we treat people who live with excess weight terribly. Willpower is something that is often spoken about in relation to our well-being,

in relation to people's weight. And of course, you tackle that. What's your current view on willpower and its relationship with obesity? So I spend a whole chapter on willpower, because it feels so important to demolish it. And even now, I get a lot of people who live at excess weight, writing to me and going, I like the book or whatever, but I think you're wrong about this one thing. It is my fault. I am choosing to eat these foods. And there's a whole bunch of different ways we can tackle that problem. When we look at populations as a whole, weight gain started, if we look at the States, starts in the mid-1970s. And it didn't just start in one group. It's black, white, Hispanic, men and women of all ages start

gaining weight at the same time in 1975 as the food environment changes. And so the food we eat, we think we're making a choice, but we're making a choice, you know, about as much as we are when we decide to drink something. You know, for many people in this country, the only food that is affordable or available to them is ultra processed food. Every petrol station forecourt, every train station, this is our food culture. Yeah. I mean, when I think about this, and I, like you, have spent a long time thinking about these ideas and writing about them, I think it's, it's kind of ridiculous on one

level to think that we just happen to be the laziest generation of humans ever to have been born. Right. I mean, people have been, every generation has said that since records began, haven't they? Yeah. Because every generation before us, you can be damn sure if they lived in the modern Western or global, frankly, food environment, a huge proportion would also end up carrying extra body fat. I think one of the problems, Chris, and maybe you've faced this since the book came out, that there are people who have struggled, right? They've struggled in the food environment and they've ended up, let's say, putting on large

volumes of weight. And maybe for whatever reason, they reached a crunch point in their life, of weight. And maybe for whatever reason, they reached a crunch point in their life, whether it was a book or a podcast or a friend died or something happened. And they then did exert willpower over their food environment and they managed to lose weight, get their energy, get their vitality back. And so... How do I explain them? Because the best example of that is my identical twin brother who has all my genetic risk factors for weight gain. We both, we've been studied and we have all these different polymorphisms, these little genetic changes that put us at risk of weight gain.

He had a son in an unplanned way, who's my very dear nephew and is very much a part of the family, but it was stressful at the time. He moved to America. He lived above the burger bar. And in a year he put on almost 30 kilos. And Zahnd then, a decade, a decade of me nagging him later, I finally stopped nagging him and he lost that weight. He married a public health academic. Now, did Zahnd exert willpower. Well, I think all kinds of different things happen and it's his

story to tell, but the people who do manage to go on that journey are often advantaged by education, privilege, money, something changes in their lives. It's not the raw exertion of will. And when it comes to a population, so individuals, I think, I mean, I send people to your, my patients, all of us want short-term help. I send people to your podcast. I send people to all kinds of resources going, it can be done. I don't feel it's my role to inspire anyone to do that. My interest is in the population as a whole. There's no way, as in terms of the UK population, we have some of the highest rates of obesity of any group of kids, particularly in the world. You can't inspire the whole population in the current food environment. So I think there's a question between what individuals need to do, and there are many, many resources,

and some people will have just enough resources in their lives to sort of get over that point and recover, and very good luck to them, versus we just need to change the food environment for everyone. So that that's, I mean, I'm very conscious, Rangan, that when I speak, look at the big voices in UK food, all essentially privileged white men of a particular age, you know, I don't think the world needs more people like me, telling them what to do. My feeling is we need to change the environment and I'm happy to give people information and I wish them very good luck doing what they want to do. Yeah, that's one of the things I really appreciate about the tone throughout your book is

you're not telling anyone what to do. You actually explicitly say what I often have said about my patients, which is it's not my job to tell anybody else what they should or could be doing with their life. Because I don't think anyone responds well to being told what to do by any other human being. I'm the same. I think that's completely right. And it's particularly true when you have people of one demographic talking to people of another demographic, especially when there's a sort of privilege gap. But your language around this, and I think

you've been doing this so instinctively for such a long time, just to slightly blow some smoke here. But in every one of your tweets, there was a message you sent out the other day, and you kind of concluded going, you know, don't, this is not me telling you to do this, just do this if you want to. I'm not telling them what to do, because if you treat them like a partner or an adult, I think actually it lands better. They may not be ready for it right then, but I think they reflect on it. They think about things, you know. So I went to see a behavioural change expert, and I sort of wanted this person he was called Alistair Cantor I mean he was a remarkable guy and he he said um I said look can

you change Zahn and he said no I don't need to speak to Zahn I need to speak to you and he explained this thing to me that for Zahn to lose weight would be to lose a 10-year argument with me that I had been nagging him so much. And it was only when I stopped really kind of abusing him about this that he did all the things that he would talk about, you know. But it was, nagging people isn't just not beneficial. I think it really holds people back. And I think there is a tendency among lots of media doctors to kind of nag people en masse. And I don't think it works very well. I think one of the most powerful times in my life, which really changed the way I see health,

was the seven years I spent working in Oldham in North Manchester. I worked in a very deprived area. It would be an area that would be definitely put into the low socioeconomic status category. Huge numbers of immigrants, a lot of single parent families, a lot of parents working two jobs, a lot of poverty. And when I started working there, maybe 2011, 2012, something like that, maybe a bit earlier, I was starting to get into changing my diet quite significantly. I was reading things, I was thinking, oh, you know, how much is this impacting the way that I feel? And I used to, at the time, you know, I was single, I didn't have children, I had a lot more time on my hands

than I might do now. I would generally take my lunch with me because I was single. I didn't have children. I had a lot more time on my hands than I might do now. I would generally take my lunch with me because I was trying to eat well. And I still remember one day I forgot to bring my lunch with me. I thought, all right, I'll just go and buy something. No word of the lie. I can remember the walk from that surgery.

It was maybe about a 10, 50 minute walk to the Sainsbury's, to this big Sainsbury's. I would have passed seven to 10 fast food joints. And I can still remember the signs in the window where it would be like £1.50, eat as much as you can, feed your family with a family bucket for £2.20, whatever it was. That was one of the most powerful and eye-opening walks I had ever done as a doctor, because I thought, wow, I'm spending as much time as I can with these guys, trying to educate them on better choices. But they're walking out into this food environment where,

unless they have the means, the time, the strongest will in the world and no other problems to contend with in life, they're not going to be able to do it. And that was a really eye-opening experience for me. I mean, you look at people, you know, we know people living in this country, a million families without a stovetop cooker or a fridge. Now, you can't make real food without those items. You know, if you and I cook a meal, we sort of generally take it for granted that we bought a knife on some previous occasion. We own a cutting board, we own a countertop. And if we cook a big batch, we can

stick it in a freezer in a piece of Tupperware. You have to buy all that. And then there's the time to prepare it. And meanwhile, the kids we're cooking for on their bus tickets, the discounts for fast food restaurants on their Spotify, on their YouTube, on their games, on their walks, exactly as you say. So they're sort of surrounded by this marketing effort. And the marketing budget of any one of the 15 or 20 companies that feed us, the annual marketing budget of one of them is more than double the entire World Health Organization annual budget. So, you know, you're there doing, you know, doing your, essentially you're doing counter-marketing. You're trying to flog stuff that people can't afford, don't know how to prepare,

don't have the equipment to prepare, whilst against you is a team of geniuses who spend 24 hours a day, you know, selling this stuff that is addictive and affordable. Yeah. What would you say to someone, Chris, who's listening and going, okay, Chris, I'm hearing what you're saying. The environment influences our behavior. It's harder for some people, but of course it is possible because I did it. I grew up in that environment. My brother struggled with obesity, but I managed to exert my force over it. Everyone else should be able to. What would you say to that person?

Well, I'd say, you know, good for you. I don't know your specific story. I don't accept that anyone should be a different weight. So I don't, I wouldn't say this person is more worthy of love or good treatment because they managed to lose weight. I don't feel that weight loss is a thing to be celebrated. You know, it's a thing that person did. And if they did it for them, that's great. I don't, I don't feel the need to, I don't feel the need to engage with it very much. It's like if you achieve anything in your life and you're happy with it, then that's great. But it's not, that's not, it's not of great interest to me, I suppose. I, I know that, you know, many of our, you know, patients have lost their own body weight many times over. They've got incredible willpower and they're surrounded by this addictive stuff. We also

know that the vulnerability to food is very, very genetic and thin people who live at healthy weight, thin people have an entirely different set of behavioral genetics when it comes to food than people who live with excess weight, you know, and they, and you cannot understand what it's like to be inside the head of a food motivated person if you're not that person any more than you can understand what it's like to be in the mind of someone who's addicted to a drug of abuse if you don't find them tempting.

I mean, I've tried cigarettes. I've tried alcohol on television. I've tried other addictive drugs of abuse. Just for disclosure there, it was all done in a legal setting. I've never got addicted to any of them. I've tried heroin after an operation when I was at medical school.

You're given diamorphine, it's heroin. I didn't become addicted. So addictive substances are very, very contextually dependent. And if one person manages to throw off their addiction, well, good for you. But that shouldn't mean we then go and tell everyone else that they can do exactly the same. Does that seem reasonable? I think it sounds very reasonable. And I think, I mean, let's look at what you just said through the lens of the so-called diet wars on social media, which have existed for many years now. What is the best diet for any human to eat for optimal health? And there's a lot of different candidates. And what I see commonly happen is a person has struggled with their health and or weight for a period of time. Nothing has worked.

It's impacted the quality of their life. They then come across a particular way of eating, whether it is paleo or vegan or low carb or carnivore, whatever it might be, they come across something that works for them. Yeah. So because it's worked for them, which is amazing that that individual has found something that works for them, what I think then happens, and I think this is a human tendency, this is like our bias as humans unless we're aware of it, is that, oh, I found the solution now. Everybody, if they found my solution, they would also... We want to help other people. It's often quite a generous place.

I get it, totally. And I've probably fallen into that trap in the past myself, so I totally get it. I think what insulates me from it somewhat is because over the course of my career, having seen tens of thousands of patients, you actually end up going, if you're open-minded, oh, wow, people can thrive on all kinds of different diets. That person crushed it on a vegan whole food diet. That person crushed it on the paleo diet that they started last year. And so by being exposed to that many people, you go, wow, well, it's not necessarily the diet, or it could be for that individual. But I think what is powerful about putting a lot of this on ultra-processed foods is I think it cuts through so many of the diet wars,

because actually most of the diets people are going on to improve their health and well-being, of the diets people are going on to improve their health and well-being, whether it's low-carb or carnivore or paleo or whole food plant-based, generally speaking, the ones who are thriving are reducing the amount of ultra-processed foods they're having. I mean, the data entirely support what you're saying in the sense that every traditional human diet we've ever studied, whether it's fish diets in East Asia, vegan diets in South Asia, human diet we've ever studied, whether it's fish diets in East Asia, vegan diets in South Asia, sea mammal, high fat diets in the high Arctic, the French diet of red wine and cheese, the Mediterranean diet, you can go on and on, all these different diets, all of them are associated with good health, robustly. They're all extremely different in terms of nutrient composition and

everything else. The only diet we've ever studied that's associated with disease is an ultra-processed Western industrial diet. So we, you know, we, there are all kinds of, I mean, we're going to come to the definition, but you know, there's this very long 11 paragraph formal definition on the United Nations Food and Agriculture website, but we can sum it up by going, it's like food made by companies to generate growth for pension funds. That's a good working definition. High fat, salt, sugar is sort of a, it's, it's sweet. If you use the definition as we, as we do in law in the UK, it sweeps up about 85% of the problem products. We could say anything with a health claim, almost all of those low fat prebiotic, um, supports your immune system, has 30% less sugar, all of that is ultra-processed, or most of it. So how we define the harmful food, we're talking about American food. We're talking

about if your food is made in a big factory owned by a transnational food corporation, there is a good chance that it will cause you harm. Ultra-processed, There's two words there. Okay, let's put the ultra to the side for a minute and just deal with processed. Right. Which is very important. Yeah, good.

So let's maybe walk us through that. What is the difference between, you know, an apple, right? We've got an apple and compare that to, I don't know. How do we ultra-process that? Yeah. apple and compare that to i don't know how do we ultra process that yeah the mental wellness app calm are also sponsoring today's show now do you ever feel like your brain is on overdrive and your mind is constantly racing the plans worries and to-do lists can often feel never-ending. Well, Calm can help your mind take a break from the noise by softening anxiety symptoms in the moment

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You shouldn't because you'll get brucellosis, but you can do it. You can eat apples, oysters. I mean, we can come up with a short list. You can pull certain stuff off a tree or a bush and just eat it. Fish, you can eat raw and unprocessed. But for more than a million years, humans and hominids have been processing our food. So we started cooking probably more than one and a half million years ago. We have good evidence for cooking 400,000 years ago. And the signatures of food processing are written into our genes and our anatomy and our physiology. So we've got all these genes for starch digestion. You know,

that's because we've been processing and milling our flour for ages and ages. We've got genes for alcohol metabolism. If your ancestors are from parts of the world where there was a culture of fermentation. And we think that you can't really live on a whole food diet. You know, people have tried that and they get very ill. So processing is very normal. It's very ancient, canning, smoking, tinning, preserving, fermenting, salting, curing,

you know, grinding, milling, extruding. It's all, all of that has been done for a very long time. Is heating, do you- Heating, cooking. That's processing? Yeah, cooking is processing, yeah. Everything you do to a food before you eat it

is processing based. If you chop it up, that's mechanical processing. You put it through a meat grinder, that's mechanical processing. But that's not, doing this is not a problem. None of that seems to be a problem.

