Ultra-Processed Foods: Concerns, Controversies, and Exceptions

Category: Nutrition

Tags: diethealthnutritionplant-basedprocessed

Entities: American Heart AssociationBeyond MeatDiet CokeDr. Michael GregerFood CompassImpossible FoodsNutritionFacts.orgStanford SWAP-MEAT study

Transcript

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"Ultra-Processed Foods: Concerns, Controversies, and Exceptions" And now for our final speaker of the conference. He is the founder of NutritionFacts.org,

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which has over 2,000 educational videos on pretty much any topic on  nutrition that you could want. And over the last couple of years, we’ve learned How Not to Die, How Not to Diet, How Not to Age.

And today, he is answering a burning  question on everyone’s minds.

00:34

And that is, what is the role of ultra-processed  plant-based foods in our diet? Ladies and gentlemen, it is an absolute honor to  welcome our final speaker, Dr.

Michael Greger.

00:59

Hey, hey, hey! Welcome everyone.

I love this conference so much. So honored to be here.

Alright. There is no conference I’d rather  be premiering a new talk for,

01:17

so let’s do this. Modern nutrition science began about a century ago in the context of nutrient deficiency diseases.

So, there were editorials with  titles like “Sugar as Food,”

01:37

heralding sugar as one of the  cheapest sources of calories. For a mere six cents, you could  buy three thousand calories.

What a bargain! But the Nutrient Deficiency era  gave way to the Dietary Excess era.

01:54

No longer were we dying of nutrient  deficiency diseases, like scurvy, as much as we were dying from  nutrient excess diseases, like obesity and heart disease. So, it became more about  avoiding too many calories,

02:10

too much saturated fat, too much sugar, too much sodium, but either way still focused on nutrients. This allowed food companies  to get away with abominations like frosting-filled cereal,

02:26

because it was fortified with  twelve vitamins and minerals, 50% better than the measly eight  in Marshmallow Froot Loops. However, food, not nutrients, is  the fundamental unit in nutrition.

02:45

And to their credit, the field of nutrition started moving  toward a more holistic view itself. So, first generation dietary guidelines  emphasized individual nutrients moved on to second generation  food-based dietary guidelines,

03:02

which largely converged on encouraging  diets rich in vegetables, fruits, legumes—which are beans, split  peas, chickpeas, and lentils— whole grains and nuts, but an area of emerging importance

03:17

was the degree of food processing. What if, when it comes to nutrition and health, it’s not so much the food or the nutrients as much as the level of processing?

For instance, a food-based dietary  guideline might say something like

03:33

“Eat more vegetable soup.” Great! But there’s vegetable soup, and  then there’s vegetable soup.

Are we talking a  clean-out-the-fridge vegetable soup? A health-haloed quinoa and kale organic

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with a heart-stopping 1,200 milligrams of sodium? How about a vegetable soup with  more salt than there are vegetables?

Or a vegetable flavor soup that  has more artificial colors and MSG

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than it has vegetables. All soup is not the same.

The degree of processing matters. Ultra-processed foods are these  industrial formulations which, besides salt, sugar, oils, and fats,

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include substances that are  really not used in cooking, like added flavors, colors, artificial sweeteners, emulsifiers, and other additives  used to imitate real foods, like a frosted grape Pop Tart with more grapes on the front of the package

04:42

than are actually in it, with less grapes than there are salt, but it may artificially taste like grapes and look like grapes because of one, two, three, four, five different food dyes.

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Simply put, ultra-processed foods are foods that can’t be made in a home kitchen, because they have been chemically  or physically transformed using industrial processes. They typically contain little or no whole foods, are ready-to-consume or heat up,

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and are fatty, salty, or sugary and depleted in dietary fiber and other nutrients. So, that’s like all the sweet, fatty, salty snacks like potato chips, ice cream, soda, candy, French fries, burgers, hot dogs, chicken nuggets, fish sticks.

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Basically, everything in a box or a bag. Why not just call them “packaged foods”?

Well, they were actually thinking about it, but they were afraid that some consumers would look at like a bag of apples and get confused or something.

05:47

But what is so revolutionary about this concept of ultra-processed foods? I mean, wasn’t fatty, salty,  sugary junk always a bad idea?

Why isn’t it enough to just tell  people to stay away from junk?

06:06

Because, Diet Coke. Diet soda is the perfect example of why a new kind of term like  ultra-processed can be so useful.

Because it has no calories.

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No fat. No sugar.

So, no problem, right? Well then, why is diet soda consumption  associated with premature death, stroke, heart disease, hypertension, diabetes, metabolic syndrome, leukemia?

And most studies controlled for body weight;

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so, it’s not just because heavier  people are more likely to drink it. Health risks are not only related  to the nutritional quality of ultra-processed foods but also  to the presence of additives.

No apparent calories, fat, sugar, or salt,

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but contains caramel color, which results in the formation  of 4-methylimidazole, which is a potential human carcinogen. And contains aspartame, also recently classified as  possibly cancer-causing in humans

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And contains phosphoric acid  which is a phosphate additive that may be damaging our health as well. And contains a benzoate preservative.

If you remove artificial colorings  and benzoate preservatives from the diets of preschoolers and then randomize them to be slipped a placebo

07:29

or a hidden cocktail of colors and benzoate, there is a significant reduction  in hyperactive behavior when they removed these compounds and then a significant increase  in hyperactive behavior when they got the colorings and benzoate compared to getting the placebo.

