Demonizing Processed Foods: It's the Additives, Stupid

Hello and welcome. I am Dr George Lundberg, and this is At Large at Medscape.

If you, like the rest of us, are trying to figure out how to prevent yourselves and your patients from dying of coronary artery heart disease, stroke, or diabetes, you could do a lot worse than reading Yale professor Harlan Krumholz's reasonable viewpoint[1] titled Treatment of Cholesterol in 2017 published online July 24, 2017, open access, not behind a paywall. Thank you, American Medical Association (AMA).

Krumholz selects what he considers the best studies, assigns comparative numerical risks and benefits to statins, and counsels a healthful lifestyle for everyone. He adds a heavy dose of patient/physician participation in decisions when the directions in which the data point are unclear.

I have always thought of Professor Krumholz as particularly ethical, insightful, and more unbiased by conflicts of interest than most. His bottom line: smoking cessation, healthful diet, regular physical activity, and optimal weight.

Hmmmmm. So I emailed him (thanks to JAMA for including helpful author email addresses) and asked, "What is a healthful diet?" His immediate response: one without excessive calories, excessive processed foods, excessive sugary drinks, and excessive red meat.

Seems like everyone, including me,[2] is down on "processed food." Has that become a knee-jerk mantra? What is processed food? Is it always bad?

Processed food is any food that has been altered from its natural state in some way, either for safety reasons or convenience. Cooking, freezing, canning, drying, and pasteurizing are examples—many quite healthy. Thus, "processed food" is not the demon. One must look at what the process was and, more particularly, what has been added.

The answer is, a whole lot of stuff has been added. It is like the old Amos 'n Andy radio show: The big print gives it to you and the small print takes it away. Do not trust the marketing hype on the front of the box. Check the "Nutrition Facts" subsection labeled "Ingredients."

From labels in my pantry: Multigrain Wheat Thins lists 22 ingredients, including sugar, molasses, salt, and canola oil. All-Bran lists only nine, but includes salt and sugar. Creamy peanut butter lists 15, including sugar, salt, corn syrup, and hydrogenated vegetable oil. Ranch dressing lists 18, including sugar, salt, and canola oil. In some processed foods, you are swimming in sugar, salt, and oils. Notably, the type of sugar is often not specified.

Things to Avoid

What should you really try to stay away from? Here is a short list.

  • High-fructose corn syrup and "sugar" derivatives;

  • Partially hydrogenated vegetable oils;

  • Trans fatty acids;

  • Nondairy coffee creamer; and

  • Of course, too much of almost any food.

I know you know all that stuff, although you may not practice it. But here is some new stuff.

The gut microbiome is very complicated, [and] probably very important in obesity, diabetes, and metabolic syndrome. We have previously written about the probable adverse effects of ubiquitous antibiotics on the microbiome.[3]

Oil and water don't mix. They naturally separate, unless an emulsifier is present. Many emulsifiers are natural, such as gelatin, lanolin, and lecithin in milk and eggs. But antifat zealotry drove the food industry away from milk and egg products. So, synthetic and semisynthetic emulsifiers came into widespread use in the food processing industry in the latter 20th century. They are in many foods, such as ice cream, biscuits, cakes, bread, cookies, caramel, mayonnaise, jam, and breakfast cereals.

Seven common emulsifiers are carboxymethycellulose (CMC), polysorbate 80 (P80), lecithin, mono-and diglycerides (MDGs), stearoyl lactylates, sucrose esters, and polyglycerol polyricinoleate.[4]

Of course they, like all food products, have passed through US Food and Drug Administration testing for adverse effects. But those tests may not detect more subtle pathobiological effects.

Mouse studies demonstrate that the diminished gut mucus associated with two emulsifiers (CMC and P80) may permit penetration of gut microbes through the epithelium.[5] Relatively low concentrations of those same two commonly used emulsifiers, CMC and P80, induced low-grade inflammation and obesity/metabolic syndrome in wild-type hosts and promoted robust colitis in mice predisposed to this disorder.[5] Of course, that is mice.

Recent studies using microscopy in human colon specimens have demonstrated that the distance between colonic microbes and the epithelial surfaces is narrowed.[6] This colonic microbiota encroachment correlates with dysglycemia, but not with obesity. Obviously, much more research is indicated to connect (or not) these dots. As for me, to the extent possible, no more emulsifiers.

Be careful what you put in your mouth.

That is my opinion. I am Dr George Lundberg, At Large at Medscape


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