INCLUDES EASY RECIPES, MEAL PLANS & ULTIMATE UPF LIST
HOW NOT TO EAT ULTRAPROCESSED NICHOLA LUDLAM-RAINE
HOW NOT TO EAT ULTRAPROCESSED
HOW NOT TO EAT ULTRAPROCESSED
Ebury Press, an imprint of Ebury Publishing 20 Vauxhall Bridge Road
London SW1V 2SA
Ebury Press is part of the Penguin Random House group of companies whose addresses can be found at global.penguinrandomhouse.com
Copyright © Nichola Ludlam-Raine 2024
Nichola Ludlam-Raine has asserted her right to be identified as the author of this Work in accordance with the Copyright, Designs and Patents Act 1988
First published by Ebury Press in 2024
www.penguin.co.uk
A CIP catalogue record for this book is available from the British Library
ISBN 9781529940114
Photography: Joe Woodhouse
Food Stylist: Eleanor Mulligan
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I dedicate this book to my two little children.
May you both grow up to be healthy and happy.
Chapter
PART THREE: LOOKING AHEAD
A note before we begin
I have worked clinically as a dietitian for 15 years, and in all that time, I can honestly say that my eating habits and the way I viewed food hadn’t really changed much at all … until I began researching and writing this book. Before I really looked into it, I thought the conversation around ultra-processed foods (UPFs) was just healthy eating wrapped up in different paper – but I was wrong to make this assumption. Writing this book has not only allowed me to share the advice and practical tips around diet that have helped my clients and patients over the many years I’ve been practising, but it has also allowed me to share the new issues associated with modern-day diets and UPFs –as well as the accompanying nuances – alongside potential solutions to help.
My aim isn’t for you to drastically overhaul your diet in one go, but to instead encourage you to pause and reflect on your current diet and, over the next month (and beyond!), make sustainable swaps and simple changes to improve your health not only for now, but for the future too. The information in this book applies to everyone, and although I truly believe it will help to educate and empower you, it is not a substitute for personalised advice from a healthcare professional.
PART ONE GETTING TO KNOW UPFs
CHAPTER 1
INTRODUCTION TO UPFs
It may be tempting to pick up this book and skip straight to the weekly plan, but having worked with thousands of people who wanted to improve their diets, I know that a diet plan alone (sadly) doesn’t result in long-term change. What’s needed is the backstory, and the reasons why change matters. During this introduction I will tell you what ultra-processed foods (UPFs) are, and why you need to pay attention to them.
Here’s to improving your knowledge and your diet quality by making empowered choices, which will result in eating fewer UPFs once and for all.
WHAT ARE UPF s ?
Have you been hearing more and more about UPFs (ultraprocessed foods), yet are confused about what they are, as well as their importance? If the answer is yes, you’re not alone! Even as a dietitian with over 15 years of clinical experience, I’ve had to do some serious digging, research, thinking and discussing with colleagues about what UPFs actually mean for me and my clients, and how best to translate this fairly new scientific area into practical, take-home messages regarding diet and nutrition. To put it simply though, UPFs are foods that have undergone significant processing and modification from their original state.
They are usually hyper-palatable and often contain many ingredients, including those that are not typically found in a home kitchen, such as stabilisers, emulsifiers, preservatives, colours and artificial flavourings to enhance the taste.
WHAT WILL THIS BOOK SHOW ME?
Healthy eating has become a complex web of dos and don’ts that can leave even the smartest and most well-informed people baffled. One minute we are told that a certain food should be part of our diet, then in the next breath we are told it should be banned altogether. It can be exhausting, and social media only perpetuates these confusing matters.
This is exactly why I decided to write this book – to share my knowledge and insight with anyone who is keen to know more about UPFs, or who has ever reached out to me with questions or concerns in regard to food and nutrition. This book aims to simplify the subject of UPFs, and will help you to eat fewer of them on a daily basis (in particular the less-nutritious UPFs) without feeling like you are on a diet! After all, it’s not about diets, it’s about a way of life.
With this book, my promise to you is this: we’re going to cut through the noise and confusion in order to address UPFs more directly; we will demystify the inner workings of UPFs, and I will provide simple advice that makes sense for your everyday eating habits. Think of reading this book as like having coffee with someone who genuinely wants you to feel better, both inside and out, and is willing to share practical steps on how to achieve this.