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Now, of course, it could have been the colors, not the benzoate, but that’s one of the problems. As little as we know about the  effects of these individual additives, we know even less what  combinations of them can do.

There is a large body of evidence

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suggesting toxicity from certain food colors, preservatives, sweeteners, and emulsifiers, in part sometimes through our gut microbiome. Now, industry apologists argue that the FDA carefully evaluates food additives

08:19

to make sure that they are  safe, until they’re not. In fact, to show the system works, they cite the removal of six  carcinogenic artificial flavors in 2018.

Artificial flavors that had  been in the food supply, approved for safety, since 1964.

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So, we were exposed for more than  50 years before they were banned. And that’s their example of the system working!

Aspartame, NutraSweet, was officially recognized as a potential human carcinogen in 2023,

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42 years after the FDA’s  own public board of inquiry opposed approval based on it  causing brain tumors in animals in the industry’s own studies. This included several FDA scientists  who didn’t think it should be approved.

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The FDA Commissioner, however, rejected these concerns and approved it anyway, before leaving the agency to enjoy  a $1,000 a day consultancy position with the aspartame company’s PR firm. And then, the FDA actually prevented  the National Toxicology Program

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from doing further cancer testing. Meanwhile, literally tens of millions of pounds made its way into the food supply.

Remember when the food industry thought partially hydrogenated oils was a good idea?

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Let’s replace saturated fats with trans fats. Although many countries now restrict their use, trans fats continue to kill an  estimated half-million people around the world every year.

Of course, saturated fat is also probably  killing hundreds of thousands a year,

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but the point is that trans fats from  partially hydrogenated vegetable oil killed people for decades before  there were any limits on it. The FDA didn’t ban it until 25 years after the first solid evidence that it  increased the risk of heart disease,

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and meanwhile, every single one of those years, trans fats were killing an  estimated 50,000 Americans a year. That is quite the death toll that can be laid at the feet of  the ultra-processed food industry.

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But they originally thought it was safe! That’s the problem.

Any time a chemical company  comes up with a new preservative or sweetener or artificial color, we have no idea how it is going  to turn out decades later.

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So, we can start to see the value of  this ultra-processed food concept, in which an entire category of products is essentially presumed  guilty until proven innocent. This drives the food industry crazy,

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but look at their track record, look at the trail of bodies they’ve left behind. If additives are the problem, well then,

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why not just stick to so-called clean label foods, made with simple, recognizable ingredients, no matter how the food is processed. But that’s assuming additives  are the only other reason that ultra-processed foods may be unhealthy.

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Harmful additives are just one of many ways ultra-processed foods have been linked to disease. At least the food additives  are listed on the label; so, we could avoid them if we wanted to.

Unlisted are some of the sneakier ways ultra-processed foods may be unhealthy.

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Harmful additives are just one of the ways that ultra-processed foods  have been linked to disease. Like advanced glycation end  products (AGEs), for example.

Increasing evidence has shown  that uptake of dietary AGEs, advanced glycation end products, is closely related to the  occurrence of many chronic diseases:

12:16

diabetes, chronic kidney disease, osteoporosis, and Alzheimer’s disease. In fact, it’s hard to find  a single age-related disease not associated with AGEs.

Dietary AGEs are abundant  in highly processed food, because thermal treatments are commonly used,

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but thermal treatment just means heat; so, we can get AGEs from industrial processing or just from home cooking. So, let’s look at some examples.

Canned corn has 20 units of AGEs per serving, compared to corn chips at 151  and corn pops cereal at 373.

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Rice only has 9, but rice crackers 275, and Rice Krispies has 600. So, you might be at the store and see some a no-salt-added rice crackers or a no-sugar-added puffed  rice cereal and be like,

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“Oh, it’s just straight rice. Perfect—one ingredient.” But no, because of the processing, it’s not just that one ingredient. A boiled potato has 17 per serving, potato chips 865, and fast-food fries over 1,500.

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So, ultra-processed plant foods can have  nearly 100 times more of these toxins than minimally-processed plant foods. But even raw, unprocessed animal foods start out with high levels  and just go up from there.

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Instead of the 10 or 20 in  cooked whole plant foods, fish, poultry, and meat start out at  around 500 or more in their raw state and then jump into the thousands once cooked,

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which is still considered minimal processing, though processed or ultra-processed meat can exceed 10,000 per serving. Although these contaminants are not  limited to ultra-processed foods, you can see how just considering foods  based on their listed ingredients

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fails to capture how food processing  can sometimes transform food at a molecular level. So, it’s clear that just using  this kind of clean label strategy of sticking to foods with simple  ingredient lists isn’t going to cut it, since you’re never going to read  something like AGEs on a label.

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It’s the processing itself, whether traditional or industrial, that is affecting the healthfulness of the food. In the latest dietary guidance document  from the American Heart Association, they advise choosing minimally processed foods, instead of ultra-processed foods.

Now, of course, they’re not  telling people to eat a steak,

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which is considered minimally processed, because they also emphasize that we should eat foods low in  saturated fat and cholesterol. But just like there can be unhealthy  unprocessed foods, like steak, they suggest there may be some  healthy ultra-processed foods,

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like what about, plant-based  milk and meat substitutes. Admonitions against the consumption of products simply because they are classified  as ultra-processed foods may impair society’s acceptance  of a plant-based diet—

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thus preventing any related health  advantages from being realized. And indeed, that does appear  to be a significant reason why many people avoid these products.

Is that a good thing?

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Is that a bad thing? Are plant-based alternatives healthier than conventional animal products?