Now, you could come up with some certain specific examples that you probably wouldn't want to eat loads and loads of smoked food. But broadly, all of those techniques, they're ancient. We've been doing them for ages. And they form part of dietary patterns that are very broadly healthy. So there is a huge difference between processing, which is ancient and we have to process our food, and ultra processing, which is new.

It's exclusively industrial. And it is about making products that are convenient, easily marketed, addictive, and very, very profitable. And so there is some social theory in the definition of ultra-processed food that it, the shorthand is does the food have on its list of ingredients something you don't find in a domestic kitchen, like a synthetic emulsifier, xanthan gum, a non-nutritive sweetener. These are industrial ingredients, wheat gluten, you know, all these things. But the longer definition has baked into it an idea that this is stuff that is made for profit, it's marketed, and it's addictive. And it was an attempt, this wasn't done arbitrarily, it was an attempt by some scientists in Brazil who'd watched this terrible transition from where obesity was

basically unheard of to where obesity and metabolic disease were the dominant public health problems. And they wanted to describe the foods that seemed to be driving this because they were very diverse. It was biscuits and instant noodles and ice cream and confectionery and packaged goods, industrial bread, all this had come in. And so the definition was to describe this new category of food. You mentioned addiction there or addictive qualities. That has been contentious in, I guess, the scientific world for many years. Can a food truly be addictive? I definitely want to talk about that. But this idea of processing,

and at what point this becomes ultra-processed. Where is that boundary? And I know it's very hard to say for sure. One of the things I found fascinating in the book was this idea that you could have a food and you could have the minimally processed version and the ultra processed version. And on the ingredient label, it could actually look very similar. Fat, sugar, salt, whatever. It can almost be matched. But the fact that it was ultra processed in and of itself was thought to be causing problems in a way that the minimally processed version wasn't? Could you maybe just talk us

through that? So one of the crucial things is you can't... So you want to do an example. Let's take an apple. So that's a whole food. Now we can process it in all kinds of different ways. We can cook it and turn it into apple sauce. We can chop it up into bits. We can blend it. We can squash the juice out of it. We can do all kinds of different things. And all of those products will be more or less healthy. Now, ultra-processing it is when we break it down into its component parts

and we put that apple into a product for making money out of. So the purpose of ultra-processed food is to generate money. So if we think of an apple pie that's been frozen and it contains stabilizers to retain the water in the pie, it might contain apple flavorings because we've used very cheap out-of-season apples. It might contain emulsifiers to glue the whole thing together and lots of other ingredients that may or may not be harmful. They're a sign that now those apples have been turned into a product that has to make money for its parent company. So you can make an apple pie at home with sugar, apples,

you know, flour and butter. You know, you don't need a long list of ingredients. The apple pie you buy in the shop might be quite similar in terms of the list of ingredients, but it will have been designed with a very different intention. And one of the things that's very clear when I, you know, I spoke to a huge number of people in the food industry when I was writing the book, was to understand the design process.

When you make ultra-processed food, how is it working? And there are two ways of thinking about this. First is to imagine yourself as a farmer. If you sell cobs of corn, okay, or soybeans, the market is tiny. Yeah. How often do you eat a cob of corn with butter and salt on it? I mean, you might, in a very diet, you might eat it once a fortnight, maybe once a month. You might never be that into it. If you eat soybeans, you eat edamame soybeans that you grow them in the early season. But again, it's not a big market. If you can turn your soy into soy protein isolate, soy starch, soy oil, if you can turn your corn into high fructose corn syrup, modified corn starch, corn oil, if you can turn your corn into high-fructose corn syrup, modified cornstarch, corn oil, and corn protein isolate, now you have these commodity ingredients that you can add to anything. And so on almost all ultra-processed food, if you look, the first ingredients are

one of four different crops, soy, rice, wheat, corn. There may be some dairy fat there. There might be one of three meats. But but basically our food is made of eight different things. And those things are broken down and turned into pastes and powders with nearly infinite shelf life that you can then reassemble into proprietary products to make money out of. So the logic, if you think the food supply system exists to make food for you, you've entirely misunderstood what's going on. The food supply system exists to extract food for you. You've entirely misunderstood what's going on. The food supply system exists to extract money from you, to supply money from you to intermediate food processes and ingredients companies. That's its function. You're clearly very passionate

about this issue. You can read it throughout the book. I can hear it in your words. Has this been done on purpose? Well, it can sound a bit anti-capitalist. So a lot of my research now is with economists. So I've just published a big paper mainly with economists. So yes, it's intentional in the sense of the purpose of the companies that make our food is not to make food. Indeed, many of them are not food companies. They do lots and lots of things. Food is part of a diversified portfolio of ways of making money. So if we look at Pret, for example, Pret is sort of the coffee arm, if you like, of a thing called JAB Holdings, which is a big family-owned investment holding company. Costa is the coffee arm of Coca-Cola. Starbucks is part owned by Nestle. So we have these sort of very big corporations that do lots and lots of different things. And they all have a coffee arm that sells some food and they all

make other things as well. So understanding the financial incentives isn't about going, there's some massive global conspiracy. It's going, if you don't understand what it's like to be the chief executive of a big food company, you will never ever be able to regulate them or you will never force them to change. So for me, one of the crucial things in the book was an analyst at one of the really big institutional investors called BlackRock. So BlackRock has trillions of pounds and dollars under management. And they own a little piece of lots of different food companies. And there are other big investors like this, Jupiter and Vanguard. And they're where you and I have our pensions. They'll have a bit of NHS pension, they'll have state pensions in the States. If you've got a private pension, it's probably at one of those two providers. So they exist to make

money and they do that by owning a piece of lots of different companies and some of them food companies. Now when the food companies try and make healthier food, so this happened at Danone most famously, the chief exec was a guy called Emmanuel Faber and he said, I don't like making all this unhealthy food. I want to turn Danone into a social enterprise and make really healthy food. The Danone share price went down, essays went up. Activist investors who owned a big chunk of Danone called Bluebell Capital had him removed. Danone realigned its portfolio with Nestle and the share price went back up and everyone was happy. So if you scream and shout at these big food companies, and I do a bit in the book, you're misunderstanding that they are unable to change.

You know, Nestle comes into a lot of criticism, as does Coca-Cola. But there are many good people at these companies who know exactly what they're doing, but they are required by their board and their owners to make money and to make more money every quarter. And this is sort of the way the world works. It's not, you can get angry about it, but that's just the way everything is. Do you see what I mean? It's like, is it a conspiracy? No, it's just right there in the open. That is the stated purpose of publicly limited companies. How is knowing that relevant to... To what do we do? Yeah, or I don't know, a 45-year-old mum of three who's listening right now going, hey, Chris, listen, I just want to make better choices for me and my children, right? How is me knowing Coca-Cola's incentive structure relevant? So you're the first person to ever ask

me that. And I think for that 45-year-old mum of three, it is so important to know that because for several different reasons, like for almost too many reasons for me to get into. The most important thing is we know when it came to tobacco control, we know when it comes to dealing with addictive substances, that turning your shame and your guilt outwards from yourself and having somewhere to focus it and direct it is really important. Understanding that cigarette companies knew they were harming people and were selling addictive products anyway was really important for smokers to get a hold of. And many, many smokers found that helpful to quit.

Also understanding that despite what it says on the can or the packet, despite what it says on the company websites about their support for traditional farming systems and the fact they don't like child labor or they don't want to support child slaves picking cocoa in West Africa. They want to reduce plastic pollution. All these things they say on their website. We can demonstrate that those things aren't true. And so if you are minded to be an activist, and by the way, this hypothetical 45-year-old mom of three will need a lot of resources if they're to stop buying lots of

ultra-processed food because their life will become more expensive. But knowing that they are supporting a system that is causing environmental destruction, carbon emissions, and so on, I think is really important. Yeah, it strikes me that that's step one, isn't it? Because what keeps so many people trapped and stuck in these cycles of yo-yo dieting and whatever it might be, whatever changes they're trying to make with their health of having a bit of success and then falling back and then feeling even worse than how they never tried in the first place because they thought, you know, there's something wrong with me. I can't stick to this. I guess the real power of knowing that is, listen, it is not your fault, right? You have got big corporations, big marketing budgets, very, very clever people who are doing what they need to do to service their business. That's their job, right? You as an individual,

sure, you may be blessed with high amounts of willpower. You may have had certain experiences in life that mean, yeah, you know what? You are going to make a change now in a way that you never could do before, whatever it might be. But it doesn't change the fact that everyone is working against a very toxic food landscape. And so I guess what's powerful about that is that anyone who has struggled, the first thing, it doesn't necessarily help them change that. But what it does help them do is not necessarily feel shame and guilt about it. You're framing this so much more powerfully than I have. You know, I've tried to articulate these things, but I mean, that is right. If you're feeling like you aren't in control, it's like, well, you aren't really. And what we also know is that people

with low incomes eat a lot of this food. When you give people lots of money, by and large, they make really sensible decisions. We've got masses of evidence that people who live in poverty are not stupider or don't have less willpower than people who live with wealth. They are unlucky. They're born into different circumstances in different countries in different parts of this country. And so those people knowing that there is understanding the magnitude of the force they have to oppose is really important. If you think that, if you're someone who does want to lose weight and you think it's going to happen easily, despite the very best efforts of some of the biggest companies on earth, you're kidding yourself. You know, I do think it's important to understand the scale of the challenge that people are facing. And it isn't, it is not

impossible. It is impossible if you don't understand yeah the incentives i can remember back to my time working in oldham i remember there was a family who i'm trying to think now i think the parents had type 2 diabetes i was seeing this middle-aged couple they were struggling with the health i think they were pre-diabetic and they thought, you know, my parents had it, I'm going to have it. And I was trying to explain, well, not necessarily. And they brought in, I think to one consultation, what they were eating in the morning. And it was a breakfast cereal. And it said heart's healthy on the packet. Did it now? It did. I wonder if I know where this is going. Well, what was interesting to me, and I think it's really important that we all recognise this,

we all sometimes fall into the trap of thinking that everyone around us knows what we know. We forget that at one point we didn't know what we know now. And I know it's... Doctors are amazing at doing that. Yeah, but I think it's such an important point, mate, because I remember explaining to them, look, I know it says heart's healthy, but actually I genuinely don't think this is helping you with your health. It's not helping you guys with your pre-diabetes.

It's small pieces of chocolate or whatever. Yeah. Yeah. And they were totally shocked. Now, it was an immigrant family, so they weren't from the UK. They moved here. It was an immigrant family, so they weren't from the UK. They moved here. But I remember it so well because I thought, oh, wow. We can talk about this stuff on podcasts and books and whatever it might be. But actually, there is a lot of people out there who believe that if the packet on it says heart healthy, that someone, the government checked this, that it was all right. It is good for me.

But you are reminding me that this is entirely what I believed for a very long time. You know, we are taught at medical school that nutrition, the nutritional composition of food is the important thing. How much fat and salt and sugar is in it. And there's lots of these breakfast cereals that have quite good nutritional composition if you don't eat too much of them. I mean, the same is true of cigarettes. You know, if you only smoke one, it's not all that bad for you. You know, alcohol, if you only drink one glass, it's fine.

It's, yeah, and I think migrants and displaced people to the UK, I run a clinic for asylum seekers and refugees, and they have, I think, a very exaggerated idea of the extent to which the UK government protects its citizens from predation. And so I can well imagine being in the position of moving from a very low income state to the UK and going, well, if it says it on the box, it's probably true, isn't it? I'm sure someone in Great Britain has rubber stamped that heart healthy claim and said it was all fine.

Yeah, there really is a belief about that. Let's talk about these ultra-pros. Let's get some examples. I did something this morning, which I haven't done in a long, long time, right? I went to our local corner shop, which I do go there to get certain things, but I came back with a bag full of shopping of things that I haven't bought in a long, long time. I'm going to get them on the table, Chris. And through the lens of what you've been writing about and talking about so far, I really want, I guess what I want is, I want you to help us all understand how do we figure out whether that food product that we're buying is helping us or harming us.

Ingredient labels are things that I've spoken about on this show for many years. You've got to read ingredient labels because otherwise you simply don't know what you're getting. I had never read an ingredient list until maybe 2019 or something. You're kidding me. I just didn't, I just assumed it was

probably all fine. You know, I was a molecular biologist. I'm like, well, chemicals are normal. It's fine to have chemicals in food. I just hadn't read it. And then, and now I assume everyone does read ingredients labels. And when I show, you know, I mean, you know, you've worked in hospitals. We all eat it the same. We all eat it at Pret or Greg's or Boots or we buy our sandwiches from rns when you get people to read the ingredients

on a sandwich in these places and it's got 38 different ingredients people are like wow i just never looked so doctors we you know you're right we don't we forget what we we didn't we didn't used to know right okay what have we got? I'm getting a selection. Awesome faves. Things, right. I've got more. This is just to start off. Okay, so has anything got a heart on? That would be quite nice.