We’ll delve into what is actually in our food, discuss how to make smarter decisions and tackle questions like, ‘Can I still enjoy my favourite chocolate biscuit?’ Spoiler alert: yes, you can – think moderation, not deprivation! After all, life is too short to
completely avoid what we love. In my dietetic practice, there is always room for ‘soul foods’.
So, when you’re ready, grab your favourite cuppa and your favourite unprocessed or ultra-processed snack (there’s no judgement here – who doesn’t love a chocolate digestive with a tea?!), and let’s begin this journey of understanding and consuming fewer UPFs together.
WHAT’S THE DIFFERENCE BETWEEN UNPROCESSED, PROCESSED AND ULTRA-PROCESSED FOODS?
Let’s break it down. We often hear categories of foods such as unprocessed, processed and ultra-processed, but what are the definitions of these terms? Understanding these categories in greater depth is essential for making better choices to improve our physical health, mental health and emotional wellbeing, too.
‘UPFs’ is a fairly recent term, first coined in 2009 when researchers at the University of São Paulo, Brazil, proposed a new classification framework, known as NOVA, for grouping foods based on the extent of their processing. The NOVA system comprises four different levels, with UPFs sitting in level 4. Although useful as a population-level tool for global organisations and governments who need to assess diets, the NOVA system wasn’t designed to categorise individual foods, so I find it easiest to talk about food processing using three main groups:
Unprocessed foods * : Unprocessed foods are those that are relatively untouched, just as nature intended them. Think fruits, vegetables, potatoes, nuts, dried lentils and grains such as
* Unprocessed foods may have undergone very minimal processing in order to get them from nature to your table, but in general they have not had any other ingredients added, or nutrients taken away (unlike more refined carbohydrates where some of the fibre is lost).
wholegrain rice. These foods make it to your plate without much processing at all. Unprocessed foods are packed full of nutrients and are essential for good health.
Processed foods: So, this is when it starts getting controversial. Processed foods, as the name suggests, have been altered in some way by humans – but that does not mean they are necessarily ‘bad’. For example, tinned butter beans are ‘processed’, as the beans have been cooked and then tinned with water, but these ‘processed’ beans are a wonderful source of plant-based protein as well as fibre, plus, ready-to-go beans are also super convenient, meaning you’re more likely to use them than you are to use dried beans. Most milks and yoghurts have also been processed, as they’re pasteurised to ensure safe consumption, but they are a great way of getting both calcium and iodine into our diets, and additionally, they help with healthy gut bacteria. Pasta is another example of a (minimally) processed food – it contains just one ingredient (wheat), but is still processed as it isn’t found in nature.
Ultra-processed foods (UPFs): Now let’s go one level up to ultra-processed foods (UPFs). According to the NOVA classification, UPFs have undergone significant processing and modification from their original form. UPFs also contain ingredients that aren’t found in a typical home kitchen: additives including preservatives, emulsifiers, artificial colours and flavours. Typical UPFs include soft drinks and fizzy drinks, packaged snacks, reconstituted meat products, as well as pre-prepared frozen meals, which tend to contain excessive amounts of fat (saturated fat in particular), sugar, salt and calories, while falling short in essential nutrients. These foods may also be known as HFSS, which identifies foods and drinks that are high in fat (particularly saturated fat), salt and sugar. Healthier and nutritious foods may also fall under the UPF category though, including wholegrain breakfast cereals, fish
fingers, supermarket sliced breads (even wholemeal) and baked beans too.
How do I know what is ultra-processed?
We’ll get into how to further identify and evaluate UPFs later in this part of the book, however, as a quick cheat sheet, I have included a list of the most commonly eaten foods and drinks in the Appendix of this book (see page 259). I have divided them into four different groups: unprocessed, minimally processed, more processed yet nutritious, and more processed and less nutritious. You may find it useful to refer to this list as you work through this book:
• GROUP 1: Unprocessed
e.g. oats, apples and potatoes
• GROUP 2: Minimally processed
e.g. 100 per cent fruit juice, most hummus and tinned butter beans
• GROUP 3:
More processed yet nutritious (technically UPFs)
e.g. fish fingers, most baked beans, oat milk and some wholemeal bread
• GROUP 4: More processed and less nutritious (UPFs and HFSS)
e.g. chocolate biscuits, some oven chips and crisps, and most low-calorie snack bars.