Let’s find out. Food Compass is a nutrient-profiling system that rates foods on a scale from 1 to 100,

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with 1 being least healthy  and 100 being most healthy. Eight thousand foods have been scored; so, you can see where your favorite food falls.

And when I have my laptop next to me, I ask people to yell out their favorite foods, and we look up to see what the score is, and they’re all disappointed that their  raspberries are only 93 or something,

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but unfortunately, laptop’s in the back. Here are some examples of perfect 100 foods, and foods that score the worst, all the way from kale down to Coca-Cola.

OK, so the main objective of  ultra-processed “fake” foods

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is to imitate real foods. Like strawberry Pop Tarts trying  to mimic real strawberries.

When you start with a perfect-100  food like strawberries, the only way to go is down. So, fruit is better than  fruity-shaped marshmallows.

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But when the “real” food is ultra-processed meat, processed meat, or unprocessed meat, or dairy, there is a lot of room for improvement. Food Compass has scored nine  ultra-processed meatless alternatives.

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Let’s compare them to the closest  conventional meat matches. In every single case, the  plant-based meat was rated higher, healthier, and sometimes by a large margin.

Nearly all scored at least twice as high. Or three times the health score, seven times,

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20 times, even 60-fold higher. Other common nutrient scoring systems  all found the same general trend.

Now, better than chicken would be chickpeas. And better soybeans than soy burgers—

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soybeans are another perfect-100 food, but the choice on the Burger King  menu is between this and that, not between this and that. (Though, of course, there is a third choice:

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not ending up at Burger King.) This was just a few products  though, just as an illustration. A 2024 systematic review identified nine studies using nutritional scoring for the  assessment of over 2,000 meat alternatives

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and their meaty matches, and all of the studies, nine out of nine, sometimes found comparable scores, but mostly showed meat alternatives score better. Based on their nutrient profiles, plant-based meats and milks would be  expected to reduce chronic disease risk.

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When it comes to heart  disease, stroke, and cancer, plant-based meats would be  expected to decrease risk of these killer diseases by about 3% per daily serving replacement. Now, whole soy foods might  take that down an extra 2%,

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because they’re not weighed  down by the sodium issue, but overall, swapping in even just one serving of plant-based meat a day nationwide could potentially prevent more than  100,000 cases of heart disease, stroke, or cancer in the U.S. every year.

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It’s hard to get everyone to go  all kale and quinoa overnight, but a veggie burger should be easy. 100,000 cases prevented every year, with a single daily serving  swap of plant-based meat.

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Now, that’s just based on their  respective nutrient make-up— like how much saturated fat  versus fiber they each had. But remember how all the harmful effects of ultra-processed foods are not necessarily  captured by their nutrient profile?

There are 16 proposed mechanisms

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linking ultra-processed  foods to disease and death, and balance of nutrients is only one of those 16. And so, using these 16 criteria, normally, when you compare  ultra-processed products to the foods they were designed to replace,

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for example, water vs. Kool-Aid, or fruit vs.

fruit-flavored candy, the ultra-processed product tends to do worse and not just because of the  junkier nutrient profile. However, plant-based meats  appear to be the exception,

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better in most ways compared to the  foods they were designed to replace. We already covered nutrient profile, where plant-based meat tended to  score healthier than regular meat, based on every study, using every major nutrient profiling system.

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I don’t have time to go  through all of these right now. For those who want dive a little deeper, I had a paper published this year on the subject, which you’re welcome to download.

This Thursday, the 21st, I’m going to be giving a  three-hour webinar on the subject, where I will go into detail through  all the rest of those criteria,

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and I’ve got a book coming out on ultra-processed that will be out in January; so, you’ll have all the references handy, but with limited time, I’m going to skip through a bunch of these, though happy to talk about them in Q&A. In terms of additives,

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I’ve been long concerned that Red  No. 3 hadn’t been banned from food, given that it was banned over 30 years ago from anything going on our  skin, due to cancer risk.

But it’s still ok to eat?

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Thankfully, California passed a Food Safety Act, set to ban Red Dye No. 3 by 2027.

So, in 2027, Loma Linda Big Franks  will be illegal to sell in Loma Linda

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but would still be available to  potentially contribute to cancer risk throughout the rest of the country. But, the FDA finally decided to ban it from food, 35 years after it removed it from cosmetics, starting in 2027 as well.

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So, for now, this veggie bacon is  considered too toxic to rub on your skin but okay to eat— at least, for the next two years. Why has the pork bacon industry  figured out how to use cherry powder

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as a coloring before the  plant-based bacon industry? The most harmful additive in  plant-based meat, is ironically, really the most traditional and that’s salt,

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contributing to the #1 dietary risk  factor for death on planet Earth, excess sodium consumption. It is one of the most common ingredients  in plant-based meat alternatives.

But, also one of the most frequent ingredients used in conventional meat processing, and not just in processed meat.

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While the #1 source of sodium for  kids in this country is pizza, and in older individuals bread, one of the reasons the #1 source of sodium for those aged 19 through 50 in this country is chicken is because injecting  raw chicken with saltwater

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is a widespread practice in the poultry industry, something they’ve been doing since the 1970s, resulting in raw chicken breasts reaching  as much as 400mg of sodium or more, six times more than they’d naturally have. When it comes to salt, how does  meat and plant-based meat compare?

