STEWARDING: MENTAL & METABOLIC HEALTH

Hundreds of epidemiological studies and meta-analyses have reported associations between ultra-processed food consumption and adverse health outcomes. The literature is increasing - the evidence - is pointing to the fact that poor diets with high levels of ultraprocessed foodstuffs, not only drive diabetes - but most illnesses that are common New Zealand. Ultraprocessed foods are low in bioavailable nutrients, frequently high in carbohydrates, and contain high levels of manmade chemicals and high levels of chemically refined (as opposed to naturally refined or cold pressed) vegetable oils. Synthetic chemicals and vegetable oils are recognised as drivers of inflammation, while refined carbohydrates (or starches) drive insulin resistance. Nutritionally bioavailable vitamins and minerals are critical to all body functions, often acting as important co-factors in critical biological processes, from growth, to sleep, to brain health (memory, cognition and resilience and positivity), to reproduction and energy. Low levels of vitamins and minerals, systemic inflammation and insulin resistance are commonly recognised drivers of chronic and communicable illnesses. When people are unwell with inflammation or an illness, they more rapidly vitamin and mineral levels.

PSGR have identified a worrying gap in New Zealand's health governance. The Public Health Agency was established in 2022 to guide health decision-making, including to advise the Director-General and the Minister of Health. As with all agencies operating under the Health Act 1956 (s3A), the PHA must work to improve, promote, and protect public health. The PHA are focussed on equity but are not focussed on dietary nutrition. There is information or advice that states that dietary nutrition is outside the scope of the PHA, however, dietary nutrition and diet and nutritional deficiency as a driver of chronic disease is not in the work programme of the PHA. This was further confirmed via four Official Information Act requests, made in December 2023, and answered in February 2024, to the key members of the Senior Leadership Team (at that time) that this work was not being undertaken:

An Expert Advisory Committee on Public Health (PHAC) was established (Pae Ora (Healthy Futures) Act 2022 [s93]). The terms of reference for this Advisory Committee does not include any requirement to review dietary guidelines or nutrition standards (including to assess the literature on optimum levels of vitamins and minerals) and the position statement on Māori Health does not refer to diet and nutrition. Poor diets and sub-optimum nutrition are recognised drivers of risk for an extraordinary range of chronic and communicable disease, and poor diets will be more commonly experienced by low-socioeconomic groups.

There appears to be no other agency tasked with this responsibility, inside the Ministry of Health. The PHA in the role of advising the Director-General and Minister, and updating guidelines and regulations, should be reviewing best practice nutrition to increase knowledge on poor diets and nutrition, and to ensure that our regulations and guidelines do not drive disease but that they improve, promote, and protect public health, due to the regulations and guidelines being outdated. But this work is not being undertaken.

Drawing attention to poor diets, and sub-optimum nutrition is a big focus for PSGR.

We're looking for scientists and doctors to interview to support massive efforts already underway across New Zealand, working to bring this environmentally-driven sickness epidemic into public view in New Zealand. PSGR recently published a Substack article reviewing three groundbreaking books on the evidence that poor diets not only drive mental illness, but that dietary and nutritional changes can exert profound improvements in mental health.

We recently interviewed Professor Julia Rucklidge on amazing outcomes for high dose nutrients for pregnant mothers taking higher dose multinutrient formulations, where the nutrient levels are higher than (what appear to be) out-dated guideline and regulatory levels. We've previously interviewed Professor Ashley Gearhardt on how ultraprocessed foods likely meet the category for an addictive substance, and Dr Jen Unwin on reversing type-2 diabetes and the challenge of food addiction. We have also interviewed Dr Glen Davies on his work reversing type-2 diabetes, and we also interviewed Dr Emma Sandford on nutritional medicine and eye health, and how high carbohydrate diets are driving poor vision. We've also interviewed Dr Anna Goodwin on cancer and the role of diet and nutrition in not only supporting cancer recovery, but improving clinical treatment outcomes, which we published as a two-part series (Part 1 and Part 2).