I mean, can we start with Coco Pops? Yeah, yeah, yeah, please do. Coco Pops is kind of my favourite, really. Partly because it was my favourite serial as a child. It's my daughter's favourite. Can I just say, I know you had lawyers look through your books. I don't have any lawyers on this show, so be careful with what you're saying.

I've been legaled here, if you like. So the book was read by three teams of lawyers, Canada, the US and the UK. Wow. And there's a lot more other lawyers involved. So I'm quite careful. Cocoa Pops, you know, is my daughter's favourite cereal. She doesn't have it very often

and it tells us it's not just safe for kids but it's positively intended for them I mean you know it's not a grown up thing

right you and I do not respond to monkeys on boxes right so we've got a monkey source of fibre supporting your family's health with iron and vitamin D

I mean you know what I'm looking at brain oh look supporting brain function with iron folic acid and riboflavin help reduce tiredness fatigue I mean, you know. Well, I'm looking at that, right? Oh, look, supporting brain function with iron, folic acid and riboflavin help reduce tiredness and fatigue. I mean, this is, wow, they've really amped up this box.

I haven't looked at a Cocoa Box box in a few months. They've, I think, moved. For me, you know, it's the yell, it's the brightness. It's got added goodness. Yeah, added goodness. But just turn it around. Supporting your family's health. Yeah.

Okay. Now, out of everything on there, I get there's a monkey on there with a smile on his face, which is going to appeal to children. I get that it says iron and vitamin D, which of course is important, but the fact that it says supporting your family's health. Now, I'm a parent, right? If I was a young parent, I didn't know anything about nutrition, and I was trying to look after my family, supporting your family's health, that's a powerful phrase, isn't it? It's a very bold, it's a bold claim, source of fiber. And then, if we were to look at the nutritional labeling system,

which is optional, but we look at these traffic lights, two greens, two oranges. So this is, maybe it's not all greens, but it's pretty healthy. Greens and oranges. There are no reds there. Walk us through the traffic light system in case anyone's not aware of it. So the traffic light system means that if you eat 30 grams of this cereal, you pour out a 30 gram bowl, then it's got a healthy amount of fat, a healthy amount of saturated fat, and not too much sugar and salt. If they were all reds, it would mean you were over the limit on all of them.

And that's if you pour a 30 gram bowl. So is this an ultra processed product? Well, we can tell it is because the ingredients are rice sugar, glucose syrup. We don't have that generally in our kitchens. Fat reduced cocoa powder. We don't usually have that cocoa mass. We don't have barley malt extract. You can buy, but you probably don't. Flavourings. Flavourings are the big clue. This is made in a factory. It's not made of real food. Remember that list? Rice, palm, soy, corn. This is deconstructed food. So we've got rice as the first ingredient, big commodity crop. We've got sugar, another big one, glucose syrup, probably from corn. And then we've got, and then all that. Although it doesn't taste of anything, then you flavour it and you add some chocolate.

When it said flavourings, does it say natural flavourings? It just says flavourings. Flavourings, okay. So a lot of products... Natural flavourings, I would say, natural flavourings are a complete misnomer because natural flavourings occur in food, right? A tomato has natural flavourings in it.

If you take those flavourings out of the tomato and add them as a concentrated solution to a mixture of sugar... I've got you too. Unnatural flavouring. Well, it's like either flavouring is in food or it's added flavouring. So flavouring is natural. It's like natural sweetness. It's like, no, it's all a sign of

ultra-processed. And just to go back to what we were talking about before then, so we've concluded from our forensic investigation of the Cocoa Pops ingredient label that this is ultra processed, right? Why is that a problem? So in terms of the ways, so for a start, we can't necessarily demonize just this product,

or at least not quite yet in this podcast. But for the moment, what I say in general is there's no one thing that's poisonous. It's the eating an ultra-processed dietary pattern is harmful because humans don't just eat Cocoa Pops. We eat Cocoa Pops and then we have some broccoli for lunch and a steak for dinner. We eat all kinds of things. So it's when the whole pattern of your diet, when 60% of your calories come on average from products like this, ultra-processed products, that's what we are sure is harmful. With any one of them, it's pretty hard to do an experiment that proves that Cocoa Pops are harmful because you'd have to,

how would you do it? You'd randomize people to what? Cocoa Pops versus Rice Krispies? Well, they're both ultra-processed. It's quite complicated and expensive to do that. But we can say certain things about this product that are clues about how it might drive excess consumption. So one of the first clues, can I open this?

Yes, please do. So the first clue is to go, what about that 30 gram serving? Now have you, you might have done this, have you ever weighed out a bowl of cereal? I have actually many years ago, and I was like, hmm, that's one serving. I could probably have six of those at uni.

I would eat it straight from the pack. So I'm going to pour out, I'm going to make a rough, so I'm getting Coco Pops on your floor. I'm going to make a rough, I'll do that roughly. I've done this a few times. I think it's a bit less than that.

That is about 30 grams of Coco Pops, okay? Now my six-year-old can eat four of these at a single sitting and not feel full. So one of the things about this kind of food is it has properties that we're sure drive excess consumption. It's very energy dense. It's a mixture of carbs and fat. There's no water in it.

It's bone dry. We then mix it with fatty milk, and this leads us to consume a lot of it. The flavorings, we think, drive excess consumption. The sugary fattiness drive excess consumption. So if you eat, if we were to go and look at how much you and I would eat, we're not going to eat 30. I mean, I could probably eat five times that. I quite like Cocoa Box. So the traffic light labeling system is all based on a 30 gram serving, which probably no one stroke, very few people ever have. No, well, no one has a digital balance

in ways that they're breakfast cereal. I mean, I maintain that no one, arithmetically, no one does it. Yeah. So even if you believed that Cocoa Pops are supporting your family's health with the iron and vitamin D that's been added in, that would only be valid if it was at all valid for that 30 gram serving.

That's right. Yes, exactly. That's exactly right. And no one eats a 30 gram serving. Therefore, we can almost, it's not black or white, but we can semi-ignore the claim because no one's actually consuming the amounts that they're giving you that information about. No, humans, you know, most of us lack the equipment. People do not have digital balances and the ability to weigh out 30 gram portions. You need quite a good balance to do it.

So it's, even if we were so motivated, but then you, you know, try getting my six-year-old to only eat 30 grams. You know, it is literally saying to an addict, you know, you say to your smokers, to only eat 30 grams you know it's lit it is literally saying to an addict you know you say to your smokers well if you just smoke five a week that'll get rid of most of the harms you can still enjoy it's like that that isn't how our relationship with these products works that's coco pops right so i'd love to i'd love to sort of understand what has changed in these products coco popsa Pops was around when we were kids.

If we were to have got a cereal box of Cocoa Pops from 30, 40 years ago, I'm making us a bit younger than we are. You could go back to the, I think the 60s for Cocoa Pops. Okay. It's been around for a very long time. What would be different in the 60s compared to that packet of Coco Pops today? Probably very little. It might actually be somewhat less harmful now than it was then. One of the things that everyone at the food company says is that the way that all these

products, it's not just Coco Pops, they're all developed, is they're tested on very big groups of people and they do A-B testing. So you get Coco Pops A, Coco Pops B. And the main thing you measure is how much do people eat and how quick do they eat it? Because we know that speed of consumption is very important for increasing intake. And so every year you try a slightly new ratio of sugar and salt, a little bit more cocoa mass, slightly different flavorings, crispier rice, softer rice. You do all these different adjustments and the food becomes more and more palatable.

So I can't say without going back and getting a box, but I would imagine it's much more edible now. And that is with any ultra processed product, you can say the emulsifiers harm you, the non-nutritive sweeteners harm you. It's the softness. It's the sugar fat ratio. It's every single aspect. It's the combo. Of every, like part of the ultra-processing. One of the things that makes you eat more

is this claim about your family's health. I'm sure that promotes for many, many people. They go, supports my family's health. Well, kids, tuck in. I mean, there's also some concern about if you're eating many times more than you should, what's happening to your intake of some of the added vitamins, the B vitamins and the iron? The reason those vitamins are there is not because vitamins and minerals are intrinsically healthy. They're there because they were all stripped out of the rice and everything else during the processing.

So they're just adding back in what would have been there potentially if the whole food was being consumed. If you ate porridge and some fruit for breakfast with some milk, you get all the iron and vitamin D and everything you need without it driving excess consumption. You mentioned porridge. I guess one of the themes I wanted to explore with you today is this idea that a food is not a food. And what I mean by that is porridge

is not necessarily porridge. Of course it is, but there are many ways to do porridge. Bread, saying bread is good or bread is bad is problematic. A good or bad is problematic anyway around food, but whether it's a health promoting food or a food that isn't promoting health, it kind of depends how the bread is made. Right. So let's just go to porridge for a minute. This is a quick and easy one, ready in two minutes. People are busy. It helps lower cholesterol, it says on the packet, no added sugar. So this all sounds good. Can I see? Maybe have a look and see how this compares.

So this is just porridge. Cracker whole grain rolled oats. So this is just porridge. So that is not ultra-processed. No, that's just a whole food. So that's a whole food, even though it's quick and easy. Because people talk about the difference between rolled oats and steel-cut oats. Oh, yeah. about the difference between rolled oats and steel cut oats oh yeah i mean so so there's a i'm trying

to sit in a in a in a in an evidence-based public health space so i work with the world health organization and unicef i'm on a lancet commission so i'm interested in sort of health for for everyone now down at the at the sort of micro level you can get into the benefits of like, should you make your coffee with cold or hot water or seed oils or there's a whole, is fructose worse than glucose? And there's some interesting stuff there. In general, I'd say that from a public health perspective, we are so far from worrying about whether steel cut oats are better than rolled oats, for me, it's an irrelevance. I think there are some people who are, you know, at the edge of performance, you know,

they're corporate executives or they're elite athletes and they may get some marginal benefits from cutting their oats in a different way. I think from public, oats are oats as far as I'm concerned. So that one is not ultra processed. No, it's processed in the sense the oats are rolled. I mean, you can't eat a raw oat. And this is the thing with the definition is with every definition of healthy food, there is some blurring around the edges. And in the UK, particularly, the food

companies have got quite savvy to sort of clean label food. So there's a lot of stuff that I would think, you know, is probably going to drive you to eat more and would be a risk factor for obesity, but it hasn't got emulsifiers. It hasn't got weird stuff in it. So it's probably not going to do lots of that other stuff. Yeah. So interesting because we've got to be careful here that we keep the big picture in mind, don't we? It is easy to get super granular on these foods and go, oh yeah, well this is or this isn't. I think the key point for us to remember, like you've already emphasised, it's about a pattern. If you're having, I don't know, let's say a bowl of Coco Pops, let's say you're really fit, you love exercising, you eat well, but after one of your gym sessions each week, your treat to yourself

is a bowl of Coco Pops. Well, you know what? In the whole scheme of things, it's probably not going to be a problem. People go out and they have a cigarette and a glass of wine. Some people have difficult relationships with certain products and they may find abstinence easy. So for me, I have a real problem with ultra processed food. I've been very addicted to it, so I am abstinent. But that's quite an extreme position. And that's the position that someone who lives with a difficult relationship with alcohol or tobacco would live in.

People, addicts can't be moderate. But I think most people don't become addicted and they can just cut down if they can afford to. The word abstinent is quite an interesting one that you use there in relation to food. one that you use there in relation to food. A lot of people I think would say, you know, there are certain foods. If I buy those foods and keep them in my house, I'm going to eat them. But when you use the word abstinence, that's typically a word we associate, I think, with drugs. Yeah. Or let's say someone who had a problematic relationship with alcohol, and they now are choosing to, I can't drink anymore, ever, under any circumstances.

Why do you use that word? Before we get back to this week's episode, I just wanted to let you know that I am doing my very first national UK theatre tour. I am planning a really special evening where I share how you can break free from the habits that are holding you back and make meaningful changes in your life that truly last. It is called the Thrive Tour. Be the architect of your health and happiness. So many people tell me that health feels really complicated, but it really doesn't need to be. In my live event, I'm going to simplify health and together we're going to learn the skill of happiness, the secrets to optimal health, how to break free from the habits that are holding you

back in your life, and I'm going to teach you how to make changes that actually last. Sound good? All you have to do is go to drchatterjee.com forward slash tour and I can't wait to see you there. This episode is also brought to you by the Three Question Journal, the journal that I designed and created in partnership with Intelligent Change. Now, journaling is something that I've been recommending to my patients for years. It can help improve sleep, lead to better decision making, and reduce symptoms of anxiety and depression. It's also been shown to decrease emotional stress make it easier to turn new behaviors into long-term habits and improve our relationships there are of course many different ways to journal and as with most things it's important that you find the method that works

best for you one method that you may want to consider is the one that I outline in the three question journal. In it, you will find a really simple and structured way of answering the three most impactful questions I believe that we can all ask ourselves every morning and every evening. Answering these questions will take you less than five minutes, but the practice of answering them regularly will be transformative. Since the journal was published in January, I have received hundreds of messages from people telling me how much it has helped them and how much more in control of their lives they now feel.