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A systematic review found that  the average levels of sodium were not significantly different overall between plant-based and conventional meat, which is not great, but there are some products are improving. When I created a chart five years ago for UBS, Beyond Meat burgers had 390 milligrams of sodium,

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which is in the typical 290 to 400  range of a regular American hamburger, but the current version is 20% lower at 310 mg, thanks to the use of potassium salt, potassium chloride instead of sodium chloride,

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and Impossible now has a  beef “lite,” with only 260. Ideally, we would be under 180, meeting the World Health  Organization’s recommendation for less than a 1:1 ratio of sodium to calories.

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All the foods we eat ideally should  have less sodium than calories. Plant-based meat tends to be better  when it comes to some additives, like carcinogenic nitrite preservatives, similar with salt and sugar,  and worse with emulsifiers,

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which might be expected to  hurt the gut microbiome, but vegetarians who eat plant-based meat actually end up with lower rates  of irritable bowel syndrome than those who don’t, which suggests that at least on that metric the emulsifiers don’t seem to be a problem.

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In fact, all three studies on  the impact of plant-based meat show microbiome benefits; for example, this randomized, controlled trial analyzing stool samples before and after even just swapping out about  five meals of meat a week

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for plant-based meat, confirming that even just the  occasional replacement of meat may promote positive changes  in the gut microbiome. In the second trial, the Mycomeat study, people were randomized to replace  a few servings of meat a day

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with the mycoprotein meat Quorn— made from the mushroom kingdom  rather than the plant kingdom. This swap not only increases the abundance  of beneficial microbes in the gut, it reduces fecal genotoxicity, which is the amount of DNA damage that  their feces can cause colon cells.

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Now, that may just have been because  they were cutting down on meat, but on the Quorn, there was  a boost in good bacteria, like lactobacillus, which may have benefits, suggesting that the fiber in mycoprotein  may have prebiotic potential.

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The two-week swap did not  seem to be long enough time to affect TMAO levels, though, but in the 8-week Stanford SWAP-MEAT study, in which two or more servings  a day of beef, pork, or chicken were swapped out with plant-based  beef, pork, or chicken, several cardiovascular risk factors improved,

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including TMAO, which stands  for trimethylamine n-oxide, considered like the smoking gun in  gut microbiome-disease interactions. When we eat meat, dairy, or eggs,

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the carnitine and choline get turned by  certain bad gut bugs into trimethylamine, which is oxidized by our liver into TMAO which can go on to damage various  organ systems throughout the body. So, the cardiovascular harm from eggs and meat

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is more than just cholesterol and saturated fat. TMAO is linked to some of our deadliest diseases— cardiovascular disease, diabetes, high blood pressure, stroke, cancer.

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Check out those P values. Those, are my kind of P values.

Like six times ten to the negative 21st. That means you’d only get a  finding that extreme by chance if you ran the study about  a billion trillion times.

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So, TMAO may also mean time to  minimize intake of animal products, which we can do by switching to plant products. Plant-based meals can also be better  for the upper digestive tract.

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If you randomize people to eat  chicken, cheese, fish, and steak, versus tofu, soy steaks, seitan, and soy burgers, you see twice as much heartburn  after the animal protein meal than after the plant-protein meal. And stick a probe down their throats,  and after the animal products,

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you see three times as much acid  exposure refluxing up from their stomach into their esophagus. The bottom line is that, unlike almost any other ultra-processed product, plant-based meat appears to be the rare case

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in which ultra-processed products  are actually better, overall, than the foods they were designed to replace. Now, this probably says less how healthy they are and more about how really  unhealthy modern meat is.

Take food safety, for example.

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In response to a Super Bowl ad placed by a meat-industry-funded lobbying group questioning plant-based meat for  its hard-to-spell ingredients, Impossible Foods responded with a parody, questioning an unintentional  additive in conventional meat.

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Fecal contamination of the  carcass in the slaughter plant is considered unavoidable, and though there are methods for removing  visible fecal contamination on meat, and even experimental imaging technologies

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designed to detect more  “diluted fecal contaminations,” we’re still left at a retail level  with guess what proportion of meat contaminated with fecal  bacteria at the grocery store? About 85% of ground beef and turkey  contaminated with fecal bacteria,

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and about half of chicken on store  shelves, and a third of pork, found contaminated with Enterococci, which is used as a marker of  fecal contamination of food. But you don’t have to cook the  crap out of plant-based meat,

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because there shouldn’t be any crap to begin with. Fecal contamination is not just unseemly  but a critical public health issue.

Fecal matter is considered the main source of some of our most serious foodborne pathogens

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like Salmonella and Campylobacter. Salmonella is the leading cause of foodborne  hospitalizations in the United States and the #1 cause of foodborne death, and 1 in 4 packages of chicken sampled  in the United States by the USDA contaminated with Salmonella,

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1 in 8 packages of ground turkey, 1 in 24 packages of pork, and 1 in 67 packages of ground beef, and 1 in 4 packages of retail chicken. Campylobacter, which sickens more  than 800,000 Americans a year,

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is also found in every 1 in 3 or  1 in 4 packages of retail chicken. Even just shopping for meat can be risky, as disease-causing fecal bacteria can  contaminate the outer packaging of meat.

But, the good news is that food-borne  illnesses are largely preventable,

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and the simplest approach  to reduce their occurrence is to greatly reduce the consumption  of animal products like meat. They’re intestinal bugs, and since plants don’t have any intestines, we can reduce the risk with plant-based meat,

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though there are always cases of  manure run-off contaminating crops. But the leading causes of large food-borne  outbreaks of food poisoning are all meat, and every single one of the  top pathogen-food combinations that cause the greatest burden of  disease are all animal products,

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mostly meat. That second one is toxoplasma, which is a brain parasite that may  infect a million Americans a year, making it a leading source of severe  foodborne illness in the United States.