In early 2024 academics from Australia, the US and France reviewed the evidence for diseases associations and ultraprocessed food across 45 meta-analyses. These meta-analyses covered some 10 million participants. Melissa Lane and colleagues identified direct associations between exposure to ultra-processed foods and health conditions which included mortality, cancer, and mental, respiratory, cardiovascular, gastrointestinal, and metabolic ill health. As the paper stated:

Overall, direct associations were found between exposure to ultra-processed foods and 32 (71%) health parameters spanning mortality, cancer, and mental, respiratory, cardiovascular, gastrointestinal, and metabolic health outcomes. Based on the pre-specified evidence classification criteria, convincing evidence supported direct associations between greater ultra-processed food exposure and higher risks of incident cardiovascular disease related mortality and type 2 diabetes, as well as higher risks of prevalent anxiety outcomes and combined common mental disorder outcomes. Highly suggestive evidence indicated that greater exposure to ultra-processed foods was directly associated with higher risks of incident all cause mortality, heart disease related mortality, type 2 diabetes, and depressive outcomes, together with higher risks of prevalent adverse sleep related outcomes, wheezing, and obesity.

Lane M M, Gamage E, Du S, Ashtree D N, McGuinness A J, Gauci S et al. Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses BMJ 2024; 384 :e077310 doi:10.1136/bmj-2023-077310

WHAT ARE ULTRA-PROCESSED FOODS?

What contributes to my chronic condition? There is compelling evidence that diet is the main driver of health status.[i][ii] [iii] The last 30 years of gene science has demonstrated that while individuals may be predisposed to a genetic condition, it is predominantly environmental drivers, or stressors, that tip people into health or disease.

Stressors can be acute or chronic. If people are (acutely) exposed to large amounts of poison, trauma, stress and pollution bodies can reasonably quickly tip into with a long-term illness or condition. However, if people are exposed long-term to food that wouldn't cause harm if we had a little bit every now and then. However, if we are chronically exposed to poor diets that promote inflammation, insulin resistance and poor nutrition - people can also tip into a long-term illness or condition. Frequently, chronic exposures promote multimorbidity. Chronic conditions can include a metabolic illness, such as pre-diabetes and Type 2 diabetes, heart disease, cancer, chronic pain. But also mental illness, included depression, anxiety and many other brain-related conditions, that might have previously been regarded as exclusively a neurotransmitter problem.

When infants, children and young people consume 40-60% of their diets as ultraprocessed foods, they may be expected to tip into a range of conditions, earlier than their ancestors.

By contrast - if food is nourishing and health promoting, bodies and minds[iv] [v] - are more resilient. Resilience means people recover better from the challenges, and insults of daily life. Even after trauma - we return to healthy sleeping patterns more quickly.

There is increasing evidence (as we discuss here) - that healthy diets can reverse many chronic mental health conditions.

Traditional (historic) diets depended on what food-types were seasonally available a person's region, and what skills human ancestors had to prepare and store food over colder months. Today people are generally sicker at an earlier age with long-term ‘chronic’ diseases and diagnoses. Studies of cellular biology, nutrition, case studies and large analyses demonstrably pattern the origin of these diseases, all too frequently, to poor diets.

These are generically referred to as ‘lifestyle diseases’, but the way people and families consider, cook and consume food is influenced by cultural, historic, social and economic factors which shape knowledge and capacity.[vi] [vii] [viii] [ix] Health is part of a big picture.

Human ancestors did not consume ultra-processed foods which promoted insulin resistance and inflammation.

Ultra-processed foods (UPFs) are industrial formulations of processed food substances (oils, fats, sugars, starch, and protein isolates) that contain little or no whole food.[x] UPFs typically include flavours, colourings, emulsifiers, as well as other cosmetic additives to make them taste better.[xi] UPFs contain many more industrial ingredients than traditional, lightly processed foods such as cheese; tinned fruit, beans, and vegetables.

Monteiro, C.A., Cannon, G., Lawrence, M., Costa Louzada, M.L. and Pereira Machado, P. 2019. Ultra-processed foods, diet quality, and health using the NOVA classification system. Rome, FAO.

UPFS: MIXTURES OF REFINED INDUSTRIAL INGREDIENTS

How are UPFs different? UPFs deprive your body of complex nutrient mixtures. Formulation ingredients can be derived from a remarkably small range of ingredients. Manufacturers do add nutrients – but these cannot reflect the complex nutrient and fibre bioavailability of, for example, a single vegetable. When you eat lots of these foods, you can end up eating a narrow range of ingredients all day, just in different formulations. So, you don’t get the nutrients which are required to keep you humming along.

