Are food companies responsible for the epidemic in diabetes, cancer, dementia and chronic disease and do their products need to be regulated like tobacco? Is it time for a class action suit?

Adapted from: Peper, E. & Harvey, R. (2024). Are Food Companies Responsible for the Epidemic in Diabetes, Cancer, Dementia and Chronic Disease and Do Their Products Need to Be Regulated Like Tobacco? Is It Time for a Class Action Suit? Thownsend Letter-the examiner of alternative medicine.  https://www.townsendletter.com/e-letter-26-ultra-processed-foods-and-health-issues/

Erik Peper, PhD and Richard Harvey, PhD

Why are one third of young Americans becoming obese and at risk for diabetes?

Why are heart disease, cancer, and dementias occurring earlier and earlier?  Is it genetics, environment, foods, or lifestyle?

Is it individual responsibility or the result of the quest for profits by agribusiness and the food industry?

Like the tobacco industry that sells products regulated because of their public health dangers, is it time for a class action suit against the processed food industry? The argument relates not only to the regulation of toxic or hazardous food ingredients (e.g., carcinogenic or obesogenic chemicals) but also to the regulation of consumer vulnerabilities. Addressing vulnerabilities to tobacco products include regulations such as how cigarette companies may not advertise their products for sale within a certain distance from school grounds.

Is it time to regulate nationally the installation of vending machines on school grounds selling sugar-sweetened beverages? Students have sensitivity to the enticing nature of advertised, and/or conveniently available consumable products such as ‘fast foods’ that are highly processed (e.g., packaged, preserved and practically imperishable). Whereas ‘processed foods’ have some nutritive value, and may technically pass as ‘nutritious’ food, the quality of processed ‘nutrients’ can be called into question. For the purpose of this blog other important questions to raise relate to ingredients which, alone or in combination, may contribute to the onset of or, the acceleration of a variety of chronic health outcomes related to various kinds of cancers, cardiovascular diseases, and diabetes.

It may be an over statement to suggest that processed food companies are directly responsible for the epidemic in diabetes, cancer, dementia and chronic disease and need to be regulated like tobacco. On the other hand, processed food companies should become much more regulated than they are now.

More than 80 years ago, smoking was identified as a significant factor contributing to lung cancer, heart disease and many other disorders. In 1964 the Surgeon Generals’ report officially linked smoking to deaths of cancer and heart disease (United States Public Health Service, 1964).  Another 34 years pased before California prohibited smoking in restaurants in 1998 and, eventually inside all public buildings. The harms of smoking tobacco products were well known, yet many years passed with countless deaths and suffering which could have been prevented before regulation of tobacco products took place.  Reviewing historical data there is about a 20 year delay (e.g., a whole generation) before death rates decrease in relation to when regulations became effective and smoking rates decreased, as shown in figure 1.   

Figure 1. The relationship between smoking and lung cancer. Reproduced by permission from Roser, M. (2021). Smoking: How large of a global problem is it? And how can we make progress against it? Our world in data.

During those interim years before government actions limited smoking more effectively, tobacco companies hid data regarding the harmful effects of smoking. Arguably, the ‘Big Tobacco’ industry paid researchers to publish data which could confuse readers about tobacco product harm. There is evidence of some published articles suggesting that the harm of cigarette smoking was a hoax– all for the sake of boosting corporate profits (Bero, 2005).

Now we are experiencing a similar problem with the processed food industry. It has been suggested that alongside smoking and vaping, opioid use, a sedentary ‘couch potato’ lifestyle, and lack of exercise, ultra-processed food (UPF) that we eat severely affects our health.

Ultra-processed foods, which for many constitutes a majority of calories ranging from 55% to over 80% of the food they eat, contain chemical additives that trick the tastebuds, mouth and eventually our brain to desire those processed foods and eat more of them (Srour et al., 2022).

What are ultra-processed foods? Any foods that your great grandmother would not recognize as food. This includes all soft drinks, highly processed chips, additives, food coloring, stabilizers, processed proteins, etc. Even oils such as palm oil, canola oil, or soybean are ultra processed since they heated, highly processed with phosphoric acid to remove gums and waxes, neutralized with chemicals, bleached, and deodorized with high pressure steam (van Tulleken, 2023).

The data is clear! Since the 1970s obesity and inflammatory disease have exploded after ultra-processed foods became the constituents of the modern diet as shown in figure 2.

Figure 2. A timeline from 1850 to 2000 reflects the increase in use of refined sugar and high fructose corn syrup (HFCS) to the U.S. diet, together with the increase in U.S. obesity rate. The data for sugar, dairy and HFCS consumption per capita are from USDA Economic Research Service (Johnson et al., 2009) and reflects  historical estimates before 1967  (Guyenet et al., 2017). The obesity data (% of U.S. adult population) are from the Robert Wood Johnson Foundation’s Trust for America’s Health. (stateofobesity.org). Total U.S. television advertising data are from the World Advertising Research Center (www.warc.com). The vertical measure (y–axis) for kilograms per year (kg/yr) on the left covers all data except advertising expenditures, which uses the vertical measure for advertising on the right. Reproduced by permission from Bentley et al, 2018.