Now, if you already have a journal or you don't actually want to buy a journal, that is completely fine. I go through in detail all of the questions within the three question journal completely free on episode 413 of this podcast. But if you are keen to check it out, all you have to do is go to drchatterjee.com forward slash journal or click on the link in your podcast app. Abstinence is at the core of the dilemma around food addiction. So the heart of the problem with calling food addictive has been the problem that we can't be abstinent from food.

But baked into your definition of addiction is the only therapeutic approach that works is to quit your addictive substance if you possibly can. No one has ever been able to live with a problem relationship with alcohol and then drink moderately. It just doesn't happen. With ultra-processed food with the definition comes the possibility of abstinence

because at least in theory, it's discretionary food. Some people might be forced to eat it because it's all they can afford, all that's available to them. But in theory, you don't have to eat it. It's only been in our diet for less than a hundred years. So when we ask the questions to determine addiction, and there are lots of different ways we can do it. You'll have done it many times as a GP. It's always a questionnaire. There are the cage questions for alcohol. Control. Do you feel like you're in control when you're drinking? Do you feel like you're in control? And people listening should ask themselves these questions. Do you feel like you're in control when you're eating certain products? Many of us feel like we're not. Do you ever feel anger when someone raises how much you're eating of particular things? Do you ever

feel guilt? And do you ever have an eye opener? Now, in terms of alcohol, that means do you drink early in the morning? But do you ever find yourself eating things at odd times of day when you normally wouldn't? The definition of addiction is the continued use of a substance or behavior that you know is doing you psychological, social, or physical harm, and despite many attempts to quit. That's our definition of addiction. And so the Yale food addiction questionnaire is broadly derived from the way we diagnose alcohol addiction. And about the same number of people report addiction to ultra-processed foods, and it is always ultra-processed foods, as do report problems with alcohol.

So the rate of cessation is lower with the food. So when it comes to addiction, there were these headlines that appeared a few months ago. You may have saw them. You know, ultra-precious foods are addictive. It's heroin, it's tobacco, it's drugs of abuse, it's cocaine. And a lot of people thought, that's a bit over the top, isn't it?

The evidence is really good. And people listening to this will recognize, they will have tried cocaine, cigarettes, alcohol, and they'll be like, no, my problem is the donuts, the fried chicken, the frozen pizza, the confectionery, the chocolate. And for the people who are addicted, they are really addicted. So we've got MRI data, we've got population data, we've got physiological data, we've got masses of data that for those who are addicted ultra processed food is is very addictive it seems to me for many years that there's been a real desire to say well food is not addictive it's ridiculous a you have to eat

food as you mentioned so you can you call something that you're having to have every day to sustain yourself addictive my feeling has always been that we're having to have every day to sustain yourself, addictive. My feeling has always been that we're getting a little bit over academic with whether it is technically an addiction or not. This is maybe six, seven years ago. I thought, look, what matters to me at that time was, look, so many of my patients are struggling with this. Whether you want to call this a physiological addiction, a behavioral addiction, it doesn't really matter to me because there is an issue here where people are really, really struggling. And to them, it does feel like an addiction.

And the person who gets to say whether they're addicted is the patient, is the person who's living with the addiction. We all know this. You don't do a blood test. You don't scan people. If you do scan people, you see the same parts of the brain lighting up. But we don't diagnose addiction with MRI scans. We diagnose it by looking at behavior and asking questions. So there's another really important aspect there where you mentioned physiology. Ashley Gearhart, who's at Yale and has done some of the most amazing work on this, she's pointed out with some of her collaborators that ultra-processed food has in common

this refinement that lots of addictive substances do. So if we look at methamphetamine, extremely addictive drug, but we give a slow-release version of that to treat kids with attention disorders. Nicotine, nicotine gum, slow release, not very addictive. In fact, we can use it to treat tobacco addiction. The tobacco cigarettes have these accelerants. They deliver nicotine incredibly fast. Ultra processed food, because of that softness, because of the energy density, it delivers the rewarding molecules, the sugar, the fat, and the protein extremely quickly into the gut. And so if we look at all our most addictive substances, they're all very, very rapid

delivery. Shots are more addictive than small beer. You know, snorted drugs are way more addicted than pills. You can go through the whole list. So physiologically, that's the other set of evidence is everything addictive is industrially processed to drive addiction. And remember the tobacco, we say, should we consider the food companies to be like tobacco companies? The tobacco companies and the food companies were the same companies from the 80s to the 2000s, right? The biggest food companies in the world were owned by the biggest tobacco companies in the world. Philip Morris and R.J. Reynolds bought Nabisco, Kraft, and General Foods and turned them into these food giants. And they took all their tobacco marketing technology and they applied it

to the food and their flavor technology. So it is fair. You say rapid delivery. That's what these ultra processed foods, these UPFs do, right? They are rapidly absorbed. A lot of them rapidly elevate your blood sugar. If you've ever worn a CGM, a continuous glucose monitor, you must just see how quickly your glucose goes up often when you're consuming these foods. So it kind of fits as well, doesn't it? There's an immediate feeling in the body

you get from these things, which of course makes it easier to get addicted. And the prep time is nil. Part of the definition is they're convenient. You just open the pack and they're gone. And the other issue with food addiction, people always said, well, food doesn't contain any addictive molecules.

And aside from caffeine, that is broadly true. But the thing you get addicted to, addictive molecules are only addictive in some contexts at some speeds of delivery. The addictive molecules in food are the sugar, the fat, and the protein. If you eat them slowly in the context of normal food, you don't generally become addicted. It's when they are wrapped up with accelerants in products that you can virtually inhale, that's when they become addictive because they're giving the same physiological reward.

You can virtually inhale them. Yeah. I remember in first year at university in Edinburgh, maybe it was second year, but in the end of the nineties, one of these big pizza chains in Edinburgh would have either on Tuesdays or Wednesdays, it was eat as much as you want for, I don't know, five quid or something, which was quite appealing to a student. And I remember going with my mates, I remember once saying to my best mate, because I was very competitive back then and I would always try and eat the most slices of pizza back then. And I remember saying to my friend- Is there any footage of this? I mean, I'd love to see. I think this was pre-social media, pre-fans.

Mighty Rogan Chatterjee chowing down. I've gone the other way now. But I remember telling my mate Steve, mate, you're eating it too slowly. You've got to get it in before you realise you're full. Oh, how to win an eating competition. This is a whole separate podcast, man. It is a separate podcast, but...

It's a whole new audience. It totally relates to what's in the book, right? Because, well, you can perhaps tell me how totally relates to what's in the book, right? Because, well, you can perhaps tell me how it relates to what's in the book, but I had figured out that the way you actually get the most pizza slices in was do it so rapidly, because if you do it slowly, your brain starts to realize, oh yeah, you're full. I don't want any more. So I would actually go really hard early. Can't believe I'm saying this, but that's exactly what I did. Can you explain to me through the lens of what you've been writing about what was going on? While you were doing this in Edinburgh in the

late 90s, someone called Barbara Rolls was doing proper experiments in the late 90s on exactly this. I definitely didn't sign up for her trial. It wasn't on me. Well, you had intuited exactly the same thing. So inside all of us, there's an idea that with an abundance of calories around, humans have just sort of evolved to eat loads of calories. And if there's too much food, we'll eat it and we'll gain weight. And that isn't true. We've had abundant calories for centuries, for a really long time, many populations have, without any weight gain. And so inside us, we have this satiety mechanism. There's a long-term one that regulates the amount of fat on our bodies. And there's a short-term one that midway through the pizza eating contest goes, mate, you have to stop.

You've eaten too much. Now that short-term satiety mechanism is a set of, it's very complex, and we don't understand it fully, but it's a set of hormones and nerve signals from the gut. And in simple terms, ultra-precious food is sort of pre-digested, if you like. It is so broken down, the particles are so fine, that partly you can consume it without really chewing, so you don't get the hormonal release that you get from the chewing. And partly it seems to be absorbed in a part of your gut that doesn't release a fullness signal. It never gets to the bit of your small bowel where the hormones come from that say,

it's time to stop eating now. And so this is one of the reasons we think why so many people listening and have this experience of you're sort of continuing to eat food and you know you should be full and you kind of are almost full and yet you can't seem to stop eating. It's that disconnect between, you know, your evolutionary expectation of when you should feel full and when you actually do. So this is, but this is how the food is designed. It's not surprising when one of the things you're measuring in these design trials is how quickly do people eat it and how much do they eat? You famously did this 30-day trial where you would mostly eat ultra-processed

food. 80% of my food, 80% of my calories came from ultra-processed food for 30 days. Maybe talk us through the thinking behind doing that. And then if you can, Chris, the thinking behind doing that. And then if you can, Chris, paint us a picture, like a really vivid picture of what that was like. And because I'm interested, and we'll pick this up shortly, that the fact that you are now abstinent, I'd love to know, what does abstinence mean? UPFs are everywhere. So how can you be abstinent? Well, we live in a weird food apartheid in this country, where if you have money, time and resources, you can buy better, more varied food than in any other time in human history.

You know, I can go and get an avocado or a mango from the end of the road and it'll be pretty delicious. And, you know, it's incredible. And yet most people, that food is absolutely unaffordable. It is more expensive per gram than steak. So it's quite easy if you don't mind preparing your own lunch. So I brought my lunch today. I brought some peanuts, salted peanuts, some tomatoes, and a whole bunch of fruit. Now the bill, and I got it from the supermarket at Euston station, so you can buy it at some stations. The bill for all that was about 16 quid. And I didn't get very many calories for that, but it was fine. So you can do it. It takes a little bit more time or you have to tolerate a fairly simple lunch. I don't mind.

Have you been in a scenario where- Oh yeah. So when did I last have ultra-prosperous food? Yesterday, I was at a friend of my parents, so I had to sort of turn up, and it was a Christmas party. Had to be, you know, these people you've known for like your whole life, so you have to be polite. And they were bringing around little trays of oven-baked,

like little cheese twisty, vol-au-vent kind of, you know, sort of varied snacks, little spring rolls. And it just looked rude to not have some. So I ate some, and it was fine, but that didn't result. Did you enjoy it? Really? No. So one of the things that I really focused on trying to write the book is there was this experience midway through this diet that I went on. This 30 day trial. The 30 day trial was done not as a stunt for the book or for telly. It was

done to generate data for a big trial that I'm now running at University College in London. So we did it really properly. And it wasn't some heroic experiment. This is a normal diet for 20% of the UK population. It's a normal diet for a UK teenager. So this was normal. It wasn't extreme.

And I didn't expect much to happen. Can I just pause you there, Chris, a minute? Are you saying the average British teenager is consuming... A typical one. So on average, they probably just over 60%, we reckon, but it would be many teenagers eat 80 or 90% of their calories from UPF. I want to just remind us all of something that you said right at the start, which is that UPF consumption in high volumes is linked with early death cancer, inflammatory bowel disease, heart attack, strokes, metabolic poor health like type 2 diabetes, mental health and dementia. And eating disorders, I think is the only one you missed off. That was a very good list, yeah. So let's keep that at the top of my mind, right? That's what UPFs are causing. And a typical British teenager is

maybe having 80% of their diets. That would be quite normal. As a parent, that is... It's sort of terrifying. I mean, this is the tightrope that I'm walking on, I think you walk this as well, is going, do I terrify everyone and sound a bit hysterical? do I terrify everyone and sound a bit hysterical or do we sort of try and find a balance there and I think I think it's very hard what I work at is going we need to stigmatize the corporations and we need to regulate them we mustn't stigmatize or shame the food itself or the people who are forced to eat it so there's probably no way of perfectly getting that balance right. And sort of underlining, like it's not any one product. It's not that it's poison.

It's that when this is your dietary pattern, if we could switch down to 40% or 30% or 15% like they do in France, you know, the benefits are kind of enormous, but you have to be able to have real food to do it. So the diet was a normal diet. And midway through it, I was talking to a collaborator in Brazil called Fernanda Rauba. And she kept saying to me, you know, this isn't food, Chris. It was almost like an argument. I was going, well, it is food, Fernanda. She went, no, no, no. It's an industrially produced edible substance. You mustn't think of it as food. The purpose of food is nourishment. This is not

produced for nourishment. It's produced for profit. And mustn't think of it as food. The purpose of food is nourishment. This is not produced for nourishment. It's produced for profit. And she kept kind of underlining this. It was a bit irritating. And I sat down that night to eat. In the book, I say it's a turkey Twizzler. Actually, it's the one thing that isn't true in the book. I'd already used a fried chicken and I couldn't eat it. And I was reading the ingredients list and she'd made it disgusting for me. And we know this happens to addicts of all kinds. And you've spoken a bit about this and you may have experienced it. You can feel very attracted to something or someone

and suddenly a switch is flicked and they're repulsive or the substance is repulsive. And it happens with smokers. And we have some evidence about how this happens. So that kind of cheesy self-help book, The Alan Carr Easy Way to Quit Smoking, has three randomized controlled trials showing it works pretty well,

as well as any other intervention. It's recommended by the World Health Organization. So I, the second it happened to me, I was like, oh, she's done a kind of Alan Carr thing where the food wasn't forbidden to me. So I was eating it very mindfully and I was learning about it. And that was what enabled the switch to be flicked. So at was eating it very mindfully and I was learning about it. And that was what enabled

the switch to be flicked. So at the beginning of my book, I say, please eat this food while you read. And only by not forbidding it, do we think that you may be kind of released from its spell. And that's proved really powerful for people. And that isn't me saying I've got some solution or weight loss program, but it does seem to work for people. If you inspect this food, it doesn't stand up. So for 30 days, you were eating this diet of 80% ultra-processed foods. And during that, so you're consuming these foods, but you're also talking to these expert scientists who are educating you on just how problematic they can be for various parts of your health. And you're saying learning about that whilst eating helps what? Create some sort of disgust or some sort of... Disgust and addiction are quite... Love and disgust are quite closely linked in our brains.

