The Junk Food Doctor: "THIS Food Is Worse Than Smoking!" - Chris Van Tulleken Ultra-Processed People

1. 0:00 – 2:45

   🌟 Intro

   1. CTDr. Chris van Tulleken0:00

      I ate a diet that's very normal for a British person. I gained so much weight, got in this vicious cycle of overeating, anxiety, sleeplessness, scanned my brain and if I continued for a year, I would have died.

   2. SBSteven Bartlett0:12

      Dr. Chris van Tulleken.

   3. NANarrator0:13

      Doctor, researcher and a BAFTA award-winning broadcaster. Chris forensically examines- The effects ultra-processed food have on us all.

   4. CTDr. Chris van Tulleken0:21

      75% of calories that are consumed globally come from six companies.

   5. NANarrator0:25

      The food mafia.

   6. CTDr. Chris van Tulleken0:26

      They are controlling our food and what we eat. Engineered to be consumed to excess, whether it's a burger from a fast food chain or supermarket bread, everything is adjusted so that things become irresistibly. And the pandemic of diet-related diseases has taken over the world. One in five people in this country get 80% of their calories from ultra-processed food. Poor diet has overtaken tobacco as the leading cause of early death on planet Earth. And from the age of five, kids in this country will be that much shorter, nine centimeters, compared to other countries. And it is all diet. Now you can't stunt a body by nine centimeters and not also stunt them intellectually.

   7. NANarrator1:03

      Why don't we just all make better choices?

   8. CTDr. Chris van Tulleken1:04

      I have almost no interest in personal responsibility. This is about social justice. And people without money, they're forced to eat bad food. If you got rid of poverty, you would get rid of around 60% of the problem with diet-related disease.

   9. NANarrator1:16

      What about the people that say this is just about calories in, calorie out?

   10. CTDr. Chris van Tulleken1:19

       There are two very big problems with that. And this is very good robust science. The first is that... And if people are listening and they want to lose weight, the evidence says ...

   11. SBSteven Bartlett1:30

       I just wanna start this episode with a message of thanks. A thank you to everybody that tunes in to listen to this podcast. By doing so, you've enabled me to live out my dream, but also for many members of our team, to live out their dreams too. It's one of the greatest privileges I could never have dreamed of or imagined in my life to get to do this, to get to learn from these people. To get to have these conversations. To get to interrogate them from a very selfish perspective, trying to solve problems I have in my life. So, I feel like I owe you a huge thank you for being here and for listening to these episodes and for making this platform what it is. Can I ask you a favor? I can't tell you how much, um, you can change the course of this podcast. The, the course of the guests we're able to invite to this show, and to the course of everything that we do here just by doing one simple thing. And that simple thing is hitting that subscribe button. Helps this channel more than I could ever explain. The guests on this platform are incredible because so many of you have hit that button. And I know when we think about what we wanna do together over the next year on this show, a lot of it is gonna be fueled by the amount of you that are subscribed and that tune into this show every week. So, thank you. Let's keep doing this. And I can't wait to see what this year brings for this show, for us as a community, and for this platform.

2. 2:45 – 6:36

   🤯 Impact & Concerns about "Ultra-Processed Food"

   1. SBSteven Bartlett2:45

      Dr. Chris van Tulleken. You wrote a book, Ultra-Processed People. I know from firsthand experience that writing books is a painful experience. It takes a long, long time to do it. And you have an extensive experience across medicine, um, across different sort of scientific disciplines. Why does this book and this subject matter, matter to society? And maybe even more importantly, why did it matter enough to you?

   2. CTDr. Chris van Tulleken3:18

      It matters to all of us, because for a very long time, we've been incredibly confused about what to eat. And we've called the foods that harm us junk food and processed food and high fat, salt, sugar food. And we've, we've not had a way of labeling foods even as a pandemic of diet-related diseases take, taken over the world, really. And this is particularly true now in low-income countries. And particularly true with low-income people living in the UK. So poor diet, which means a diet high in ultra-processed food has overtaken tobacco as the leading cause of early death on planet Earth. For humans, the animals we farm and for wild animals, of course, because ultra-processed food is produced by a food system that is the leading cost of, cause of loss of biodiversity. The second leading cause of carbon emissions and the leading cause of plastic pollution. So about 12 years ago, the definition was developed to describe a Western industrial American diet. And it was done by a team in Brazil. And not much of the best work on this stuff has been done by teams in Central and South America. Because what they saw in those countries, whereas this has crept up on us in the UK, in places like Mexico and Columbia and Brazil, obesity was essentially unheard of. And within a decade, it went to being the dominant public health problem. In towns in Mexico, you wouldn't know anyone who was living with obesity. And within a decade, everyone would know someone who'd had an amputation for type 2 diabetes. The only thing that had changed was the influx of broadly an American diet, industrially-processed foods. So the definition was invented 2009, 2010, and we've had a decade of evidence now that is very clear that it is ultra-processed food that is responsible not just for pandemic weight gain and obesity, but also for a long list of other health problems, including early death.

   3. SBSteven Bartlett5:14

      Why did this matter so much to you? What is the personal reason here?