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What may end up in your brain  may start in your burger. Tapeworms in your brain from pork have become an increasingly important  emerging infection in the United States.

What you think is a migraine  may not be a migraine.

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This is what they found in the brain of our current Secretary of  Health and Human Services. You may even get bladder  infections from eating meat,

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particularly poultry, urinary tract infections, or viral hepatitis from pork  products—hepatitis E infection. There aren’t any prions in plants either, the cause of fatal spongiform brain diseases, which is why there’s a mad cow disease,

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but not a mad Quorn disease. And I didn’t include other meat-borne pathogens, like trichinosis or E.

coli O157:H7, which still sickens 50,000  Americans a year, mostly from beef,

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or the 100,000 sickened by  yersinia-infected pork every year, but let’s just stick to the major pathogens, some of which can become antibiotic-resistant. Consuming contaminated meat with  antibiotic-resistant bacteria

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is considered a severe public health hazard. To help compensate for the overcrowded,  stressful, unhygienic conditions, animals raised for food are  dosed en masse with antibiotics.

Lots of antibiotics. This is in kilos;

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so, we’re talking 10 million pounds a  year of medically-important antibiotics. So, we give farm animals in the United States more than a million pounds  of penicillin drugs a year.

Four thousand tons of tetracyclines.

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Millions of pounds of drugs, laced  right into their food and water. Antibiotics important to human medicine being fed to cows, pigs, chickens by the ton— by the thousands of tons every year.

And so now in chicken breasts, for example,

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most of the Salmonella and  Campylobacter found is now resistant to at least one class of antibiotics, and about half of the Salmonella is resistant to three or more classes of drugs. Even organic meat raised without antibiotics

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can be contaminated with  multidrug-resistant bacteria, often because there is cross-contamination  in the slaughter plant. It’s funny—in the cover story of Consumer Reports that urged retailers to stop selling  meat produced with antibiotics, they noted, some store employee confusion:

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“An assistant manager at one store, when asked by a shopper for  meats raised without antibiotics, responded, ‘Wait, you mean,  like, veggie burgers?'” Exactly.

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Antibiotic-resistance genes can  also be transmitted through meat, which can then transfer to  other pathogens in our gut, as well as residues of the  antibiotic drugs themselves, which is itself considered a  serious public health threat. You can correlate how much meat people eat;

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you can just measure the amount of antibiotics flowing out of their urine every day. These drug residues in the  meat can cause allergies, nerve damage, liver damage,  reproductive disorders, bone marrow toxicity, even increased cancer risk,

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not to mention what eating antibiotics  every day is doing to your gut microbiome. In contrast, the production of  plant-based meat involves no guts, no feces, no antibiotics necessary.

In addition to antibiotics, livestock  may be fed or injected with hormones.

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Currently, seven hormone  drugs are approved by the FDA to bulk up the production of milk and meat. In Europe, there exists a  total ban on all such use.

But even without injected hormones, animal products naturally contain hormones because they come from animals.

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I already touched on processing contaminants, but there are also industrial contaminants  that build up in the food chain, like certain pesticides, PCBs, heavy metals, and flame retardant chemicals that  end up concentrating in meat. Can’t you just choose organic meat?

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Surprisingly, the consumption of organic meat does not seem to diminish  the carcinogenic potential associated with these industrial pollutants. If you look at the micropollutants  and chemical residues in conventional vs.

organic meat,

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several environmental contaminants—like  dioxins, PCBs, lead, arsenic sometimes measured at significantly  higher levels in organic meat, though cooking does draw off some of the fat where the PCBs are concentrated.

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Seafood seems to be the exception, though, with steaming, for example, generally increasing the concentration  of contaminants like mercury. There is, however, no mercury  added to plant-based tuna.

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When researchers tested retail meat for the presence of 33 chemicals with  calculated carcinogenic potential, like organochlorine pesticides  like DDT and dioxin-like PCBs, they concluded in order to  reduce our risk of cancer,

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we should limit our ingestion  of beef, pork, or chicken to a maximum of five servings—a month. Meat presents the only scenario in which ultra-processed products  were designed to replace foods that we know cause cancer,

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in fact, the #1 cancer killer of  nonsmokers, colorectal cancer. These are foods in desperate need of replacement.

Processed meat—bacon, ham,  hot dogs, lunch meat, sausage— is considered a known human carcinogen,

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leading major cancer centers, like Mount Sinai, Memorial Sloan Kettering, and MD Anderson, to recommend flat-out avoid processed meat. All in all, plant-based meat is  better than animal-based meat in about 40 different ways.

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Now obviously, some of these categories  are more important than others. The fact that bacon is officially  designated as cancer-causing is more important than the fact  that it may have a few more calories than plant-based bacon.

But cancer is just killer #2.

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The leading cause of death in  men and women is heart disease, and hidden in that nutrient profile, are the three things that raise LDL cholesterol: saturated fat, trans fat, and dietary cholesterol. Yes, there are other factors,  like TMAO and sodium.

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But LDL cholesterol, also  known as bad cholesterol, is unequivocally recognized  as the principal driver in the development of atherosclerotic  cardiovascular disease, our leading cause of death. Basically, we should try to  get our LDL as low as possible.