It's the same set of emotional systems. I don't think we quite understand all the neurology. We do know that liking things and wanting things, being addicted to them, are very, very different. And we can like things we don't want and we can want things we don't like. And that was established doing lots of different experiments in the 80s and the 90s. And often people who smoke will say, I don't like cigarettes. I don't like anything about them, but I do want them. And when I'm smoking them, I don't even like them. And when you ask people who live with addiction to this food, they often don't really like the food. And especially if you ask them after a few bites, they're like, no, I'm satisfying a craving. So a lot of it is what you said about people hate being told what to do. When you take the brakes off and you stop forbidding

yourself the food, that seems to be quite crucial to unlocking this disgusting where you then stop wanting it. Yeah. It's interesting that one of these researchers said to you, it's not food. I looked up this morning some of the definitions of food. So the Cambridge Dictionary say food is something that people and animals eat or plants absorb to keep them alive. Collins English dictionary said, any substance containing nutrients such as carbs, protein and fats that can be ingested by a living organism and metabolize into energy and body tissue.

Now, according to those definitions, UPFs are food, but I totally get what these researchers are getting at. It might be more helpful for us to not consider them food. But I totally get what these researchers are getting at. It might be more helpful for us to not consider them food. I think Michael Pollan called them food-like substances. Yeah, and Michael Pollan had a huge influence over Carlos Montero, who came up with the definition. They know each other and they're friends. So there are several instances in this story of journalists pointing out problems with science, the scientists then going and fixing things. Mark Schatzke wrote an amazing book called The Dorito Effect,

which then influenced a lot of the research that was then done at Yale on flavouring and artificial sweetness. So, yeah, I would say we have a cultural understanding of food, that everyone kind of gets that food is about nourishment. Food is the substance that binds us together. It binds us to our heritage, our ancestors. It binds us to our heritage, our ancestors. It binds us to our family and our community. It's not mere nourishment.

And there are things missing from those definitions of food. Food can't be toxic. It can't induce disease, or it shouldn't. I feel like that is baked into all our common understanding of what food is, is that it won't make me ill. Yeah, it's interesting that because UPFs, according to that definition, you just said that it mustn't cause disease or be harmful. Well, you know, it's tricky because they clearly are when consumed in the amounts that we're

consuming them. I think that's key. If it was only 5% of your diet, you're probably going to be okay. It's the volume, isn't it? Yeah, and we can say, well, trans fats. Are trans fats food? Well, you can get calories from them, and we all ate masses of them for ages, but now they're banned because they're called disease. So, yeah, there's no legal definition of food,

but I think it's helpful for people to not think of a UPF as food. I think it's a bit of artifice there. This 30-day trial you did, at the end of it, you said your weight went up by six kilos. Your levels of leptin, the satiety hormone, went up five times. Your levels of CRP, the marker of inflammation, doubled. Those were quite remarkable findings in just 30 days. Those are the kind of objective measurements that you could do pre and post. But it was also

interesting to hear those more subjective things, how you felt, what happened when you woke up at night, how did your brain function. You're also very open in the book about what it did to your bowels and how quickly that returned or it returned back to normal when you returned back to a whole food diet. That was really cool. The intellectual lesson was underlined by kind of overdosing on the problem and then suddenly going cold turkey because I didn't want it anymore. And it was like the clouds parted. So as a physician, I think we live often very different lives to our patients. We're generally more privileged in just in pure finance, but we also generally make more money because doctors are paid. And so we eat different food. We have different levels of education about food. And so what happened in the space of that month was I kind of aged 10 years and I developed all these problems that I hadn't had before. The sleeplessness where you wake up in the middle of the night and you go to the fridge,

that was kind of new. And the piles and the general aching and misery, all of which at the time I didn't, it was weird, I didn't associate it with the food until I quit the food and it all went away. You've talked about this. I think you understand this better than me. When we feel anxious or unhappy, we generally point at the thing in front of us and go, that's the problem. It's my work. It's my children. It's my marriage. And it was when I stopped the food, I went, oh, my wife didn't suddenly become an absolute pain in the neck for a month. In fact, the opposite was true. It was me that had become unbearable and it was driven by the food. So I was very inflamed and the sleeplessness was, you know, you get into,

it's that vicious cycle. I mean, you took this, it was your pillars. It was like I destroyed those pillars one by one, starting with the food and that interrupted everything else. I mean, Chris, hearing that is really powerful because I almost do the opposite with my patients. So you went onto a specific diet, which then gave you a whole host of non-specific and specific symptoms, right? General malaise, moodiness, low energy, low vitality. Stopped exercising. Stopped exercising, work was hard, all these kinds of things. But you also had constipation, anal fissure, all these things that you write about. And I'm going to draw this into another part that you think that we shouldn't be looking to the

industry for the solution. The solution has to come from government and doctors. I want to talk about that in just a moment. From a medical perspective, I qualified in 2001 for Edinburgh Medical School. I, like many doctors when they finished medical school, I qualified in 2001 for Edinburgh Medical School. I, like many doctors when they finished medical school, thought that they had been taught all the tools that they need to get their patients well. And then I started practicing. And I thought, well, what I've learned is fantastic for maybe 20% of my patients, but there's a whole 80% of people with chronic symptoms, sometimes vague, non-specific symptoms that I can't quite put a label on, that I don't really have many tools to help. And listeners to my show will know I went on a journey

from 2010 or so, I've been going around the world, going to conferences to try and learn about nutrition and movement and sleep and stress and the gut microbiome and how did these things affect us. And I would say around 2013, I made quite a significant change in the way I practice, which is with a lot of patients who came in who had chronic symptoms, whether it was, you know, whatever it might be, sometimes autoimmune conditions, sometimes fatigue, energy, was, you know, whatever it might be, sometimes autoimmune conditions, sometimes fatigue, energy, irritable bowel syndrome, even vague things I didn't know what it was, I would try and suggest to them that they go on a whole food diet for two to three weeks if they could. And I remember on a scrap of paper from the printer, I'd write down, I said, look,

if they could. And I remember on a scrap of paper from the printer, I'd write down, I said, look, if you can, what I'd recommend for the next few weeks is just see what happens if you're only consuming whole foods. Now, I recognize it can be hard. I recognize there's a poverty issue. I recognize all of that. But I started to get truly mesmerized when people would come back a few weeks later and go, oh, my mood's better. Oh, I don't have that anymore. Oh, that sort of vague arm pain that I don't have that anymore. I've got more energy. I'm sleeping better. I'm not talking about weight. Blood sugar measurements. I'm not talking about weight. My hypertension, my high blood pressure's gone. And I thought, wait a minute, how many of the problems that we're seeing that we're taught to diagnose,

give a label to, and then give a treatment to, how many of these are downstream consequences of the way that we're eating? And I'll tell you what, this is, again, Chris, I don't think this is well-known enough. You mentioned the link between ultra-processed food and inflammatory bowel disease, things like Crohn's disease and ulcerative colitis. We can talk about this through the lens of autoimmune disease. I remember so clearly,

one of the first times this had happened, I've seen this many times since then, but years ago, a lady came to see me with hypothyroidism. So she had an underactive thyroid. She was on 75 micrograms of levothyroxine a day, which is very standard treatment, but she didn't feel good in herself. And, you know, so her blood tests were exceptional. You know, everything was in the correct range. So as doctors, we feel pretty good with ourselves, right? Because, you know, we've treated her condition. She still feels rubbish. Now, so when I saw her for the first time, I said, listen, your blood tests look great, but I understand that you're not feeling good. In the first instance, would you be open to maybe changing what you're eating? And she said to me,

you know, do you think this will make a difference? I said, listen, I don't know, honestly, but I know what you are currently eating, and I know that food impacts your gut microbiome, which has an impact on your immune system, and this is an autoimmune issue. So there's definitely no harm here. So why don't we try this? This completely changed her life. I think she got this paleo cookbook, actually, which she followed. Within six months, cookbook actually, which she followed. Within six months, she was down to 25 micrograms on levothyroxine a day. So we could reduce her dose of thyroid hormone and she felt amazing. And that just continued. But I don't think, I still don't think across medicine, across the population, we understand that the food we're eating, and I get it's hard, right? I'm not saying

this is easy. It can impact all kinds of different things, right? It's not just your weight. It's so much more. I mean, if we break down the evidence, because we're sure that ultra-precious food, that a non-whole food diet is causing these problems. And if you go, well, what are the plausible mechanisms? You're like, well, synthetic emulsifiers. We've got really good data now that they scrub out your gut, they thin the mucus lining, they disrupt the microbiome. Now, do we understand all the knock-on impacts of that? No. But do we know that it generates terrible inflammation and metabolic disease in rats? Yes. You know, are rats people? No. But if it does it to rats, do we have reason to be concerned about the number of synthetic emulsifiers we're eating? Yeah, absolutely. Do we have early

human data that's troubling? Absolutely. And could this also explain, if we scrub out the gut, we inflame it, and we start leaking fecal bacteria into our bloodstream that drains to our liver, do we think this cycle of inflammation that that's going to drive might be explaining the increases in GI cancers, in gastrointestinal cancers, including liver cancer in young people. Yeah, it could be. It's pretty plausible. And the emulsifiers, and then we can go through that with carboxymethylcellulose, with maltodextrin, with non-nutritive sweetness. So with the additives alone, we can start doing that. Then we could look at all the synthetic fats and on and on and on. So the idea that this food might be driving all

these problems isn't exactly wildly improbable. It's extremely likely and well-evidenced. And where I feel comfortable as a doctor making these recommendations is, if you think about what's the risk of harm here? Well, there's pretty much zero risk of harm when you improve your diet. Like with that lady, I thought, well, if nothing changes, okay, fine. But at least I know and she knows that diet is not playing a role. Because when you do that with patients, it's just like your experience of 30 days of doing it. And then within 48 hours, your sleep, your bowels, everything starts to return back. I think that's a very powerful experience for a patient to go, wait a minute. I had no idea that this was impacting me that much. Because it's sort of like the, it's the water you're

living in, the air you breathe. You sort of can't, you can't understand that all our lives have a lot of causal density. And so we, of course, work is stressful and family life is stressful. We don't understand that it was the food we ate last night and the problems. And the food we've actually been eating for five, ten years, that's the proximate cause of why we ended up screaming at our kids. Let's just talk about how, in inverted commas, real foods become ultra-processed, right? And two examples I want to talk about are bread and pizza. Now, I think I've got it here.

Have you got some bread? I don't have any pizza, but I've got bread, right? So again, I just looked in the local newsagents, I just thought, what is looking healthy? Right? Medium slice, wholemeal, no added sugar, right? So perhaps talk me through what's in that. Let's have a quick look at the ingredients and check it is. So it's got vegetable oils, including sustainable palm. There's no such thing as sustainable palm. Let's be clear about this.

And palm fat that's in this is not the red spicy liquid that you squeeze out of palm nuts for West African cooking. This is refined, bleached, deodorized, hydrogenated, and inter-esterified palm fat. So that is, makes it up. Then there's wheat gluten, and then there's emulsifiers E471, E481, E472E. So that is diacetyl tartaric acid esters of mono and diglycerides of fatty acids. So this is ultra processed bread. It meets all my, you know, other foods with lots of ingredients. Yes, tick. Foods with health claims, no added sugar.

Real bread, so I would say it may be useful for many people to not think of this or any bread like this as real bread. Real bread has three ingredients. It has water, wheat and salt. That's how you make bread. You can use naturally occurring yeasts. This has, you know, no added sugar. Sugar should not be in any bread.