WHY DO (PROCESSED AND) ULTRA-PROCESSED FOODS (UPF s ) EXIST?
The cynical answer here is that UPFs exist because a manufacturer’s main aim is to make money, and processed foods containing flavourings and relatively high amounts of sugar and salt not only taste good, but they make us want to eat more too. The real answer, though, is that it doesn’t just boil down to taste –ultimately, UPFs exist due to the need for preservation, logistical considerations and economics, too.
Their emergence dates back to World War II, when there was a dramatic shift in lifestyles – more women began entering the workforce, and with less time at home, families needed more convenient and quick meal options. Enter UPFs – heroes of convenience and shelf life! Let’s peel back the layers in order to understand manufacturers’ motivations, and to determine how and why UPFs exist at all.
Preserve food for longer: the miracle of shelf-life preservation
In large part, UPFs exist for one main reason: preservation. Before refrigeration and modern food processing methods were available, preserving food was essential. People needed a means of keeping it safe for longer. This led to canning, drying, salting and, later on, more complex methods like adding preservatives and emulsifiers – techniques that not only extend shelf life but help preserve texture and nutritional value too; think tinned vegetables or dried fruits – convenient options that let us enjoy off-season produce all year round.
Transportation: on a global scale
Have you ever gone to the supermarket and been surprised when a certain food is not there? We expect an abundance of foods to be presented to us every day of the year, and in order to provide access to this wide range of diverse foods, UPFs have been specially engineered so that food items can withstand the long journey from farms to factories (across the world), to supermarkets and then onto our plates. While this has revolutionised our eating habits, it has also led to the widespread popularity of heavily processed products.
Economic considerations: the cost factor
UPFs are cheaper to produce and are therefore more accessible to people and families with small budgets.* Plus their longer shelf life means less food waste, which is also necessary for some families.
Convenience: time-saving and eating on the move
Don’t overlook the convenience factor. Time is precious in our hectic world, especially since World War II, with most adults working at least a nine to five (and often more). Cooking from scratch is hard when time is scarce, and UPFs can offer quick and convenient meal solutions that assist busy lifestyles. Ready meals, instant noodles, frozen chips and microwave pizzas are popular as they are convenient and quick to prepare, and other UPFs such as packaged sandwiches, bottled fizzy drinks
* It must be acknowledged that there is often a financial cost and privilege when it comes to avoiding or reducing UPFs, as cooking more from scratch and preparing foods takes knowledge as well as time and cooking equipment. This book aims to provide you with the knowledge to make informed decisions and choices about food within your own personal means.
and snack bars are ideal for eating and drinking on the go – a common trait of modern-day life.
The rise in free-from and veganism: dietary requirements
My son has several food allergies, including dairy, eggs and soya, so I can safely say that without ‘free-from’ foods (most of which are classified as UPFs) and plant-based alternatives, I would struggle to feed him a balanced diet containing all the nutrients he needs. He has drunk oat milk (fortified with calcium) since he was a toddler, eats frozen fish fingers on an almost weekly basis for the omega-3 and iodine (I get the ones branded as high in omega-3) and his bread has to be carefully selected when we’re at the supermarket to make sure it doesn’t contain soya flour (the majority do) – so these restrictions cut our choices down dramatically. However, he has his oat milk on a highfibre cereal (wheat biscuits most of the time, with banana), and has peas with his fish fingers and baked beans (sigh, yet another UPF, we just cannot escape them!), meaning that overall, he does eat a nutritious and balanced diet.
As you can see, even dietitians (and children of!) do not eat a completely UPF-free diet, as the right UPFs can add nutritional value. ‘Good’ and ‘bad’ binary thinking when it comes to unprocessed foods versus UPFs, isn’t helpful and can cause unnecessary anxiety, as we shall explore later.