This graph clearly shows a close association between the years that high fructose corn syrups (HFCS) were introduced into the American diet and an increase in TV advertising with corresponding increase in obesity. HFCS is an ultra-processed food and is a surrogate marker for all other ultra-processed foods.  The best interpretation is that ultra-processed foods, which often contain HFCS, are a causal factor of the increase in obesity, and diabetes and in turn are risk factors for heart disease, cancers and dementias. 

Ultra-processed foods are novel from an evolutionary perspective.

The human digestive system has only recently encountered sources of calories which are filled with so many unnatural chemicals, textures and flavors.  Ultra-processed foods have been engineered, developed and product tested to increase the likelihood they are wanted by consumers and thereby increase sales and profits for the producers.   These foods contain the ‘right amount’ processed materials to evoke the taste, flavor and feel of desired foods that ‘trick’ the consumer it eat them because they activate evolutionary preference for survival.  Thus, these ultra-processed foods have become an ‘evolutionary trap’ where it is almost impossible not to eat them.  We eat the food because it capitalized on our evolutionary preferences even though doing so is ultimately harmful for our health (for a detailed discussion on evolutionary traps, see Peper, Harvey & Faass, 2020).

An example is a young child wanting the candy while waiting with her parents at the supermarket checkout line. The advertised images of sweet foods trigger the cue to eat. Remember, breast milk is sweet and most foods in nature that are sweet in taste, provide calories for growth and survival and are not harmful. Calories are essential of growth. Thus, we have no intrinsic limit on eating sweets unlike foods that taste bitter.

As parents, we wish that our children (and even adults) have self-control and no desire to eat the candy or snacks that is displayed at eye level (eye candy) especially while waiting at the cashier. When reflecting about food advertising and the promotion of foods that are formulated to take advantage of ‘evolutionary traps’, who is responsible?  Is it the child, who does not yet have the wisdom and self-control or, is it the food industry that ultra-processes the foods and adds ingredients into foods which can be harmful and then displays them to trigger an evolutionary preference for food that have been highly processed?

Every country that has adapted the USA diet of ultra-processed foods has experienced similar trends in increasing obesity, diabetes, cardiovascular disease, etc. The USA diet is replacing traditional diets as illustrated by the availability of Coca-Cola. It is sold in over 200 countries and territories (Coca-Cola, 2023).

An increase in ultra-processed foods by 10 percent was associated with a 25 percent increase in the risk of dementia and a 14 per cent increase in the risk of Alzheimers’s (Li et al., 2022). More importantly, people who eat the highest proportion of their diet in ultra-processed foods had a 22%-62% increased risk of death compared to the people who ate the lowest proportion of processed foods (van Tulleken, 2023). In the USA, counties with the highest food swamp scores (the availability of fast food outlets in a county) had a 77% increased odds of high obesity-related cancer mortality (Bevel et al., 2023). The increase risk has also been observed for cardiovascular disease, coronary heart disease, cerebrovascular disease and all cause mortality as is shown in figure 3 (Srour et al., 2019; Rico-Campà et al., 2019).  

Figure 3. Association between consumption of ultra-processed foods and all cause mortality. Reproduced from Rico-Campà et al, 2019.

The harmful effects of UPF holds up even when correcting for the amount of sugars, carbohydrates or fats in the diet and controlling for socio economic variables.

The logic that underlies this perspective is based upon the writing by Nassim Taleb (2012) in his book, Antifragile: Things That Gain from Disorder (Incerto). He provides an evolutionary perspective and offers broad and simple rules of health as well as recommendations for reducing UPF risk factors:

• Assume that anything that was not part of our evolutionary past is probably harmful.
• Remove the unnatural/unfamiliar (e.g. smoking/ e-cigarettes, added sugars, textured proteins, gums, stabilizers (guar gum, sodium alginate), emulsifiers (mono-and di-glycerides), modified starches, dextrose, palm  stearin, and fats, colors and artificial flavoring or other ultra-processed food additives).

What can we do?

The solutions are simple and stated by Michael Pollan in his 2007 New York Times article, “Eat food. Not too much. Mostly Plants.” Eat foods that your great grandmother would recognize as foods (Pollan, 2009).  Do not eat any of the processed foods that fill a majority of a supermarket’s space.

• Buy only whole organic natural foods and prepare them yourself.
• Request that food companies only buy and sell non-processed foods.
• Demand government action to tax ultra-processed food and limit access to these foods.  In reality, it is almost impossible to expect people to choose healthy, organic foods when they are more expensive and not easily available in the American ‘food swamps and deserts’ (the presence of many fast food outlets  or the absence of stores that have fresh produce and non-processed foods). We do have a choice.  We can spend more money now for organic, health promoting foods or, pay much more later to treat illness related to UPF.
• It is time to take our cues from the tobacco wars that led to regulating tobacco products.  We may even need to start class action suits against producers and merchants of UPF for causing increased illness and premature morbidity.