I mean, sugar's what you put in cake. It doesn't go in bread. And again, we've got the great traffic lights. They're all greens apart from the yellow. So these are all good signs that something is ultra-processed. Yes. And do you know, can I just say, Chris,

one of the ways that you outlined in your book I thought was brilliant, which was if you're wondering whether that food is ultra processed, it probably is. If you're reading an ingredients list, you're probably eating an industrially produced food. If you go and buy broccoli, there is no ingredients this time. There's also no health claim on broccoli or cabbage or tomatoes or onions or garlic one ingredient foods it's like one ingredient food you know the one thing we're sure is that if you cook at home unless you are cooking those kind of internet cakes where you make them all out of candy yeah you know if you're cooking at home you know almost

no matter what ingredients you're using you're going to be doing yourself a service so so that bread so the the difference between that bread and what I would call real bread is there are several things about that are harmful. It's incredibly soft. So that is one of the products that you will spread with an ultra-processed spread of some kind, some margarine, maybe some low-fat mayonnaise or some chocolate spread, and you will consume calories at a rate your body cannot keep up with. The flour is very, very fine particles and the protein has been back added keep up with. The flour is very, very fine particles and the protein has been back added to the flour. Bread flour should be very high protein. They've back added the wheat gluten into that for absolute control. And then it's emulsified and the

emulsifiers do all kinds of things. Broadly that bread is a kind of whipped foam of these commodity carbs, proteins and fats. And then it's sort of baked into this very light, soft, spongy substance that is a vehicle for ultra-processed spreads. So the main thing about the difference between that and real bread is you'll consume it very quickly. But it has got those emulsifiers, which we have some evidence will drive some harms. We as a family went to Corfu a couple of years ago for a holiday. And I remember going to this really old Greek bakery. It's been there for years. It had a great

feel in it. And I think we'd missed, I think we were driving past it on the way back to where we were staying. It was around lunchtime and we thought we'd go and get something. And all the bread had run out and they said, you can't have any now until tomorrow morning because it was all made in that kind of, you can't just turn it around in an hour like you can now at the supermarkets. It's actually, no, there's a process to make this And when it's gone, it's gone. And the next day, we picked up what she said was a very ancient bread called, I think it was called Zaya bread. And, you know, I don't eat much bread, right? So it was a real treat. And it tasted completely different. It wasn't soft or chewy, right? It was a bit harder.

it wasn't soft or chewy right it was it was a bit harder um it took longer to eat you couldn't just wolf it down and i think the point i'm trying to make here is that and you can also make it with pizza if you want that bread is not bread right bread is just the word how is that bread made what is the ingredients what is the list within it? There should be. I mean, we have this with cheese. We have this with Cornish pasties. Bread should have a standard where you can't just call any old stuff bread. I mean, at the moment, there isn't really a definition of bread. You can call anything you want bread. You can call a lot of bread is much more like cake. It's got huge amounts of sugar in it. And you say in the book that actually most supermarket bought bread these days is ultra processed. Yes. Now there are supermarket breads you can buy that will not have very many And you say in the book that actually most supermarket-bought bread these days is ultra-processed.

Yes, now there are supermarket breads you can buy that will not have very many ingredients, won't have any weird ingredients. Perhaps only one of them is really truly non-UPF bread. There is this loophole in the ingredients list, whereas if you use additives that don't have a function in the final product, so they are merely processing agents, the oil you put on the rollers, for example, or some way of treating the flour, those never have to go on an ingredients list.

So there are these sort of sourdoughs that seem like they are real sourdough and they're this sour pho and they'll have lots of treatment agents in them. The reason I'm bringing up pizza is because it was a very powerful section when you roast about pizza being, it starts off as a real food. Yeah, pizza's a traditional healthy food. It's a piece of sourdough or a piece of dough cooked at high temperature with tomatoes and a bit of cheese. You know, it's a really healthy meal, pizza. But when you ultra process it and you turn it into something with emulsifiers and you intensify the acids and the sugars,

and you add more flavorings, you can turn traditional healthy food into an addictive substance. The kind of appalling thing is that pizza is synonymous with junk food. The same with fried chicken. You know, fried chicken is a traditional food. It's incredibly healthy, good for you. It's got a massively rich culinary history. It was mainly developed by enslaved peoples. And it's now being commodified by gigantic companies. And it's now being sold back to particularly low-income settings. And fried chicken can be a perfectly healthy bit of a part of a healthy diet. So kind of this is the genius of the food companies in a way is to

take these traditional foods and make them feel like they are traditional, but they're really not. They have nothing to do with their origins. I'd love to talk about artificial sweeteners, Chris, because I think there's been a lot of confusion and controversy around them for a number of years now. You're very clear, I think, on your views with artificial sweeteners. I don't know your view. Can you give me your potted summary on... I'm not a fan of artificial sweeteners. I haven't been. I didn't think you would be. I haven't been at all. In fact... How long have you worried about them? I'm going to say

2015, 2016 something like that because it was when I saw early data suggesting that they may have a detrimental impact on the microbiome now I know that's not I can't remember what that study was at the time

but it may not be like a human trial that has shown conclusively. But I thought, well, there's enough here. It was a paper in Nature in 2014, a really good paper. Maybe that was it. It was rat data. It was by a group that I cite. In fact, I think that paper is in there.

A very good study, was rat data, but yeah. I always try and take that precautionary principle and go, listen, this stuff hasn't been around long, to my knowledge. I'm not sure here. And I also think we sometimes do our patients a disservice, right? Because it's easy to go, oh, you know, it's much easier, you know, at least there's no calories in this. And I know you'll kind of explain what the issue is with that. So let's say we're talking about Coke, right? Oh, Diet Coke is better. I'm like, well, I'm not sure because if my patient is really struggling, I think I'm better off trying to lay it on the line with them, be honest,

and see when they're making the transition, can they make that transition to water? And honestly, some people can, right? So I don't think we need to, I think we should be concerned. I think we should acknowledge that poverty plays a role, acknowledge that some people find it harder than others. But I think we also have to be careful we don't disempower people and go, some patients, even if they're on the poverty line, would rather know from me, is this helping me? So I've always taken the approach of trying to be honest with my patients, even though some may find it hard to implement, be honest. And I think more and more data now is supporting that very thing.

There's a difference between giving people uncomfortable information they find it hard to act on, which I think is really important. I think we're obliged to do that, and giving people dogmatic advice. And you never do that. I mean, I think of these diet drinks particularly as. And giving people dogmatic advice. Yeah. You know, and you never do that. I mean, I think of these diet drinks, particularly as a way of ultra processing water. So you can't make much money from water. You can make a remarkable amount if you put it in a fancy pack,

but it's, you know, people will only drink water to thirst, really. If you put phosphoric acid, flavorings, caffeine and sweeteners in that water and you carbonate it, and then you sell it in an ad with a sports star or a model, then you've ultra-precious water. You've added no nutrients. It's got four, you know, all the diet drinks have four green traffic lights. They've got zero nutrition, but it's a way of getting people to drink more liquid for, you know,

I mean, the cost of these ingredients is virtually nil, especially if you can get rid of the sugar. You said something, Chris, you said people will only drink water to thirst. That's a problem if you're a food company. Yeah. That's a huge problem. People only eat when they're hungry and only drink water to thirst. So if you can find a way of getting people to drink more liquid than they feel thirsty for and eat more food than they feel hungry for, that's the purpose of ultra-processing. I do have one of these diet drinks here. Come on.

Just talk us through the ingredients there. So this is my... If you can understand why this is not a healthy product, and this is not just diet coke. For the audio listeners, let's explain what it is. So this is a diet cola. It happens to be diet coke. But this will do for any of them.

It's got four green traffic lights. This is the healthiest thing you can buy on any shelf in any supermarket. Okay. This is incredibly healthy. The ingredients, and it's got all this silver, you know, writing and it's beautiful, refreshing taste, no calories, no sugar. Okay. So let's look at the, it's a sparkling low-calorie soft drink with plant extracts with sweetness. I mean, arguably- Hold on, plant extracts, sounds wonderful, doesn't it? Arguably, caffeine is a plant extract and so is citric acid, although in neither case, I suspect that they come from plants. So let's look at the ingredients. Carbonated water, fine. Color, caramel E150D. Now, caramel E150D has nothing to do with caramel on a creme brulee, right? It's an

industrially manufactured colouring agent used by modifying carbs. So why are they calling it that? Well, they call it caramel E150D. I think it should just be called E150D. What does a caramel do, do you think? When they put that on, it makes it what? It makes it sound like it's got to do with maybe something traditional, traditional confectionery, creme brulee. And it's food. Caramel, it's food. It sounds like food, yeah. Then we've got aspartame and acesulfame K.

Now, aspartame has been, I mean, the WHO has said this does cause cancer. I'm not enormously worried about that evidence. I think there are lots of things that are carcinogenic if we cook food. But the evidence is good. It's just not a very strong effect. What's a much more concerning effect is that aspartame and acetyl-flame K, two non-nutritive sweeteners, seem to cause a lot of metabolic confusion. So we've had data building for, you know, since 2014, huge paper this summer in the journal Cell, which if you're a molecular biologist like me, is the journal you want to publish stuff in. And it showed, you know, previously, here was the theory, and I think

you've probably been saying this for ages and I was, if you put sweet taste on the tongue, you get this pre-absorptive insulin release. So you release a little bit of insulin that drops your blood sugar, and then you go looking for more sugar and you eat more French fries. So your body's trying to help you. This was the old, this is the old way of thinking about the sweeteners is the reason they seem to be causing harm is they drive you to get sugar in other places. Because we've been sure for quite a long time, they don't seem to lead to weight loss, which is weird. So the old theory was by lowering your blood sugar, they made you go and eat more French fries. That was the old theory.

lowering your blood sugar, they made you go and eat more French fries. That was the old theory. What it seems now is that most of them put your blood sugar up. And this, no one's entirely sure why this happens. But it seems like the reason we have a sweet, a taste detector in our mouth to detect sweetness, it's not just for fun, it's to prepare our body to receive sugar. When that sugar doesn't arrive, it causes a kind of physiological stress. It's a confusion because it's a mismatch between expectation and what actually arrives if you just put phosphoric acid into the gut. And it seems like this stress may be leading to a stress response which elevates blood sugar. No one's entirely sure. What we are increasingly sure about is that these in the long term do not seem superior to sugar very much. They don't seem to be much worse,

but they don't seem to be any better than sugar when it comes to weight gain or metabolic health, like your risk of type 2 diabetes. They seem to elevate that over if you just drink water. So we've got these troubling non-nutritive sweeteners. Then we've got natural flavorings, caffeine flavoring, and then we've got phosphoric acid and citric acid. Both will dissolve your teeth. The phosphoric acid also leaches the minerals out of your bones and you pee out your own skeleton. Less of a problem for you and I, but if you're a woman and you're approaching menopause, you are at risk of osteoporosis and so you are increasing that risk. So this is quite, you know, I mean, I could probably do another half hour just on this product. There is nothing in this that has any benefit.

So it's symbolic of how we misunderstand healthy foods, how we think that we can just strip calories out, how we misunderstand human appetite, and how we don't have any way of, in terms of public health, talking about these acids. That difference between expectation and reality for the body is really really interesting i was thinking about that this morning chris that you mentioned that through the lens of artificial sweeteners but if i take a step back from that and i think about what's in your book, I think about the fact that we seem to have separated out the reward from the effort in so many things in our life these days.

So, you know, let's say food, right? Instead of now having to acquire, hunt, gather the food, prepare it, spend time cooking it, and then we get the rewards, we can now literally on the way home from work on our smartphone, just order something that will be there and hot when we arrive home, if we want to. So we're getting the rewards without the effort. You can make the same case for social media and our online low-grade addictions, whereby we're now getting- Or high-grade addictions.

Or high-grade addictions. We're getting dopamine for not doing very much, right? And I kind of see there's a- For literally, in my case, I mean, I want, I mean, you've, this is a good moment to say say you gave me a piece of advice we were having a drink we met at some BBC thing

like it was a decade ago and you gave me this piece of advice you didn't frame it as advice you just mentioned and I'm going to misquote you here but you just mentioned you charge your you don't charge your phone

in your bedroom and I took that very seriously for some reason something about the way you framed it. I just like internalized, it's like a core religious belief. And that night I charged my phone in my kitchen. That has got me every night, another half hour of sleep because it is the only way I can be abstinent from my phone addiction. If the phone is next to the bed,

I'm just up till one. Not like meaningfully engaging with my followers, not sending out useful information about ultra-processed food or food policy. I'm just like doom-scrolling cat videos and car crashes. I mean, it's just terrible. But it's kind of, well, first of all, I'm delighted it helped. I mean, I quote you on this and say, I always attribute it to you. It was the best bit of advice anyone has ever given me.

You didn't give it as advice. You know what it does when it's not in your room? It's also when you wake up in the middle of the night. There's no temptation. That's exactly it. Because your kids get, you know, I'm up twice a night with the girls. They want to pee or they want just a cuddle or whatever.

And if the phone was there, you know. You know, you tend to have a quick one. But it's a strong addiction. a strong addiction you talk about a mild addiction for me it is it is a huge problem and i cannot be abstinent from my phone for all kinds of practical reasons you know just getting here today i need my phone so i these things weigh on me a lot yeah we've evolved over millennia, to acquire things in a certain way, to eat things in a certain way. And of course, humans are always trying to make it easier. We always have done, but it's just now we're in a state where ease and convenience is now killing us, quite literally, it's killing us. And it's whenever we try and hack human biology, it seems that it leads to negative consequences.

Yeah, we're not quite as clever as evolution. Yeah, we think we are. We think, you know what? Soft drinks with sugar are a problem. All right, let's give you that sweet taste, but without the sugar. That'll sort it. Little by little, we're now learning, well, maybe it's not going to solve it. And maybe there may be some adverse consequences of that because we're hacking the tongue. It's part of the digestive system. When things come in, enzymes, all kinds of physiological processes change based upon what goes on your tongue.