UPF s ARE A DOUBLE-EDGED SWORD
It is essential to recognise that while UPFs provide some longterm advantages, such as longer shelf life and affordability, they may contain a greater amount of added sugars, unhealthy fats and sodium (salt) than less-processed foods, and may also fall short in essential vitamins, which could contribute to health
issues if too many UPFs are consumed over time (quantity and context matters here). This is in addition to UPFs often having additional flavourings, colours, emulsifiers, stabilisers and preservatives added to them, too.
There is evidence to suggest that people also eat more when consuming a diet that is high in ultra-processed foods, which can lead to weight gain and poorer health outcomes. Researchers aren’t entirely sure why this happens, as it may not just be down to sheer palatability, but rather due to the easy-to-eat nature of the foods, which could lead to delayed satiety signalling.
What are emulsifiers? Are they all bad?
Emulsifiers are additives that help to stabilise processed foods, meaning they stop ingredients that wouldn’t usually mix, such as oil and water, from separating. They help to provide texture and increase shelf life too. There are questions regarding the impact of consuming large amounts of certain emulsifiers on the gut microbiome, however the effects are likely individual and more research is needed. Some small studies on animals (rodents) have found gut bacteria to be impacted by very large amounts of specific emulsifiers, which caused intestinal inflammation. But evidence is limited to only a few emulsifiers, and the gastrointestinal effects in humans from long-term consumption of large amounts of common emulsifiers are currently largely unknown.
What I would like you to remember, though, is that emulsifiers are generally present in foods in very small amounts – for example, soya lecithin, an emulsifier that is found in dark chocolate. What matters most when it comes to health (including our gut health) is our diet as a whole,
i.e. what you are mainly eating. Cutting down on the number of UPFs in your diet will mean that you will naturally be eating fewer emulsifiers, so please don’t worry about the effects of consuming small amounts. I have included more information about specific emulsifiers in the Appendix of this book (see page 263).
As we explore UPFs further, let’s keep in mind that they exist for many valid reasons, and it is up to us to navigate the terrain wisely if we wish to enjoy their benefits and not miss out on social occasions (not everyone has the time or skills to make a homemade birthday cake, for example!), while making decisions that support our health. There is a complex relationship between naturalness, food processing and healthiness, particularly when it comes to UPFs, which is an extremely diverse category. To say that all UPFs are unnatural and not nutritious is not entirely true, and hopefully this book will help you to realise that we can’t be so binary when it comes to labelling food that has been processed in some way.
THE NUTRITIONAL SPECTRUM OF UPF s
Herein lies the challenge, for not all UPFs are created equal when it comes to their nutritional content. Some pre-packaged, unflavoured or flavoured porridge (the pots that you add boiling water to), for example, might technically count as UPFs, but they can still form part of a nutritious (and convenient) diet. Yet on the other hand, a bag of crisps also counts as a UPF, but has lower nutritional values, with more salt and a less than ideal macronutrient composition. Crisps can still feature in a healthy balanced diet, of course, but the key is to manage portion size and frequency of consumption, as we will discuss. Making informed
choices requires understanding this spectrum and being aware of all of the options available to us at any given time.
As we move forward, keep in mind that in order to foster both health and happiness we need to understand what we are eating, we need to know how to make informed (healthy) choices and, most importantly, we need to enjoy the variety of food available to us (ultra-processed or not!).
Let’s look, then, at a high-UPF day versus a low-UPF day, to see how easy it is to consume a lot of convenience foods, and how you can begin making tweaks to live a more unprocessed life.
High-UPF day’s diet
Breakfast
Morning snack
Lunch
Afternoon snack
Evening meal
Dessert/ evening snack
A bowl of chocolate- or honey-coated cereal with milk, served alongside a shopbought orange juice drink (with added sugar and sweetener) and an instant latte sachet containing multiple ingredients not usually found in a home kitchen.
A packaged snack bar and a can of full-sugar fizzy drink.
A microwavable ready meal (such as a pepperoni pizza or a cheeseburger) that can be quickly heated and eaten within minutes.
A packet of crisps, a chocolate bar and a diet cola to satisfy hunger pangs.
Takeaway fried chicken with chips, followed by a shop-bought chocolate pudding.
A supermarket cookie, more crisps and an instant hot chocolate while watching TV.
Low-UPF day’s diet
Breakfast A bowl of overnight oats made with milk and plain yoghurt, topped with fresh or frozen berries and crushed mixed nuts, along with a small glass (150ml) of freshly squeezed or 100 per cent pure orange juice.