UPFs increase exposures to complex synthetic chemical mixtures.

These industrial formulations include synthetic chemicals, as well as genetically modified and chemically refined cereals and oilseeds. These additives are less likely to nourish us, and at times may harm us, and drive disease. These chemical mixtures are not assessed for risk, and the science to consider how mixtures might drive inflammation and drive disease, for example, is poorly funded, in comparison to science to drive drug development for those same diseases.

UPFs deprive the microbiome of complex fibre mixtures.

UPFs are ‘smoother’ and less challenging to eat than foods with fibre. This is a problem, because without healthy fibre, people can’t sustain a healthy gut microbiome. The human gut microbiome is ground zero for human health. Health journeys are personal because of job type, exercise level, genes; nutritional intake, age; gut health, gender; financial status, address and parents’ history. While stress always was part of life, human ancestors were not exposed to the range of environmental pollutant emissions that appear to reduce our resilience to stress, at younger and younger ages.

Cumulative lifetime environmental exposures – and humans' biological responses make up what is termed the ‘exposome’.[xii] Governments do not prioritise the monitoring and risk assessment of toxic exposures to synthetic chemicals, drugs, genetically modified foods, heavy metals and radiation. This can be undertaken through biomarker monitoring and testing, for example, of hair and serum. Monitoring, risk assessment and regulation lags behind the release of technologies onto the market.[xiii]

ADDICTIVE PROPERTIES ARE FREQUENTLY 'BUILT-IN' TO UPFS

Change is especially difficult when industrial food scientists build temptation into the industrial formulations. Industrial food formulations are frequently designed to make the UPF really, really tasty – hyper-palatable. Yes. Some foods possess addictive properties.[xiv] [xv] Scientists have theorised that refined carbohydrates trigger the addiction responses in ultraprocessed foods. They’re the addiction agent.[xvi] As people have more of an addictive substance our dopamine receptors down-regulate. The body digests and absorbs refined carbohydrates rapidly. We do the same with potatoes, particularly if they are peeled.

Refined carbohydrates include sugar, white flour and white rice. These foods are metabolised similarly in the body. Refined carbohydrates together add up to a glycaemic load. They make blood glucose rise quickly. Sugar is the worst culprit. When sugar consumption exceeds our liver’s capacity to clear and metabolise sugar, sugar ends up in the brain, driving reward. [xvii]

Ingredients in UPFs are traditionally low-cost. UPFs are specially designed for travelling long distances. They have to store well. UPFs are generally low in fibre, because fibre as an ingredient in food starts to break down, or go ‘off’. The food substances are often obtained from a few big high-yield crops (corn, wheat, soya, cane or beet). UPFs contain chemically refined, vegetable oils (such as canola, corn and soybean) rather than olive oil or coconut oil or butter, which are not chemically refined.

Corn and wheat might be synthesised into many different ‘ingredients’ - but the body is only consuming two food types. It is difficult for people on a high-wheat, high UPF diet to remain healthy over time.

As UPF exposures increase, industrial chemical exposures increase, while nourishing bioavailable nutrition & fibre decrease.

Change is never convenient when a person can’t sleep, when a person is hurt, fatigued and suffering.

Understanding these factors, and particularly, how addictive properties are embedded into the products, can create challenges to change, but also can help individuals and families reconsider things. This includes stopping blaming yourself, or the household cook, and realising that addiction is a product property to drive re-purchase. Addictive properties are critical to marketing. When individuals and families recognise that industrial commercial foods are cunningly designed for repurchase, this can help in the shifting of gears away from addiction-driven habits.

Often, it can be surprising that shifting the body away from food with addictive properties, is like any magnet. The pull is stronger in the short term, while over the long term, skills and strategies can be implemented, and new, body-habits nourished, to reduce that magnetic 'pull'. Withdrawal feelings are normal, and regression is normal, as prompts and triggers are embedded in daily life, from advertising signs to shops, to digital media.

Recognising that 'this is business' can help shift dietary habits (loyalty to a product) and purchase-decisions support your body, particularly the brain, with the safe and nutritious food human bodies really need. Many people are on similar journeys, and people find that they are not alone.