For more background information and the science behind this blog, read, the book, Ultra-processed people, by Chris van Tulleken. 

Look at the following blogs for more background information.

References

Bentley, R.A., Ormerod, P. & Ruck, D.J. (2018). Recent origin and evolution of obesity-income correlation across the United States. Palgrave Commun 4, 146. https://doi.org/10.1057/s41599-018-0201-x

Bero, L. A. (2005). Tobacco Industry Manipulation of Research. Public Health Reports (1974-), 120(2), 200–208.  http://www.jstor.org/stable/20056773

Bevel, M.S., Tsai, M., Parham, A., Andrzejak, S.E., Jones, S., & Moore, J.X. (2023). Association of Food Deserts and Food Swamps With Obesity-Related Cancer Mortality in the US. JAMA Oncol. 9(7), 909–916. https://doi.org/10.1001/jamaoncol.2023.0634

Coca-Cola. (2023). More on Coca-Cola. Accessed July 14, 2023. https://www.coca-cola.co.uk/our-business/faqs/how-many-countries-sell-coca-cola-is-there-anywhere-in-the-world-that-doesnt

Johnson, R.K., Appel, L.J., Brands, M., Howard, B.V., Lefevre, M., Lustig, R.H., Sacks, F., Steffen, L.M., & Wylie–Rosett, J. (2009). Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation, 120(10), 1011–1020. https://doi.org/10.1161/CIRCULATIONAHA.109.192627

Li, H., Li, S., Yang, H., et al, 2022. Association of ultraprocessed food consumption with the risk of dementia: a prospective cohort study. Neurology, 99, e1056-1066. https://doi.org/10.1212/WNL.0000000000200871

Peper, E., Harvey, R. & Faass, N. (2020). TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Berkeley: North Atlantic Books, pp 18-22, 151. https://www.amazon.com/Beyond-Ergonomics-Prevent-Fatigue-Burnout/dp/158394768X/ref=sr_1_1?crid=1U9Y82YO4DKKP&keywords=erik+peper&qid=1689372466&sprefix=erik+peper%2Caps%2C187&sr=8-1

Pollan, M. (2007). Unhappy meals. The New York Times Magazine. https://www.nytimes.com/2007/01/28/magazine/28nutritionism.t.html

Pollan, M. (2009). Food Rules: An Eater’s Manual. New York: Penguin Books. https://www.amazon.com/Food-Rules-Eaters-Michael-Pollan/dp/014311638X/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=1689373484&sr=8-2

Rico-Campà, A., Martínez-González, M. A.,  Alvarez-Alvarez, I., de Deus Mendonça, R., Carmen de la Fuente-Arrillaga, C.,  Gómez-Donoso, C., & Bes-Rastrollo, M.  (2019). Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study. BMJ; 365: l1949  https://doi.org/10.1136/bmj.l1949 

Roser, M. (2021).Smoking: How large of a global problem is it? And how can we make progress against it? Our world in data. Assessed July 13, 2023. https://ourworldindata.org/smoking-big-problem-in-brief

Srour, B., Fezeu, L.K., Kesse-Guyot, E.,Alles, B., Mejean, C…(2019). Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé) BMJ,365:l1451. https://doi.org/10.1136/bmj.l1451 

Srour, B., Kordahi, M. C., Bonazzi, E., Deschasaux-Tanguy, M., Touvier, M., & Chassaing, B. (2022). Ultra-processed foods and human health: from epidemiological evidence to mechanistic insights. The Lancet Gastroenterology & Hepatology.  https://doi.org/10.1016/S2468-1253(22)00169-8

Taleb, N. N. (2012). Antifragile: Things That Gain from Disorder (Incerto). New York: Random House Publishing Group. (Kindle Locations 5906-5908).  https://www.amazon.com/Antifragile-Things-Disorder-ANTIFRAGILE-Hardcover/dp/B00QOJ6MLC/ref=sr_1_4?crid=3BISYYG0RPGW5&keywords=Antifragile%3A+Things+That+Gain+from+Disorder+%28Incerto%29&qid=1689288744&s=books&sprefix=antifragile+things+that+gain+from+disorder+incerto+%2Cstripbooks%2C158&sr=1-4

Van Tulleken, C. (2023). Ultra-processed people. The science behind food that isn’t food. New Yoerk: W.W. Norton & Company. https://www.amazon.com/gp/product/1324036729/ref=ox_sc_act_title_1?smid=ATVPDKIKX0DER&psc=1

United States Public Health Service. (1964). The 1964 Report on Smoking and Health. United States. Public Health Service. Office of the Surgeon General. https://profiles.nlm.nih.gov/spotlight/nn/catalog?f%5Bexhibit_tags%5D%5B%5D=smoking