Will the delicious (but ultra-processed) Coco Pops, toast and Tunnock’s biscuits I scoffed last night be the death of me?
LAST night, I got back late from work and, feeling stressed and tired, I raided the kitchen cupboards and scoffed a bowl of Coco Pops, two pieces of toast and all the Tunnock’s Milk Chocolate Caramel Wafers in the biscuit tin.
I knew what I was eating was highly processed and unhealthy — but the temptation of the short-term hit was too great to worry about any of the health implications.
As a doctor, I’m always handing out advice about eating this or that, exercising, quitting smoking, cutting down on booze and such like. I give this advice to my patients, my family and in this very column.
But following the advice is so much harder than giving it.
I’d be lying if I said those caramel biscuits weren’t delicious — but however mouthwatering, we all really do need to make a greater effort when it comes to ultra-processed foods (UPFs).
Essentially, these are processed foods packed with sugars and fat, with lots of additives — such as artificial sweeteners, emulsifiers and similar additives.
In the past few years, the noise about UPFs has become much louder. But I was never sure how much was hype and how much was actually fact.
HOWEVER, unlike with my previous late-night scoffing, this time I’m feeling more worried about it. For last week a study published in the BMJ by world-leading epidemiologists from across the continents changed everything.
In future, it will be regarded as one of those landmark studies that alters the advice we give to patients. Once and for all, it confirms the truth about the risks of ultra-processed food — it’s literally killing us.
This paper showed conclusively that people who ate the most ultra-processed food had a 21 per cent higher risk of death from any cause, a 66 per cent higher chance of dying from heart disease and a 12 per cent higher chance of getting cancer.
There were also increased risks for obesity — 36 per cent — and type 2 diabetes — 40 per cent.
But the greatest impact was on mental health — with a 48 per cent higher risk of anxiety and a 22 per cent higher risk of depression over the study period.
Previous research has demonstrated that there might be a link, but this review of studies brought together many smaller studies comprising data from more than nine million patients. With these numbers, the links between UPF and ill-health could be proved beyond doubt and with near statistical certainty.
And working in A&E, I see UPFs’ impact. I’d estimate that more than 50 per cent of the patients would not have become ill if it were not for a diet full of UPFs; strokes, cancers, heart attacks and diabetic complications are all so much more common in those who have more UPFs in their diet.
Groundbreaking, pioneering, landmark, whatever we call this paper, you can be sure that the food manufacturers are not going to take this lying down.
This industry is a multi-trillioneuro business and companies with vested interests will try every trick to delay the reforms that we need.
We only have to look into the history of smoking to see the playbook of what will happen.
Many doctors 100 years ago backed smoking and even claimed it was beneficial. They were paid handsomely to take part in tobacco marketing campaigns.
However, in the 1950s, two now famous epidemiologists, Richard Doll and Austin Bradford Hill, published a landmark study showing that smoking was associated with cancer.
The tobacco industry spent the next 50 years questioning the validity of the study, saying it was not proof and arguing that ‘being associated’ with cancer does not mean it caused it. The manufacturers argued that the only way to answer the question of whether smoking was dangerous was through a randomised controlled study. Half of the trial volunteers would smoke cigarettes and the other half wouldn’t — research that was plainly unethical and also undoable.
The effect was to delay the introduction of public health measures, such as bans on smoking in the workplace and elsewhere. Meanwhile, tobacco companies continued to make a profit, while millions around the world died from smokingrelated diseases. I see similar arguments about the research on ultra-processed food. For instance, that people who eat UPFs do die younger and suffer more often from cancer but there are other factors, such as their lack of exercise.
But as the tobacco research showed, there were other ways to prove smoking caused cancer — crucially by showing a strong statistical association. In the case of UPFs, the researchers found a 12per cent increased risk of cancer, proving beyond doubt that UPFs directly affect health.
There also needs to be a ‘biological gradient’ — in other words, the more UPFs you eat, the more unwell you become.
The new study showed this too — for example, with every 10 per cent increase in the consumption of UPFs, there was a 12 per cent increase in the risk of developing type 2 diabetes.
There also needs to be consistency in the results, which there was with the results coming from more than nine million people from multiple studies, each one providing the same results: UPFs are linked to ill-health. But, crucially, in order to prove the cause, there needs to be a scientific explanation for the findings. And we now have it.
It won’t surprise you to learn that ultra-processed food is nutrient-deficient but high in added sugars and unhealthy (but tasty) fats. Lacking in protein, they often don’t fill you up and so you eat more calories. But that’s only one half of the problem.
The foods often contain what are in effect edible chemicals, the likes of which our bodies have never experienced before in human evolution.
Studies have shown that chemicals, such as emulsifiers and artificial flavourings, can cause inflammation which triggers a whole host of ill effects. These include increasing damage to DNA that can lead to cancer and helping to create plaques in arteries that lead to heart attacks.
But it’s the disruption to the gut bacteria which I think is the most worrying and can explain the effects on mental health.
The gut-brain axis is a two-way communication system between the brain and the gut — changes in bacteria in our gut caused by UPFs disrupt the signalling from the gut to the brain via the vagus nerve (as well as changing hormones created by the gut). This is how UPFs can increase the risk of depression as well as anxiety.