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When it comes to LDL lowering for  the prevention of heart disease, “Lower for longer is better.” Even if your LDL is quote-unquote normal; even if other heart disease risk  factors are considered optimal, still, of utmost importance to control it.

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So, if LDL is the primary  driver of our primary killer, if you could just know one thing about a food, if could just ask one question, it would be “What does this  food do to my LDL cholesterol?” So, we’re looking at nutrition labels for  saturated fat, trans fat, and cholesterol,

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since any intake above zero increases  LDL cholesterol and, therefore, increases our risk of coronary heart disease. In terms of saturated fat and cholesterol, animal meats are the main  source in the American diet, and with the removal of partially  hydrogenated oils from the U.S.

food supply,

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such that these other sources are now banned, animal products are now the  leading source of trans fat as well (since meat and dairy  naturally contain trans fat). Online, some bloggers parrot  egg industry propaganda

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that the 2015 U.S. Dietary Guidelines  removed its dietary cholesterol limit, whereas if anyone actually  bothered to read the guidelines, they’d see that the guidelines actually  strengthened their recommendation, telling Americans to “eat as little  dietary cholesterol as possible,”

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as recommended by the Institute of Medicine, the most prestigious medical  body in the United States. This advice was reiterated in the  subsequent dietary guidelines: “The National Academies recommends that dietary cholesterol consumption  to be as low as possible.”

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While eggs are the most concentrated  source of cholesterol gram-for-gram, the greatest cholesterol contribution  in the overall American diet is meat, including poultry and fish. Since cholesterol is present  only in animal-derived foods, it’s not surprising that plant-based  meat contains little or no cholesterol

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(unless they have cheese  or something added in it). And saturated fat content is  usually low in plant-based meat compared to regular meat, averaging  to one half and one third.

You can see that illustrated graphically here, where the conventional meat is  those orange bars across the top,

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so better across the board,  often by a large margin. This is as true in Europe as well  as in South Africa and the U.S.— where plant-based meat may only  average a third of the saturated fat.

Swapping out meat for plant-based meat  significantly lowers saturated fat,

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but does this translate into lower LDL? That’s really what we care about.

Well, you don’t really know,  until you put it to the test. Here’s a meta-analysis of 10  randomized controlled trials

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replacing some or all meat with  plant-based or mycoprotein-based meats, and within an average of six weeks, saw a 15-point drop in LDL cholesterol. What does that mean in terms of disease risk?

Maintaining a 15-point drop in LDL for five years would be expected to decrease your  risk of heart disease by about 10%,

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and after a dozen years by more like 15%, and across a lifetime by more like 25%. And risk reduction is independent of baseline LDL, meaning you get about the  same relative risk reduction,

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even if your LDL is so-called  normal, less than 100. One would also expect the use of egg  substitutes to reduce cardiovascular risk, given that eggs are the most concentrated  source of dietary cholesterol.

What about substituting soymilk for cow’s milk?

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Based on 17 randomized, controlled trials, drinking soymilk instead of cow’s milk resulted in significant  improvements in blood pressure, in cholesterol, in inflammation, an 8-point drop in systolic blood pressure, a 5-point drop in diastolic blood pressure, a 7-point drop in LDL  cholesterol switching to soy,

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as well as a drop in c‑reactive protein, so less inflammation as well. Over a lifetime, that 7-point drop in LDL could drop our  risk of heart disease by more than 10%, just making a single dietary swap from cow to soy.

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Now, the benefit only accrues  if your cholesterol stays down. And it turns out, it may even get better.

In a four-year study in which  diabetics were randomized to swap out half their animal protein  for ultra-processed plant protein, their LDL went down year after year,

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ending up 26 points lower than the control group. Whoa, that could net you a nearly  40% drop in risk, over a lifetime, of our #1 killer, just swapping out  half of their animal protein servings.

An estimated 20 million  Americans have heart disease,

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having about 800,000 heart attacks a year. If we started swapping our animal  products for plant products, imagine how many lives could be saved  by even a 10% drop in heart disease.

Instead of swapping out a  burger for a veggie burger, why not just switch to chicken and fish?

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Because, it doesn’t work. A meta-analysis of randomized, controlled trials that compared the cholesterol effects  of beef versus poultry-and/or-fish found no significant difference in terms of LDL.

And an updated meta-analysis  of four times as many studies

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also found no benefit to  switching to chicken and poultry, and the beef was actually  found to be better than fish, which they attribute to using particularly  lean cuts of beef as the comparator, particularly because the beef industry  is the one that funded these studies.

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But even organic, grass-fed beef appeared  to be no match for plant-based meat, as shown in the Stanford SWAP-MEAT trial. With processed meat officially  classified as a known human carcinogen, global health organizations flat-out  recommend avoid processed meat,

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but looking at six health outcomes— colorectal cancer, breast cancer, ischemic heart disease, type 2 diabetes, and two types of stroke— the optimal amount of unprocessed  red meat may be zero as well, but even a 30% reduction in both types of meat

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could lead to a million fewer  cases of type 2 diabetes, hundreds of thousands of fewer  cases of cardiovascular disease, and tens of thousands fewer cases of  cancer and premature death over a decade. Diets high in processed and red meat are also the two single leading causes of  diet-related disability in the United States,

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responsible for more than a million  years lived in disability annually— three times more than diets high in  sugar-sweetened beverages, for example, and more than two million  years of healthy life lost, based on the most comprehensive  analysis of risk factors

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for death and disability in history. Millions of years of lost  life every year in the U.S.

because people are eating diets  high in red and processed meat. What do they define as high, though?

