Chris van Tulleken on Why Ultra-Processed Food is So Addictive
In his eye-opening new book, Ultra-Processed People, infectious diseases doctor and BBC science presenter Chris van Tulleken explores the question of why we keep eating food that is bad for us and delivers an arresting account of the damage that ultra-processed food is doing to our bodies and the planet. In this exclusive piece, he discusses what happens when a liking for certain foods turns into an addiction and why.
Something entirely unexpected happened whilst I was writing this book – I was released from a trap I barely knew I was stuck in.The book is about Ultra-Processed Food, products wrapped in plastic which contain at least one additive you don’t find in a domestic kitchen. Lots of it is obvious junk but there are lots of UPF products you might think are healthy. Almost all supermarket bread is UPF, likewise ready meals, breakfast cereals, snacks, yoghurts and confectionary. UPF now makes up 60% of our diet in the UK and is strongly associated with weight gain, cancer, type two diabetes, depression, cardiovascular disease and many other harms including early death. It is engineered to be overeaten but many of us have an even more troubling relationship with it: addiction.
At the heart of the book is my experience of eating a diet of 80% UPF (typical for a UK teenager) for 1 month. It should have been enjoyable because I love this stuff. In fact, for many years I have had the sense that I’m not quite in control of my food intake. I’d eat in huge binges. My brother Xand often joined in, and these feasts felt like good fun even if they made us sick afterwards. Our lives were dominated by food to the point of obsession. Xand moved to the states and put on 30kg in weight in just a few years.
I recognised in us the sort of behaviours around food that I see in my patients who live with other addictions to cigarettes, alcohol or drugs of abuse. In the latest version of the US Diagnostic and Statistical Manual of Mental Disorders, the psychiatric bible. It classifies problem use of a substance as mild, moderate or severe using eleven diagnostic criteria such as ‘Use of the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.’ That’s how we were with food.
If you meet more than six of the criteria, you have a severe problem. Xand and I both scored a solid nine for the food we love, all of it UPF, or more specifically to particular types of UPF, mainly savoury, fried, spicy and laden with monosodium glutamate (MSG).
But food addiction is, scientifically, very unfashionable. There are two problems. For a start, because food contains such a wide range of molecules, how could any single combination be identified as addictive? And the briefest thought experiment about individual nutrients like fat or sugar tells you they’re not addictive. No one drinks olive oil or eats spoonfuls of sugar.
But the biggest problem with considering food an addictive substance is that, logically, it leads to a strategy of abstinence when, of course, you can’t be abstinent from food. And addicts can’t be moderate with addictive substances. So, food just can’t be addictive.
So, how do we reconcile the impossibility of labelling food as an addictive substance with the fact that some foods, for some people, do seem to be addictive?
The person to unlock this for me and release me from my addiction was a Brazilian scientist called Fernanda Rauber. Her work and ideas permeate my entire book. We first spoke on the phone about UPF and its various effects. She told me about how the plastics from UPF packaging decrease fertility, and how the emulsifiers disrupt the microbiome, but whenever I talked about the ‘food’ I was eating, she corrected me: ‘UPF is not food, Chris. It’s an industrially produced edible substance.’ She kept saying it.
After the call I sat down to a meal of takeaway fried chicken I found I was unable to finish it. Fernanda had done something extraordinary to me – it was like a magic trick. I no longer wanted the UPF. I was instantly reminded of the book The Easy Way to Quit Smoking by Alan Carr where you smoke while you read. This is what had been done to me. And this is the invitation at the start of my book. Read it and eat while you read. You may find that just like me the food becomes inedible.
By adopting Rauber’s idea that UPF is not food, like a banana or a piece of chicken, but rather a separate category of addictive edible substance, the confusion around addiction evaporates. We’re not addicted to food, but to UPF.
An increasing amount of mainstream science is backs up this idea. It is nearly always UPF products that people report problems with. For some it will be donuts, for others ice cream. For me it was cheap takeaway but it’s always UPF.
And the evidence shows that UPF seems to be more addictive than many addictive drugs for those who are vulnerable. Of course, many people are able to consume UPF in moderation, but that’s also true for cocaine, alcohol and cigarettes.
These drugs of abuse and UPF share certain biological properties. Both are modified from natural states so that there is rapid delivery of the rewarding substance. The speed of delivery is strongly linked to addictive potential – cigarettes, snorted cocaine, shots of alcohol. UPF is extremely soft and energy dense and so delivers the molecules we think generate the rewards (fats, proteins and sugars) incredibly quickly.
People report similar addiction symptoms with UPF and other addictive substances, including craving, repeated unsuccessful attempts to cut down and continued use despite negative consequences. And those negative consequences are severe: a poor diet may have worse effects for many people than even very heavy smoking.
Finally, neuroimaging has shown similar patterns of dysfunction in reward pathways for both food addiction and substance misuse. These foods also appear to engage brain regions related to reward and motivation in a similar manner to addictive drugs.
You may find it hard to consider UPF as equivalent to cigarettes, but poor diet – a high UPF diet – is linked to more deaths globally than tobacco, high blood pressure or any other health risk. It’s the leading cause of early death on planet earth.
Realising that the problem was not me, it was the food was crucial. I put Xand through the same process as I’d been through, even making him call Fernanda. He quit UPF and lost all his excess weight in a few months.
Considering UPF as an addictive substance solves that problem of abstinence. It’s impossible to quit food, but, at least in theory, it’s possible to quit UPF. It won’t be easy, of course – the contemporary UK is to UPF what the 1950s were to cigarettes. UPF is the only available affordable food for most of us. But if you are struggling with food then I invite you to eat as you read. You may find that the same thing happens to you as has happened to so many people who have already read it. You stop being able to eat the food…or rather the industrially produced edible substances.
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