Ultra-Processed Doesn’t Always Mean Bad — Here’s How to Tell

September 11, 2024 — You may have been warned that ultra-processed foods can wreak havoc on your health. But not all of them are created equal.

A new study out of The Lancet Regional Health — Americas looked at different types of ultra-processed foods and found that some were even linked with lower risks of cardiovascular disease, coronary heart disease, and stroke.

“Avoiding all ultra-processed foods is not practical for most people,” said Dariush Mozaffarian, MD, a cardiologist, public health scientist, and director of the Food is Medicine Institute at Tufts University. “So, it is helpful to start to understand, within the category of all processing, what food might be more or less harmful.”

Researchers analyzed food questionnaires from three large groups of US adults, with most people in their review being White and female. The study found that sugary and artificially sweetened drinks, along with processed meats, were linked to a greater risk of cardiovascular disease and coronary heart disease. But cereals, savory snacks, and yogurt and dairy-based desserts were linked to a lower risk of these diseases. Ultra-processed cereals and breads were also linked to a lower stroke risk.

“We know that sugar-sweetened beverages are associated with metabolic derangement for things like higher glucose levels, insulin resistance, visceral obesity, prediabetes, diabetes, and higher triglycerides,” said Ashish Sarraju, MD, a cardiologist with the Cleveland Clinic. “Added sugars associated with all of those things are in turn risk factors for heart disease.” Sugar-sweetened beverages are often very high in sugar, artificial colors, and other additives, and almost “nothing beneficial” in terms of ingredients, Mozaffarian said. “They’re also consumed in very high doses, very quickly.”

Processed meats have 400% higher levels of salt, compared to unprocessed meats, said Mozaffarian. They also contain high levels of added nitrates, which are a carcinogen (a substance that can cause cancer) that could also affect the heart and blood vessels. Certain ultra-processed foods, such as bacon, are often fried at sky-high temperatures, which can trigger inflammatory compounds.

“If you put together the inflammatory effects, the salt, and the nitrates, this is a package of food that can really build to cause harm,” said Mozaffarian. The World Health Organization has also classified processed meats (bacon, ham, salami) as a group one carcinogen, he noted.

“Processed meats are typically high in saturated fats, sodium, and preservatives, which can increase blood pressure, promote inflammation, and negatively affect cholesterol levels, leading to a higher risk of coronary heart disease,” said Joseph A. Daibes, DO, an interventional cardiologist at Lenox Hill Hospital. “The study underscores the importance of limiting these types of foods to reduce cardiovascular risk.”

But considering that breakfast cereals — albeit highly processed — are a top source of whole grains for Americans, it makes sense that they are linked with lower risk of heart disease, said Mozaffarian.

“They have fiber, bran, whole grains, and they also have sugar, and additives,” he said. “But on average, putting all those things together, this study suggested that the net effect is beneficial. That doesn’t mean they couldn’t be more beneficial if we made them less processed, but they don’t seem to have harm.”

The active probiotics and fermentation in yogurt can make it a healthy snack of choice, as there has been more and more research showing that fermented foods with probiotics are good for heart health and work against metabolic disease, or a cluster of conditions that can increase the risk of stroke, heart disease and type 2 diabetes, Mozaffarian said.

Savory snacks, cereals, and yogurt and dairy-based desserts may also be less calorie-dense than sugary beverages and processed meats, said Daibes.

“Additionally, the type of fat used in savory snacks and the presence of probiotics in yogurt may have neutral or even positive effects on heart health, as opposed to the harmful fats and additives found in many ultra-processed foods,” he said.

How Ultra-Processed Foods Can Harm Your Health

There are “clear and concerning links” between eating ultra-processed foods and getting heart disease, according to Daibes. “In real-life clinical practice, it’s a rather clear and straightforward relationship — the patients who tend to have poorer diets, with more ultra-processed and nutrient-barren foods, tend to have worse health outcomes, both cardiovascular and otherwise,” he said.

Processing foods is centered on breaking down the natural structures of foods, as well as the loss of their natural nutrients, Mozaffarian explained. When you include the word “ultra,” this refers to putting in industrial additives.

“I think refined starches (such as wheat, corn, and rice) and sugars are some of the biggest harms because it leads to a big spike in blood glucose,” Mozaffarian said. “But also, those refined starches and sugars are digested so quickly in the stomach and small intestine that you starve your gut bacteria in your large intestines.”

Many “good-for-you ingredients,” such as fermentable fibers and bio-active compounds, are found in unprocessed, whole foods like fruits, vegetables, nuts, beans, and seeds, noted Mozaffarian. High levels of salt in ultra-processed foods are another cause for concern, as are other additives such as artificial flavorings, sweeteners, and thickeners.

Opting for Whole Foods

There may be people looking to eat cleaner, unprocessed foods, but high cost and a lack of access to them could create challenges. Sarraju advises his patients to simply do their best to eat foods in their whole-ingredient form and avoid prepackaged foods as much as possible.

SOURCES:

Ashish Sarraju, MD, cardiologist, Cleveland Clinic.

Dariush Mozaffarian, MD, cardiologist; director, Food is Medicine Institute, Tufts University.

Joseph A. Daibes, DO, interventional cardiologist, Lenox Hill Hospital.

The Lancet Regional Health — Americas: “Ultra-processed foods and cardiovascular disease: Analysis of three large US prospective cohorts and a systematic review and meta-analysis of prospective cohort studies.”