Morning snack
Seasonal fruit (fresh or dried) with almonds or walnuts.
Lunch A homemade salad made up of various fresh vegetables, grilled chicken breast, couscous and an olive oil and vinegar dressing.
Afternoon snack A homemade oat-based snack bar.
Evening meal
Dessert/ evening snack
Baked salmon, accompanied by steamed broccoli and homemade sweet potato wedges.
Greek yoghurt topped with a drizzle of honey, strawberries and homemade granola with raisins. Herbal tea.
In the high-UPF day’s diet, we observe convenience and speed – with minimal thought and no preparation required, meals can be ready quickly, yet they are often high in additives, sugars, unhealthy fats and sodium (salt), while also lacking essential nutrients. By contrast, in the low-UPF day’s diet, we observe whole, minimally processed foods which provide more nutrition and fibre, but which also require more time and effort to prepare – this may not be achievable or sustainable for everyone all of the time.
This comparison isn’t about labelling one day as ‘bad’ and one day as ‘good’, rather it aims to heighten the awareness of just how many options we are faced with every single day when it comes to our food – choices that will ultimately affect our health and wellbeing.
Pause to reflect. How did you feel reading the two diets shown? Can you relate to either? Are there variations in your own eating habits, with some days leaning towards a higher-UPF diet, and others leaning towards a lower-UPF diet? What factors influence your food choices?
As we navigate the vast realm of ultra-processed foods, it’s essential to recognise that not all UPFs are the same. There is a spectrum of choice, from more nutritious to less nutritious. Let’s look at a day where processed foods and UPFs are consumed, but more-nutritious UPF choices are made over some lessnutritious UPF options.
High-UPF (more nutritious) day’s diet
Breakfast Fortified breakfast cereal* high in fibre, calcium and other essential vitamins and minerals including iron, with semi-skimmed milk and a sliced banana (fruit is not a UPF, and milk isn’t considered a UPF either, even though it is processed during pasteurisation).
Morning snack A protein bar – high in protein and low in sugar.
Lunch A pre-packaged (long-life) tuna salad containing lentils, carrots, chickpeas, red peppers and a honey and ginger dressing. Water to drink.
Afternoon snack Baked crisps and fruit.
Evening meal
Dessert/ evening snack
Frozen breaded chicken (grilled) in a wholemeal wrap* with fresh salad (salad is not a UPF).
Low-sugar fruit yoghurt and an oat-based snack bar.*
* These foods can be UPFs or non-UPFs depending on their ingredients.
This day shows more of a balance when it comes to both convenience and health. Fortified UPFs (ones that are higher in fibre, protein and essential nutrients, while being lower in sugar and unhealthy fats) are prioritised, such as high-fibre cereal and wholemeal wraps.
UPFs, then, can be convenient and tasty options, and they don’t (all) need to be viewed as negative, as it’s the portion size and frequency with which we eat all foods that matters most. My aim is not to demonise UPFs (far from it), but rather to help you to make better choices that will lead you to habitual healthier eating in the long term. Together, we can better navigate the complex world of processed and ultra-processed food, in order to meet our health goals and needs effectively.
SO UPF s AREN’T BAD FOR US?
We’ve just explored how UPFs can have a (very convenient) place in our busy daily lives. But let’s get into this discussion, exploring the concerns and recommendations around UPFs.
As mentioned previously, a higher intake of UPFs has been linked with various health problems, including weight gain, which can be a risk factor for conditions such as type 2 diabetes and cardiovascular disease. This may be because many UPFs contain more calories (they are often energy dense), sugars, salt and unhealthy fats and lack essential nutrients such as fibre. In addition, lots of UPFs tend not to be very filling, and research shows that certain additives and flavour combinations can lead to addictive eating behaviours (once you pop …). In addition to promoting overconsumption, UPFs can also end up displacing more nutritional unprocessed and minimally processed foods from our diets. It doesn’t stop there, either – some UPFs have additional detrimental health impacts such as tooth decay (fizzy drinks and high-sugar snacks are
the culprits here) and changes in gut health, as we have previously discussed.