The problem is that it’s not easy to make changes, firstly, because these foods are so addictive and, secondly, because it’s sometimes hard to tell exactly what an ultraprocessed food is.
A rough rule of thumb is if you had all the time in the world, could you personally grow the ingredients, or use an animal, to make the food in front of you? If not, it’s a UPF.
This includes breakfast cereals and snacks I used to think were healthy — protein bars, frozen meals and ready-meals (even lowfat, low-sugar versions), massproduced bread, baked goods and margarine.
JUST because something is marketed as healthy, doesn’t mean it is: the Coco Pops I had were labelled as ‘rice with added goodness, no artificial colours or flavours and 30 per cent less sugar’, and the health ‘traffic lights’ were mainly green.
But the cereal also contains 16 different ingredients, including glucose syrup, malt extract and cocoa mass.
Tackling UPFs is partly about individual responsibility, but also legislation and policies. Like they did with smoking, the Government has to take responsibility to nudge us into eating foods which won’t harm us.
For example, with taxes on ultra-processed food, with subsidies to make non-ultraprocessed food affordable; and, crucially, ensuring that public venues such as leisure centres, hospitals and schools serve and sell healthy dishes.
The question for me is: will my late-night snack choices end up killing me?
The answer, based on this new study, is very possibly yes. And that should set the alarm bells ringing not just for me, but for all of us.
‘I was in shock . . . I felt destroyed’
father,’ says Paul. ‘But I don’t have any control over that!’
It’s impossible to comprehend the depths of grief Paul has experienced in his life, but what is obvious today is that his inner strength is truly inspiring.
‘I went through everything you could imagine,’ he says. ‘You feel every emotion from helplessness and rage to guilt and fear.
‘And you also ask: “Why me?” until eventually, if you’re lucky, you learn: “Well, why not me?”
‘But in truth, I was just in shock for a long, long time. You go into survival mode when you experience something like that. Then you have to deal with the reverberations of everything you felt then and are feeling now.’
He adds: ‘But at the time, sure . . . I felt destroyed.’
The grief of seeing one’s family decimated might have felled a lesser man, ‘but I don’t think I ever thought of ending it,’ says Paul. ‘On the one hand, I don’t think I had the courage to take my own life and on the other, [I knew that] life is such a precious thing.
‘When I was in my 20s and 30s, I may have thought I was doing OK in life, but then you go through something like this and it will either teach you a lot or it’ll destroy you.’
Speaking from his home in California, Paul remains determined to channel his experiences into helping others.
To that end, he has been holding motivational Zoom talks for the past two years entitled Power of Awareness. ‘I usually talk for about 30 minutes and then answer questions,’ he says.
‘I primarily concentrate on the presence of fear in our lives and our inability to acknowledge it and do something with it. But fear is a natural state. Without it, you wouldn’t have love.’
Of his own experience he says: ‘Obviously, it was painful; obviously, I was fearful.
‘What I’ve learned is that you can utilise a painful, difficult experience and choose to focus on the part of you that is not suffering from it.’
Paul’s admirable lack of self-pity was echoed by his late wife, who co-wrote the book In The Absence Of Angels, a moving account of her experience which acutely captures the culture of fear surrounding HIV and Aids in the 1980s.
The family had managed to keep their situation private for more than three years, when it became known some Los Angeles schools had refused to admit Ariel.
As Elizabeth described at the time: ‘Some friends refused to let my kids come to their homes at all. Some said their children could continue to play with mine, but only at the park. Some dropped out of our lives.’
Paul admits today: ‘That felt isolating, particularly when you add the celebrity aspect to it.’
Elizabeth also described how she had to learn how to forgive: ‘I had to forgive the blood donor. I had to forgive the doctors, the hospitals, the schools, and I had to forgive fate.’
Though proud of everything Elizabeth achieved, Paul baulks at how ‘her life and her story have now kind of entered the pantheon of mythology’.
He adds: ‘People wanted to make her into a saint, but she did the best she could with what she had. And she did it very well.’
Paul’s matter-of-fact attitude extends to his fame, too.
‘Well, I look at acting as something I can do and as a way I find of communicating with people,’ he says. ‘But I’m a better actor than I am a celebrity. I was never comfortable with the fame.’
As well as his most memorable turn as Starsky — which ran for four seasons — he also starred in films such as Fiddler On The Roof and the Jack Nicholson-Diane Keaton rom-com Something’s Gotta Give. He also directed several movies and TV shows.
In 2004, he and David Soul teamed up again for cameo roles in the comedy film version of Starsky & Hutch, opposite Ben Stiller and Owen Wilson.
Two years after Elizabeth died, Paul married producer Tracy Barone, with whom he had a daughter, Zoe, now 26. The marriage ended in 2007 after 11 years. He now lives alone and focuses on his work as a painter and artist.
Of Ariel and Elizabeth he says: ‘I speak to them still, to that part of them inside me.’
Despite the obvious pain he has endured, he made a conscious decision to ‘not be a victim’ of circumstances beyond the comprehension of most of us.
‘You can choose to acknowledge your willingness to carry on and your desire to hope,’ he says. ‘You can find a way to love yourself and love the journey and the battle — and be proud when you do.’