A diet “high” in processed meat is  defined as any intake of processed meat.

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And a diet high in red meat? High as in any intake of red meat.

So, millions of years of life  lost in the United States, because people are eating more  than zero red and processed meat.

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Higher intake of meat in general— red meat, white meat, processed, unprocessed— also associated with an increased risk  of death from all-causes put together. If people swapped out 75% of their meat, up to 50,000 lives a year could  be saved in high income countries.

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What would happen if the  whole world cut out all meat? We would save an estimated 7 million lives a year, and if humanity cut out all animal products,

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we might annually save 8 million lives. Hanging in the balance!

The bottom line is that veggie  burgers are not Twinkies, even though they’re both classified  as ultra-processed foods. Now, there are two directions  we can go with that fact.

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We can decry the very concept  of ultra-processed foods. Or we can take what I would  argue is a better tact: keep the baby; throw out the bathwater.

In other words, not deny  ultra-processed foods tend to be worse, not deny that plant-based  meats are ultra-processed,

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but rather that despite this classification, plant-based meats and milks are the rare exception in that they compare well with the  foods they were designed to replace, in some cases, potentially  even saving thousands of lives. But there is some merit to the argument that the ultra-processed concept is  not as useful as many people think.

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If you look at the three big Harvard cohorts— 200,000 people followed for decades. Yes, total ultra-processed foods intake  was associated with cardiovascular risk, but if you break it down, the risk is driven exclusively by soda and meat.

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Sugar-sweetened beverages, a little from artificially sweetened beverages, and the rest from processed meat, poultry, fish. If you exclude soda and meat, the relationship between ultra-processed  food and cardiovascular disease disappears completely.

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So, nutritional advice for cardiovascular health should consider the differential consequences of group-specific ultra-processed foods, and specifically, that means  processed meats and soft drinks should be discouraged. What about mortality?

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Yes, those who ate the most  ultra-processed foods in general had a higher risk of dying prematurely, but it mattered what kind  of ultra-processed foods, with ready-to-eat meat,  poultry, and seafood products showing particularly strong  associations with mortality. The apparent worst ultra-processed food

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when it comes to dying prematurely in general? Meat/poultry/seafood.

The worst when it comes to dying from cancer? Meat/poultry/seafood.

The worst when it comes to dying  from cardiovascular disease? Meat/poultry/seafood.

The worst when it comes to dying  from lung diseases like emphysema?

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Meat/poultry/seafood. The worst when it comes to dying  from neurodegenerative diseases?

(Ice cream). And the worst when it comes  to dying from other causes?

Meat/poultry/seafood. Bottom line,

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the major factors contributing  to the harmful effects of ultra-processed foods on mortality are  processed meat, poultry, fish, and soda. So, the negative, life-shortening  effects of ultra-processed food is really mostly talking about the  negative, life-shortening effect

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of ultra-processed meat like burgers,  chicken nuggets, and fish sticks. Ideally, we would have a study that  specifically looked at meat alternatives.

And, here we go: a quarter-million  people followed for over a decade, and while the higher consumption  of ultra-processed foods in general increases the risk of cancer and  cardiovascular disease and diabetes,

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but that was driven by ultra-processed  animal products and soda, not plant-based meats. They specifically studied plant-based  alternatives and found no increased risk.

And when it comes to diabetes, plant-based meat and milk appears to cut  the risk of developing diabetes in half.

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Animal-based products were associated  with more than twice the risk; plant-based alternatives with less than half. So, when the authors conclude  that higher consumption of ultra-processed foods may increase  the risk of cancer and other diseases, their data really only show

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that the consumption of foods  of animal origin and soft drinks is associated with such a risk, and indeed, when the authors were challenged to go back and exclude animal foods and beverages, the relationship between ultra-processed  foods and multiple diseases disappears.

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That’s also what a systematic review and  meta-analysis of all such studies showed. The only categories of ultra-processed  foods associated with higher mortality were sweetened beverages and meat.

So, wait. If the only ultra-processed food that  appears to be killing people is meat,

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then in that case, instead of  being a part of the problem, plant-based meats may be the solution  to the ultra-processed problem. Let me say that again; instead of being a part of the problem, plant-based meats may be the solution  to the ultra-processed problem.

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The one other ultra-processed study  that separated out plant-based meats looked at telomere length, which  is used to measure cellular aging. Their study found that a higher  consumption of total ultra-processed foods was associated with a shorter telomere length, a sign of accelerated aging.

However, some subclasses of ultra-processed foods

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were associated with longer telomere length, suggesting slower aging. And, the class of foods associated  with the longest telomeres?

Vegetarian alternatives: plant-based meat. The most important question  in all of nutrition may be,

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“Compared with what?” The effects of any given food depend on  what that food is being compared against. So, is plant-based meat healthy?

Compared to the animal products  they were intended to replace? Absolutely.

Plant-based meat alternatives are more  healthful than the meat they replace,

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but perhaps less so than whole plant foods, such as legumes and whole grains. Wait, just perhaps less so?

This is how ultra-processed  plant meat compares to meat. This, is how unprocessed plants compare to meat.

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Not only making up for all the shortfalls, but if we add an even better category, whole plant foods do even  better, in many categories. For example, bean-based meat averages  five times less saturated fat than their meat comparators,

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but actual beans have 40 times less: half the trans fat or no trans fat. Five grams of fiber is certainly better than zero, but nine grams is even better.

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And there are interventional trials  demonstrating the greater benefits. For example, better at fighting  insulin resistance and inflammation.