There are, of course, many factors that influence our health (our genetics, our access to healthcare and our social class, to name just a few!), and the research on the impact of UPFs so far does not prove cause and effect. However, the body of evidence linking a high intake of UPFs with health problems is growing, and with 50 per cent of the average diet (and up to 80 per cent in some people) now being made up of UPFs, health professionals are paying attention and are turning to the government to try to change this. Some people are even beginning to ask questions about the impacts of high-UPF diets and common mental health disorders. Despite this, the link between high-UPF diets and mental health is still far from clear, and will be difficult to unpick. This is due to the complex genetic, psychological and social factors that contribute to the development of mental health problems, not to mention the impact that struggling with mental health in and of itself might have on diet quality.
The Scientific Advisory Committee on Nutrition (SACN) in the UK has voiced concern over UPF consumption, noting how higher-UPF diets have been linked with poorer health outcomes (in particular for those who eat large amounts of them). But SACN also acknowledges that the current understanding of UPFs is limited. For instance, although the NOVA classification system (which categorises foods into four different processing levels) is helpful, it still leaves room for data error, and more research is needed in order to better comprehend the health impacts, as well as the place of UPFs within modern-day diets.
The foods that large health agencies such as the World Health Organization all agree we should be eating less of include red and processed meats, the latter of which mostly falls into the category of UPFs. We will be discussing this topic in more depth
later, but while having fresh, lean red meat two to three times a week may be within the realms of a healthy and balanced diet (lean red meat is a good source of easy-to-absorb iron), processed red meats such as ham, bacon, gammon and sausages should be eaten infrequently due to high intakes being linked with bowel cancer.
So, as you’re probably realising by now, although it may be tempting to view all UPFs as ‘bad’, their true impact is more complex, and what matters most is portion size and the frequency with which you consume them, in addition to the type of foods you are consuming most of the time. If you eat a mainly whole-food, unprocessed diet, the odd UPF isn’t going to be an issue, especially if it’s on the more-nutritious end of the spectrum.
So what can we take away from all this? We can comfortably conclude that balance and informed choices are the cornerstones of good health. UPFs are a part of modern life, and we can make decisions that will help us to maintain a healthy lifestyle – no matter how busy we may become.
WHAT ABOUT SUGAR?
Table sugar (also known as sucrose) isn’t classed as a UPF on its own, however it is found in many, if not the majority of UPFs on the market. Discussing sugar as a whole topic, however, requires nuanced consideration. While excessive sugar intake can be harmful to teeth and is linked to obesity, type 2 diabetes and other health conditions, its form and quantity matters. Natural sugars, found, for example, in fruits and milk, differ significantly from the added sugars found in UPFs, where moderation is key.
Let me explain a little further. Sugar is a type of carbohydrate, which include starches and sugars. Carbohydrates, specifically sugar (glucose), are our brains’ primary fuel source, but
our muscles use a mixture of both fats and carbohydrates for fuel – the ratio of which varies depending on demands (exercise intensity). When it comes to health, the type and portion size of the carbohydrates we consume matters, with fruits and milk (natural sugars), vegetables and wholegrain carbohydrates (starches) providing more nutrients than table sugar.
The government recommends that we limit our total sugar intake to no more than 90g a day, and our free-sugar intake to no more than 30g a day. Free-sugar includes table sugar (sucrose), sugars added by manufacturers to foods, as well as the sugar found naturally in fruit juice and honey. The natural sugars in whole fruits are not classed as free-sugars, as they are unprocessed and because fruit also contains fibre.
One of the issues when it comes to reading food labels is that manufacturers do not differentiate between the sugars that are naturally occurring and the free-sugars in a product (the latter of which are easier to overconsume and may be more harmful to health). This is why it is often more useful to look at the ingredients list instead. You will naturally start to do this more as you try to work out how many UPFs (and more importantly, what type!) are making their way into your diet. If sugar* or a syrup is near the start of the ingredients list, it means that there is a lot of added sugar within the product (relatively speaking), which implies that it could be a UPF and should therefore be consumed in moderation, and certainly less often than a more nutritious or whole-food equivalent.
* Sugar on the ingredients list can come in many different guises, including agave nectar, cane sugar, coconut sugar, maltose and palm sugar – don’t be fooled by a fancy name, sugar is sugar.