When governments don’t fund independent science, in the knowledge gap, the public can be sceptical of the safety claims of large, private companies. They can be aware of the advertising dollar in mainstream media, and the lack of focus on the addictive properties of UPFs - from toast to noodles to commercial fast food.

Key to this long journey, is becoming determined to relearn the skills of our ancestors.

Healthy diets can be remarkably cheap and simple to prepare.
As skills develop, cooking becomes efficient, planned, but also creative.
When addictive impulses are removed, and insulin levels are healthy - money can be saved, and snacks reduced, as the body doesn't have to negotiate fatigue and sugar spikes.
But like recovering from alcohol addiction - recovery is often best in community and group environments, to promote learning but also to gain support to navigate the daily hurdles that can drive .

REFERENCES

[i] Lane M M, Gamage E, Du S, Ashtree D N, McGuinness A J, Gauci S et al. Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses BMJ 2024; 384 :e077310 doi:10.1136/bmj-2023-077310

[ii][ii] Lane MM et al (2020) Ultra-processed food and chronic non-communicable diseases: A systematic review and meta-analysis of 43 observational studies. Obesity Reviews. 22(3):e13146. doi: 10.1111/obr.13146.

[iii] González Olmo GM et al 2021. Evolution of the Human Diet and Its Impact on Gut Microbiota, Immune Responses, and Brain Health Nutrients 2021, 13, 196. https://doi.org/10.3390/nu13010196

[iv] Rucklidge JJ et al (2021) Nutrition Provides the Essential Foundation for Optimizing Mental Health. 6:1, 131-154, DOI: 10.1080/23794925.2021.1875342

[v] Martínez EE et al (2020) Effect of ultra-processed diet on gut microbiota and thus its role in neurodegenerative diseases. Nutrition 71:110609 doi.org/10.1016/j.nut.2019.110609

[vi] Venn et al (2017) Social determinants of household food expenditure in Australia: the role of education, income, geography and time. Public Health Nutrition: 21(5), 902–911 doi:10.1017/S1368980017003342

[vii] Daniel C. (2016) Economic constraints on taste formation and the true cost of healthy eating. Social Science & Medicine 148:34-41. http://dx.doi.org/10.1016/j.socscimed.2015.11.025

[viii] Neuwelt-Kearns C. (2021) The realities and aspirations of people experiencing food insecurity in Tāmaki Makaurau. Kotuitui: New Zealand J Soc Sci Online. https://doi.org/10.1080/1177083X.2021.1951779

[ix] Vandevijvere S et al (2021) Food cost and adherence to guidelines for healthy diets: evidence from Belgium. Eur J Clin Nutrition (2021) 75:1142–1151

[x] Monteiro, C.A., Cannon, G., Lawrence, M., Costa Louzada, M.L. and Pereira Machado, P. 2019. Ultra-processed foods, diet quality, and health using the NOVA classification system. Rome, FAO.https://www.fao.org/3/ca5644en/ca5644en.pdf

[xi] Monteiro CA, Cannon G, Levy RB, Moubarac JC, Louzada MLC, Rauber F et al (2019) Ultra-processed foods: What they are and how to identify them. Public Health Nutr 22(5):936–941

[xii] Karlsson et al (2020). Opinion. The human exposome and health in the Anthropocene. International Journal of Epidemiology, 2020, 1–12 doi: 10.1093/ije/dyaa231

[xiii] Persson L et al. (2022) Outside the Safe Operating Space of the Planetary Boundary for Novel Entities. Environmental Science & Technology 56 (3), 1510-1521 DOI: 10.1021/acs.est.1c04158

[xiv] Praxedes DRS et al (2022). Prevalence of food addiction determined by the Yale Food Addiction Scale and associated factors: A systematic review with meta-analysis. European Eating Disorders Review, 30:2;85-95 https://doi.org/10.1002/erv.2878

[xv] Moss, M. (2021) Hooked. Random House.

[xvi] Gearhardt AN & Schulte EM (2021). Is Food Addictive? A Review of the Science. Annu. Rev. Nutr. 2021. 41:387–410. P.393

[xvii] R.H. Lustig. “Fructose: It’s Alcohol without the “Buzz”,” Adv. Nutr. 4 (2013): 226.

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Shining a Light on Nutritional & Dietary Drivers of Disease