So certainly, whole foods for the win, but plant-based meat alternatives, they are not designed to  replace whole plant foods,

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instead to offer a steppingstone  in the transition away from meat. I think of it like meat methadone.

Or, as Professor Gardner put it, “I’m hoping that plant-based meats  will be the gateway drug to legumes.”

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This is how the transition to  healthier diets is envisioned, from the global burden of disease, to the global relief of disease, as people use plant-based  and mycoprotein-based meats to transition toward a more  whole food, plant-based diet.

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With the added saturated fat and sodium, plant-based meats are not  healthy—but, they are healthier. They are healthier than the foods  they were designed to replace.

They are better, but not the best. Yes, nutrition policies and dietary guidelines,

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the bottom line is that we should  continue to emphasize a diet rich in whole plant foods. Indeed, if all meat in high income  countries were replaced with whole legumes, we could potentially decrease  overall mortality rates by 5 or 6%.

That means saving 180,000 lives  in the United States every year.

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If instead, we replaced meat with  processed or ultra-processed plants, we’d only save about 130,000 Americans a year (about a 4% drop in overall mortality). That’s still over 100,000 people saved every year.

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So, we shouldn’t let the perfect  be the enemy of the good. Plant-based meat alternatives  are better than the alternative.

Or as one study put it, plant-based meat can be  considered “meat with benefits.”

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Thank you so much.

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Wow, what a way to end the conference. That was absolutely phenomenal.

I think he deserves another round of applause. All right, Dr.

Greger, do you  have time for two questions?

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Let's do it. All right.

So, on one of the slides that you just ended on, there was, right at the bottom, it spoke about mold toxins being  higher in plant-based meats. Could you comment on that?

Yeah. So there's mycotoxins.

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So, I have a bunch of videos on mycotoxins that affect the majority of the  food crops grown in the world today. And although, you know, animals that eat contaminated moldy food crops

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can build up these mycotoxins like aflatoxin, the plant products tend to  have higher levels in general. And so the concern is— so there was a modeling study in Europe

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that suggested that if everybody switched  from their current meat consumption to 100% plant-based meat, the mycotoxin exposure, the increased  mycotoxin exposure that they get,

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based on, you know, studies of  hundreds of plant-based products, would cause, between one in one million  or one in two million more cases

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of liver cancer because of the aflatoxin content. So, one in one or two million  people would get liver cancer that wouldn’t have gotten liver cancer  if they had stuck with the meat.

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Of course, the amount of colorectal  cancer that would be prevented by switching to plant-based  meat would far overwhelm that, you know, one million cases  or one in two million cases.

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Having said that, it's  still not acceptable, right? I mean, so these plant-based companies— so I encourage—so in the book I talk  about how really they should be tested.

You can certainly— I mean, you can test for, you know, your feed, the, you know, the soy or whatever  you're using in your products,

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and you just make sure that  they don't reach levels that could cause any harm, right? We don't just want overwhelming benefit over harm.

How about overwhelming benefit with no harm? And so, unfortunately, mycotoxins is one  of the things that is actually lower—

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the concern is lower in meat— but still overwhelming for trying  to prevent cancer overwhelmingly. But that doesn't put plant-based  meat companies off the hook, and I encourage them to start testing to make sure that they indeed drop their levels lower.

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And a question that actually stumped  Dr. Christopher Gardner earlier.

Bring it. You have to answer in one word.

One word? What is your favorite  plant-based ultra-processed food after all this research that you've done?

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He couldn't answer? It took him a while.

Ah, what did he finally say? Well, no, no, no. Don't, don't.

Well, okay, this is actually controversial whether it's actually considered ultra-processed, but, so tempeh, some regard that  as an ultra-processed product

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because some—you can't really  make it in your home kitchen because they use these, you know, fancy processes. You actually can make tempeh,  but it's quite a process.

And if you read the  instructions for making tempeh, it's like if there's black mold, that's fine. But if it's gray mold, then  you don't want, you know, it's like, I'll let you make it.

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But that's an example of a processed product that's actually healthier than the whole food. So, the whole food is soybeans, and then they process it  by adding these, you know, these micro-protein threads,  you know, this culture, and they ferment it into tempeh.

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So, it actually ends— it's the rare, it's a rare processed  product essentially healthier than just the regular whole food. It has more spermidine, more  ergothioneine, all sorts of things.

So, I love that as like, you know, there's  a processed product I can get behind. You're actually processing  it to make it healthier,

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and that's unfortunately all too rare. Dr.

Gardner said soy milk. Oh, not sure which one. So, it was better.

Are we allowed to know the title  of your new book that's coming out? Yes, so, I've got three  books coming out this year.

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Three books next year. So, October 10th is the cholesterol-lowering book and then in January it will  be the ultra-processed book.

It's got some boring title like Ultra-Processed Foods: Controversies,  Concerns, and Exceptions,

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something like that. But anyway, it basically  goes through all the criteria and just has all the references so  you can use this as a reference book, and then, yeah, and this Thursday I'll be  doing a three-hour webinar.

So, basically, I’ll be giving a  three-hour version of this presentation.

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If you thought this presentation was too long, imagine adding two hours to this presentation. I mean, so I go, you know, I skipped through all those.

It's like, okay, well, let's not skip through it. So, I talk about the mycotoxins.

I talk about everything. So, if you really want to, like,  do the deep dive this Thursday,

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you can watch the extended version. All right, that's all we have time for.

Thank you so much. Another round of applause.