If that then doesn't come in to your belly and stretch and whatever it might be, your body will get confused. I mean, this food, it seems to smell, you know, you walk into a kitchen, someone's frying some onions and cooking a piece of meat. You know that your physiology is changing. Your mouth starts to water, your tummy starts to rumble. You know, there's a million other changes happening that we've barely unpicked. So when you put these molecules that lie to us on the tongue, it's a problem because it's not just the non-nutritive sweetness. They're the ones

we've studied. The flavor enhancers, glutamate, inosinate, guanylate, they signal that protein is on its way, readily digested protein, you know, fermented protein. They should be in the context of a rich ramen broth. When they arrive on a potato starch chip, you know, they're really, that's why when you pop, you can't stop. And the gums similarly. That's so interesting. So you're having a ramen, there's umami in it. Yeah. So that is signaling that protein is on its way. It's matched. The umami in the ramen is matched to the ingredients of the ramen. It's like the sweet taste of sugar is matched to what's

physiologically, what's nutritionally in the sugar. But when it's hacked and the potato crisp with the umami flavor, you've now got a mismatch in that system. Yeah. And what's amazing, and the same is true of the gums so you look at um xanthan gum locust bean gum guar gum carrageen and all these gums that are in loads of things they create a smooth fatty sliminess that means you can add them to yogurt and take out dairy fats very expensive if you can put in a bit of modified cornstarch it's very cheap so you just save money but your tongue is going oh oh, fat's on the way. When the fat doesn't arrive in the gut, again, we don't really know because all of the studies of taste and flavor happen in this whole bit of literature,

scientific literature, that's a million miles away from health. No one's ever studied how taste and flavor drive appetite. So in this Lancet series, for example, we're publishing a big series, big medical journal, all about ultra-precious food. We have basically nothing to say about how tastes and flavor drive appetite because no one's ever studied it. And yet you and I know if I just mix you up a bowl of fat and sugar, you're not going to eat it. It's going to be disgusting. If I flavor it and I texture it, now we're talking.

Now I can turn it into something you'll eat to excess. So there's so many things about our food that the food companies understand in great detail and that the academic community really don't have any idea. Where does emotional eating come in here, Chris? Because of course today, so many people struggle with making the choices that they want to make. We've already mentioned how environment hugely influences our behavior. But a lot of people will eat more, for example, when they're stressed. I think there was a stress in America report from a few years ago,

which suggested that maybe 80% or so people change their eating behavior in response to stress. It was something like 45% eat more, 35% of us eat less. And we're living in highly stressful times where, you know, increasing rates of burnouts, people are struggling with their mental wellbeing. How does our stress and the way that we eat in response to that stress relate to ultra processed foods? So I would say, I think about it in the same way that poverty drives a

lot of negative health behaviours. So we know that people who live in stress and poverty is the main driver of stress. People who live in poverty smoke a lot more. Now that doesn't mean that stress and poverty cause lung cancer. It's that they drive a set of behaviours that we know cause health problems. So ultra processed food is like one of the ways that stress manifests its harm. Gambling apps, alcohol, tobacco, drugs of abuse, ultra processed foods. These are all ways in which people who live with stress will experience that they will manifest those health harms. That's how they will come to be. So a lot of people say,

look, my problem isn't ultra processed food. My problem is stress or emotions. But when we look at the data, and I work with the Royal College of Psychiatrists on this, the only foods that those people binge on are ultra processed. So people never, when they're stressed, turn to the broccoli and the kimchi and the, you know, the salads. We turn to the ultra processed products. We don't even turn to the fatty, salty foods that we make ourselves. So one finding seems to be that you generally don't binge on your own chocolate brownies, on homemade ice cream, on homemade cakes. Part of the binging and the way that the excess consumption is they have to be wrapped up,

branded and made in this special way that hacks your appetite. So stress is a huge part of the problem. I mean, if the headline on all of this, right, on everything you and I are talking about is we stopped sweating about ultra processed food and we just dealt with poverty. We know that would get rid of 50 to 60% of the problems we're talking about. And that's a sort of whole separate thing, but that's the umbrella thing is, you know, the tragedy is people being forced to eat this. Poverty is a massive issue. To change that would require political will, it would require societal change. That can take time, right? So...

An infinite amount of time, I suspect. Well, let's say the will was there, right? Let's just be optimist for a minute and say the will is there. It is going to take time. You're very careful in the book to say you don't want to give people advice, right? You don't want to tell people what to do. This is a societal issue, but you know where this is going. For that person who is struggling with their health and saying, look, Chris, I get what you're saying. I had no idea ultra processed foods were this toxic for me in the volumes that I'm consuming them. I cannot wait for society to change. I cannot wait until my school serves my kids healthy foods and not ultra processed foods. Do you have any advice for what they can do right now?

No, but I'll tell people what I do. And they can, which is what you did for me all those years ago. So I'll tell you what I do, which is my life is much more expensive now. So I have to budget for buying real food. And you're going to spend more of your money on real food. And maybe that will be disposable income, but if you want to, then I just sacrifice money elsewhere. How much do we spend on average on food at the moment in the UK? On average, we spend about 6% to 8% of our income. 6% to 8% of our income. 6% to 8% of our...

Yeah. And if we just... Compared to Northern Europe, you're spending 12%, 14%, 15%. Compared to low-income settings, people spend 50%, 60% of their income on food. And if we look at it through a different lens, 50,000 years ago, we probably spent our entire day trying to acquire food. Animals spend, if you think of animals have a budget of resources, it's almost all spent on food and then a little bit on reproduction once in a while. But most of what animals do is acquiring

food. So this isn't a choice. In the UK, we have massive inequality. It costs, I mean, the train ticket to get here was like hundreds of pounds. It is bizarre. Our transport, our rent, our energy. We live in an incredibly expensive, iniquitous country. So it's not a choice. People don't have money to spend on food. If you can spend a bit more, great.

It will be hard. That loaf that we just looked at was, I'm going to guess, about a pound. If you go and buy a loaf of freshly baked sourdough from your local, it'll be probably 10 times as expensive. It could be up to 10 times as expensive. So what I do is I try and regard preparing food as not a hassle. It's easy to go, oh, it's a pain. And try and remember, you know, it should connect you.

This is the point you're making. It's a pain. And try and remember, you know, it should connect you. This is the point you're making. It's a core human activity. And we should regard it as like part of the essential functions of our lives. Preparing food can be meditative. It can be a cultural experience. You can learn things, teach it to your kids. It almost needs to be, again, for those who can, it almost needs to be factored into your schedule, right? It's almost like, you know, there's all these productivity hacks about scheduling this. And if it ain't in the diary, it ain't happening. And there's pros and cons of all those things. But broadly, if you don't put your trainers out the night before, you won't go for a run. I mean,

you know, these sort of obvious things that it's really true. You do have to build in a bit of time. You're not going to decide, you know, this morning to make a sandwich for your kids school lunch. You know, you're going to have to plan. You need a bit of planning. But my little tip is, well, again, it's not a tip. What I do to turn that into an enjoyable part of my day is I put on music when I'm in the kitchen. Like I know it sounds, I don't know, it sounds almost a bit cliched, but I've said this before, I'm old school. I don't know, it sounds almost a bit cliched, but I've said this before, I'm old school. I still listen to CDs. I bought a new Noah Gunderson CD this weekend because I've got a CD player in my kitchen and it keeps me off my phone.

Like one of the problems with a phone having all your music on, and I get it, and I do have music on my phone as well, but- I'm going to go and buy a CD player. Mate, honestly, they're really cheap now. So I've got it there. Can you still buy them? You still can but well, mine's I don't know actually, I've not looked for a while but mine's- you probably can. The point is that I've found what works for me which is I, like many people, also feel quite busy a lot of the time. Married, young kids, busy job, et cetera, et cetera, like many people. And so I realized if I just put on one of my favorite albums in those 30 minutes or whatever it might be that I'm in the kitchen preparing, it completely changes my experience of it.

Do you know what I mean? Which if you're doing it kind of, you know, flicking through WhatsApp. So, yeah, you get frustrated. I've got that email to get back to, I need to get back to that WhatsApp. And I'm like, no, put the phone away. But you've got to shop in advance as well. Like if you go to your shop at the end of the road, that's all the food you will be able to buy. So you also have to prep and go to a bigger supermarket or... You have to prep, unfortunately. And then my other invitation to people is simply to say you are part of an experiment you did not volunteer for, right? We do not know that emulsifiers, non-nutritive sweeteners, multidextrin, modified starches,

we don't know they're safe. They might be safe. The emerging data might be wrong. I think it almost certainly isn't. But none of us signed up for this. This stuff was just added without our consent to all our food. So you have to feel a bit angry. You can be a victim if you want, but I think you've got to move from, I moved from sort of victimhood to sort of activism quite quickly. And you have to think of shopping, I guess, as an activist project. That's how I think I just don't want to give my money, my financial support to companies that don't just harm us, that they, you know, they are harming the global ecosystem. They're harming children all around the world. I mean, they're incredibly predatory. They're very extractive from the global South to the global North. You don't really want to give most of these companies your money.

And then I invite people to just eat along for a month. Like if you, I mean, you don't have to buy my book. Lots of people can't afford the book. There's loads of, there's a great piece in the Guardian you can get for free by Bea Wilson, who's a mentor of mine, really. She's an incredible writer. And you can read Bea Wilson's piece in The Guardian for free. Eat the food for a few days, like for two, three days. Go on an 80% UPF buy-it. Buy all your old childhood favourites.

Tuck in. You're already, most of us are eating this stuff anyway. Read your ingredients lists. The one thing I did is I pour it out on a plate. Like if you get a takeaway, serve it on China with a knife and fork, and you will realize that's when the lie is exposed. You know, you get your burger and fries and you're like, this is a sad, this isn't the picture in the app. And you, you know, hopefully you can make that journey from addiction to disgust. Some people are going to find it really easy. I'm just going to cut down, you know, hopefully you can make that journey from, from addiction to disgust.

Some people are going to find it really easy. Just go, I'm just going to cut down. You know, the same people, you've had loads of patients, they're drinking a half a bottle of wine a night and they can quickly turn that to like a glass of wine, you know, every few nights and that's fine. Some people are going to struggle and those people have my love and my, my support. And I would just say, you know, it's incredibly hard. And if you do struggle, there are going to be some people who find this impossible. And I, you know, I don't know what to say to them. I don't, I think, you know, that's where someone like you, you sort of pick up at a moment where I'm, I'm uncomfortable. And I think, I think a lot of what you say will be really helpful to people. That's why it's kind of nice to come on here.

Look, it's always hard. How do you communicate this information? I passionately agree with you that our environment, in huge part, determines our behavior. But I guess where a doctor or a healthcare professional would come in is that you're generally seeing a patient one-on-one. So if it is a political solution, if it is a cultural solution, a societal solution that's required, it kind of doesn't help you in that one-on-one because that patient's coming, they're looking at you, they're struggling. One of the things I

learned in Oldham with families who were struggling and type 2 diabetes was rampant in that practice, was for patients who felt that they couldn't afford much, I'd really spend a lot of time going, okay, look, what are you eating? Okay. And I remember at the time, there was a Tesco's nearby, a big Tesco in that area. And 12 eggs. I can't remember how much it was, but it was pretty cheap. But for those individual patients, I found that just telling them about eggs and how nutritious an egg can be,

instead of, let's say, a breakfast cereal that was full of sugar and full of flavouring. You can get a dozen eggs for less than the box. Yeah, the point I'm trying to make is that my whole point of doing this show is to try and empower individuals because it's individuals who listen. Yes, there are a lot of policy makers who listen as well.

And I hope that your book and this sort of conversation helps them realise and politicians realise we have to change things because it's unfair to put this on individuals. But I also want to, without making people feel bad, I want to lead them with hope where they go, I can at least make some changes. But this is a very important distinction between us. People need to do the same thing. Now, because I am literally speaking to policymakers, I go into the Department of Health and I speak to companies, I never ever take their money because I write policy articles and I work with charities that influence policy

and I advise WHO. I refuse to have a discussion with anyone publicly about the affordability of food. I'm being a bit arch here. And so here's a sort of public confession is, it is, I think, for many people affordable to actually switch to a whole food diet. I never ever say that, because who am I to say that? I have such privilege and a history of privilege that I can't, it just isn't for me to say that out loud. I think there are so many food campaigners. I think you have a different voice to me. I think you have a slightly different audience. You're not in there with, you know, you're also not involved in a battle against industry in a way that if I open my mouth in that way and I start going, look at the price of porridge, look at the price of lentils, industry will paint me in a heartbeat

as privileged, middle-class, snobby, generating food stigma. So I'm a bit arch about it and I'm kind of almost to the point of perversity. I refuse to give advice. But that's your role. Because all my laser focus is regulate industry, stop the food industry paying the policymakers, and put a warning label on the food. And we need people in all camps, I would argue. Yeah, 100%.

We need people like you who are putting pressure on these policymakers to make changes that ultimately make it easy for people to make the choices that actually they do want to make. And did you notice, never once in that book do I celebrate real food. I mean, there is a moment where I talk about the evidence that walnuts and olive oil are good for you. But basically, I don't mention real food in that book as being sort of healthy. I don't celebrate it at all because there are so many voices from disadvantaged backgrounds and diverse voices who can speak to that cause.

And if I get involved in that, you know, it just kind of pollutes what they're doing and it muddies what I'm doing. Does that make sense? It totally makes sense. And I think this is really important because the solution is going to be multifaceted. By coming on here, the opportunity is in the, I mean, this is going to be the work of my entire lifetime, right? Like it took us 60 years from the evidence that tobacco products cause lung disease, the uncontrovertible evidence, to any meaningful regulation, fully 60 years. Now, I think this will take 30 years with food. It'll happen quicker because we will use the tobacco control template to regulate the food industry. And we sort of know how to do it. It's still going to take ages. So in the intervening

three decades, someone has to say to people, and I work with lots of people and, you know, including you, who can then promote individual solutions and solutions in the meantime. Yeah, I think it's so important. And I think I mentioned this earlier on in our conversation, but I gave a keynote in September at the British Society of Lifestyle Medicine annual conference. And just before me was Sir Michael Marmont, who of course has done incredible work in terms of the relationship between poverty and health. And I love his research. I think it's fantastic what it has showcased, what it has proven. At the same time, I think, I don't mean this with Sir Michael Marmot at all. I mean, just in general, I think within our profession, what I've found sometimes is that even online on social media, so well, this is a societal issue and it is a societal issue,

but we can take that to an extreme where I think we disempower individuals. And I think we can sometimes look down on people in poor families. I go, oh, you know, they can't do anything because, you know, what can they do until we make a big change for them? And maybe it's my background that makes me quite sensitive to that. But I think both things are true. It's really interesting.

No one's ever quite framed it like that to me. I'm not directing it at you, Chris, at all. But do you think I'm making a mistake with, sometimes I think, and everyone does say to me, look, just give us the quick guide, give us the what to do. And I kind of refuse to do it. But you're making me think like maybe there is a,

maybe I should lean in a little bit more to it. Because basically what I am doing, you're completely right that a little bit of me is going, people from disadvantage don't have any power to do this. I think what I really feel is they don't need to hear it from me. I really appreciate your honesty. I think it's really incredible what you're doing, how you do your advocating, the progress you're making. I think it's incredible I honestly think it's really incredible what you're doing, how you do your advocating, the progress you're making. I think it's incredible. And as I say, we need different voices. One thing I did want to talk about, Chris, just before we finish off, we both know a lot of

the science on ultra processed foods and what it's doing to human health, it seems from what I can tell that we have taken a slightly different approach with our children. Now- You and I have taken a different approach. Yeah, I think so. Oh, okay. Which I think is worth exploring because- Tell me, tell me. One thing I always say before talking about any parenting thing is,

I am just sharing my experience, right? I never want to tell anyone how to parent. Go for it. No, no, I'm certainly not telling you. And I think you have the same opinion, but you don't want to tell anyone else how to parent. We're trying to figure out. I have no idea what I'm doing. Like on a day-to-day basis, you know, I'm, you know, I do not, I'm not the power. Well, I'm not either, right? I think all parents genuinely are trying to do the best that they can based upon what they know. So how do you kind of feed or like, what do you say to your kids? What do your kids eat? So they will largely, until I would say the last year or two,

when my son has been in secondary school, where things start to change. They're 13 and 11. Okay, so I've got a 13 year old and 11 year olds. And again, I want to be very clear. My son was very unwell when he was six months old, right? Which is a huge part of why I do what I do today. So that has hugely influenced how I see the world and how I see the health for my kids. You know, we could have, he could have died when he was six months old in a foreign hospital. It was a very, very scary time. I've spoken about that before on the podcast. So therefore, having nearly had a son who was no longer around, I then see the world a particular

way, which is I want to do everything I can for my kids. Not that anyone doesn't, to be clear, which is I want to do everything I can for my kids. Not that anyone doesn't, to be clear, to promote really, really good health. So we've always had largely a whole food-based diet at home. And even when they were at primary school, they mostly would. So if they went to, I remember when the kids would go on school trips at their first school, we would make them fruit. I say we, my wife, let me be really clear on this. She would make these really nice fruit kebabs where they would take with them. And actually, I do remember one of the teachers once saying, wow, that's such an awesome idea. We normally give the kids sweets, but from next year, we're going to actually now, you know, make these fruit kebabs

because they're really easy to do, which that's a side note. We generally will try and eat mostly whole food at home. Yes, of course, now that my son's a bit older, he goes out with his friends, you know, they'll go to Pizza Express, whatever it might be. And I struggle, what I struggle with is knowing this science. I think Pizza Express is okay. Yeah. I don't know. But the point is, the point, I guess, in a long-winded way I'm trying to get to is, you can know the science and you've written a wonderful book on this, right? And then you're like, okay, knowing that, what on earth do we do? Because everywhere around us, they're being offered this food. At every party they go to, they're being offered this food. Often at schools, they're being offered this food. And then, they go to, they've been offered this food. Often at schools, they've been offered this food. And so how do you bring them up and not be a social outcast? This to me is the most important thing is I'm treading this kind of high wire of going,

I don't want my kids to be weird. I mean, you know, anyone who's been a kid knows the most important thing when you're a kid is to be normal. It's just as a fit in. And sure, we love our kids to be the kind of quirky outsider who's absolutely confident but most of our kids aren't like that so my view is i don't tell them not to eat stuff at parties when they go to a party it is open season my my i've got a six and a three year old right so dialogue with a three-year-old is somewhat limited but lyra knows lyra can read your chapter and verse on ultra precious food and she understands that some food is nourishing and some food isn't. When she goes to a party, she eats quite a lot of rubbish.

You know, grandparents bring it into the house, they get party bags. So we have a blue bowl in the kitchen that's up on a shelf. It's just full of absolute rubbish. And they get it, I would say, if I'm really honest, most days, they will probably most days, not every day, they get after dinner, they will get some little treat or sweet from the blue bowl. But it is not the foundation of their diet. But some, but yeah.

So does that sound? No, I really appreciate it. But how do you do it with yours at parties or when grandparents or relatives or friends bring around? The grandparents know what we're keen on, what we're not. But... You control your grandparents? Well, let me...

The thing is, it's very easy to look at the downstream situation now without looking at the upstream drivers many, many years ago. So because of what happened with my son, that then changed everything for us and how we look at this, right? So had that never happened, I'm not sure how I would parent, right? I honestly can't say.

And I think it's easier when you do it from a super young age. Now, here's the situation, Chris. I, like everyone else, is trying to do the best that I can. I don't know if in five to 10 years time when they're no longer under, well, even sooner, I don't know if they'll go off the rails and go find that this was restrictive. I don't know. I've definitely loosened up over the last few years because I think, actually, you don't want to wrong a chill out a little bit. He needs to fit in with his friends. So I've had to look at my own baggage around that and deal with that.

And I think sometimes I watch them now and I go, I think they made some pretty good choices. And I wonder, we also have always spoken about food from a very young age. Sounds like you're doing that with your kids. They understand, they know all the stuff that I write about and have been writing about for seven, eight years now. We discuss all these ideas. I remember when they were sort of six and three or six and four talking about, I mean, people might go, this is a bit over the top, right? But, you know, what phytonutrients are and, you know, this, you know, tomato's got... We talk about some foods are good for your bones,

they'll make you stronger. But my experience of, you know, so I do a kid's show on Children's BBC, Operation Ouch. And so I meet lots and lots of kids. And from a very young age, kids want to be good at sport, smart, to be healthy, to be smart, to be healthy, to be strong, to do all these things. Kids are quite motivated. And we've got data from Chile where they properly label bad food. They put big black hexagons on it. When you put big black

hexagons on packets of sugary cereal, kids tell their parents to stop buying it. Just like you and I, I mean, I remember telling my dad to stop smoking because, you know, I knew smoking was harmful. So kids care more than we think. And I suspect you do this. I try and give my kids some agency. So just as patients hate advice and the public hate advice, my kids don't love advice. But if I present them with raw fruit and veg when they're watching telly before dinner and they're bored they will eat it and if i can stop them eating too much rubbish before dinner they will eat a real dinner of sort of fish or meat and vegetables and then for putting you know they yeah but not forbid. But not forbidding. I was... I wasn't forbidden. I was...

My mum did an incredible job of creating a food culture in our household. There was food I didn't get as much as I wanted and then I went nuts on it when I was a teenager. I don't know. It's hard. I don't think there's some... I don't think there's a...

You know, I think ultimately we all have to do what we feel is right. Maybe we'll revisit this conversation in 15 years and we can compare like which approach, you know. And of course, as you mentioned before, our genetics and how susceptible we are to certain things and, you know, and peer pressure and certain foods and temptations are all going to play in. I definitely know that I feel I've softened a lot over the last few years, but I still think how I've softened is probably, to most people... An extremist.

Yeah. But then, to sort of maybe defend myself for a minute, let's look at the state of society and how sick society is. And I'm not going to blame on individuals and what, you know. You are a sane person in an insane world. One in five kids leaves primary school with obesity and at the age of five, this is how much shorter five-year-olds are in the UK than they are in Eastern Europe.

How much is that? Nine centimetres. Nine centimetres. At the age of five, right? If you took a classroom of British five-year-olds and you moved them to Bulgaria or Lithuania or Latvia or Sweden, you could tell the British class, because they would all be shorter than the Eastern or Northern European class. Because of the food. It's all because of food. And people say, no, no, no, it's because of migration of shorter populations. It

isn't. It's nothing to do with that. It's because of our diet. It's ultra-processed food. It's all our diet. It's ultra-processed food. Obesity and stunting go hand in hand, not just in the same village, in the same body. So there's a certain irony there where we are over-consuming. We have excess calories and we're ending up shorter. It's the same in America. And it's the same in Canada. It's kind of under-nutrition.

Yes, it is malnutrition, obesity, and climate change are these synergistic pandemics. So when you say, hold on, let me defend myself, look at the state of the world, it's like, you're completely right. But, you know, sane people appear insane when they start talking sense when everyone else around them isn't.

I guess, look, I'll be honest here and explain my discomfort in what I've just said, right? Which is, I feel I have to soften what I do with my kids to make it appealing. That's the truth. If we're being really honest, I feel- So that they're not weird. Yeah. Or even so, I don't come across as being weird to people. So you're not weird. I'm not judging anyone, but I really feel strongly that based upon what I know

and based upon my own life experience, I, of course, I'm trying to parent in the best way that I know how. And yeah, that's it. I kind of feel that, as I say, the worry for me is, you know, what happens as they get older? You know have to fit in but I think they've got a good group of mates and they're fitting in so I'm like I don't know only one thing certain is that whatever goes wrong in their life they will look back and blame whatever we did on that problem so well Chris listen I've I've so enjoyed this conversation we've gone into so many different areas. I'm going to push you at the end. You know I like giving advice.

I got it. I understand your reasons for not giving advice. But you've talked me a bit into it. Go on, ask. Could you, for that listener who... The one tip. Yeah, who wants to make a change. Well, yeah, the one tip or, you know, and maybe just prefix that with, are wants to make a change? Well, yeah, the one tip or, you know, and maybe just

prefix that with, are you optimistic about the future? I flip around on optimism. We controlled the tobacco industry slightly. Fewer people now smoke in the UK. We've seen the rise of vapes owned by the same companies. The companies have never lost any money. So I'm a sort of optimistic pessimist. It's like we did control smoking and we've got a map. So I think we'll get there. And people are furious. I mean, you see that the reason your podcast is so successful is because people are just wild with anger about the way they're being abused by all these different commercial determinants of health, but food is the most important.

So yeah, I am an optimist, or else I wouldn't bother doing all this. And the World Health Organization, UNICEF, certain parts of the government, different politicians, people are passionate about this and they get this. So yeah, I think we'll get there. The one, if you want like a really discreet piece of advice, my top tip, and this was told to me by a colleague at UNICEF, who's a professor of nutrition and the nutrition team at UNICEF,

like the best nutritionists in the world. And they said, if we only made one single intervention in any country, it would be to swap whatever children are drinking for milk and water. And that is, if that's the only change you make, that would have to swap whatever children are drinking for milk and water. And that is, if that's the only change you make, that would have the biggest health impact of any single health intervention. And so the place I would start with anyone listening to this is switch your liquid diet from whatever you're drinking, whether it's your supplement drinks or colas or whatever, to drink milk and water. And if you want a glass of wine on a Friday night, then don't sweat about it.

But I think that's probably the best evidence changed. Chris, ultra-processed people, why do we all eat stuff that isn't food and why can't we stop? Wonderful book. I've so enjoyed this conversation. It's so nice to see you again. And I can't wait for the next time. Thank you very much. Really hope you enjoyed that conversation. It is well worth reading Chris's book if you are interested in learning more about UPFs. And if you want practical advice on how you can actually improve your nutrition right now, I would suggest that you check out my first book, The Four Pillar Plan, which was also

released in America and Canada under the name How to Make Disease Disappear, or my fourth book, Feel Great, Lose Weight. Both of those books are jam-packed with practical tips on how you can improve your nutrition immediately before you go i just wanted to let you know about friday five perhaps this might be the ideal way to start off your new year it's my free weekly email containing five simple ideas to improve your health and happiness. In it, I share exclusive insights that I do not share anywhere else, including health advice, inspirational quotes, my comments on new research, and so much more. And in a world of endless emails, it really is delightful that many of you tell me it is one of the only weekly emails that you actively look forward to receiving. If that sounds like something you would like to receive each Friday, you can sign up for free at drchatterjee.com forward slash Friday Five.

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