   4. CTDr. Chris van Tulleken5:20

      I've, I'm an identical twin. I've got a, a brother who lived with obesity for a very long time. And I would, my weight would fluctuate. I'm, I'm insulated by, by privilege, by my surroundings, by education. But I'm always on the brink of weight gain. And I recognized in myself, uh, that I lived with an addiction to many ultra-processed products. And my brother particularly did. And so at the core of the book is, was this sort of moment of understanding where I, there's several sort of fulcrums in the book I suppose, but, but two of the key elements are: first of all, for many of us, ultra-processed food isn't just harmful, it is addictive. It meets all the criteria for addiction and it has, there's so much evidence that for some people, these products are as addictive as tobacco products, drugs of abuse, alcohol, gambling.... but that nagging people is really, really harmful. So I'd had a very toxic relationship with my brother and, and in fact our, the whole family. We, we, we're a very close family. But we had, for the better part of a decade, been nagging him to lose weight. And I took him to see a behavioral change expert who said to me, "I don't need to speak to, to Sand, I need to speak to you." And I was like, "No, no, he's the fat one. You, you gotta speak to him." He said, "No, you are the problem. For your brother to lose weight will be to lose an

3. 6:36 – 8:36

   📚 Understanding Health Issues and Addiction

   1. CTDr. Chris van Tulleken6:36

      argument that's been a decade-long with you. You are the barrier." And so because I'd been nagging him, I owned his problem and he didn't own it. And so at the heart of the book is this, this idea that nagging people generally pushes them towards doing things that, that are harmful. It, it generally makes them more likely to do the thing you're, you're nagging them about. And I've tried to engage with these products. When we come to individual solutions, I've tried to engage with ultra-processed food as an indi- addictive substance, a substance that I was addicted to.

   2. SBSteven Bartlett7:07

      What is the balance there between personal responsibility and being a victim of circumstance in the, in the sort of food landscape and society that we live in? Because there's a, there's obviously a, been a b- huge debate around obesity and, and weight. You know, there'll, there's one school of thought, maybe over on the more extreme side, that says just get out there and, you know, make better choices in your life and go, I don't know, go for a run or something. And then there's another school of thought that says weight gain and obesity are a byproduct of genetic, the, our genes and the environment we live in. What is the truth, in your view, and in the case of your brother?

   3. CTDr. Chris van Tulleken7:46

      I think we have really, really good evidence that personal responsibility, the ar- these arguments around will power and personal responsibility are morally, scientifically, and economically redundant. They, they have no value. So when it comes to population health, the- there are loads of different ways we can argue this. If we look at willpower, insofar as it's ever been operationalized for research, and there's not a huge amount, the research, and you will know some of this, the research is quite nuanced. But broadly it serves as a proxy for poverty. So the original marshmallow experiment, which I think you've talked about, where you, you offer a, a child a marshmallow and say, "You know, we'll give you another one if we come back in five minutes and you haven't eaten this one."

4. 8:36 – 23:44

   🍔 Role of Food Environment in Obesity

   1. CTDr. Chris van Tulleken8:36

      That experiment, those children who were unable to resist the marshmallow went on to really suffer in life. They had much, uh, across all kinds of different indicators, their lives were much more troubled. They had lower achievement economically and, and socially. What it turned out is when you adjusted for maternal education, the effect went away. In other words, the kids who were taking the marshmallow were from poor households and they were making a sensible choice. They were taking an opportunity when it arose, because if you come from a situation of, uh, deprivation or disadvantage, often things that are promised never materialize. So once you, you controlled for that in the studies, broadly, your ability to resist on a, a marshmallow age four predicts the household you're from, you might be from a low education, low-income household, doesn't predict anything else. So that's one way of looking at willpower, and there's lots of other evidence. The other thing is that if we look at weight, in the mid-1970s, and this is, um, uh, you know, American government data, there was a sudden inflection in weight gain where the, the obesity pandemic took off around 1975. And you look at a graph, it's bumbling along and suddenly everyone goes up. When I say everyone, Black, white, Hispanic, men, women, you know, five-year-olds, 50-year-olds, 90-year-olds, everyone starts gaining weight. So unless you're gonna propose when it comes to weight gain that there was some failure of moral responsibility in young Hispanic men and older Black women and middle-aged white people, y- you know, that just doesn't stack up. What changed was the food environment. So my feeling is the only thing that is interesting to talk about is the structure of the society around us. And, and we have really good evidence that when, when you simply give people money, and we've done this, this research has been done by economists, by doctors, by social scientists, when you give people money, they make smart choices. Rich people don't eat bad food because they don't want to eat bad food, and people without money eat bad food 'cause they're forced to eat bad food. And the, the cognitive dissonance that you and I were talking about, quite often we will find people with low incomes making quite cogent arguments about the food that they eat, appearing to side with the companies that are predating on them, because otherwise how could you live with this dissonance in your life? Otherwise you're just a powerless victim of, of transnational food corporations. So I, I have almost no interest in personal responsibility. I think you, if you give people technical knowledge, and you give people income and opportunity, most people want to be healthy and live good lives.

   2. SBSteven Bartlett11:14

      1970, the food environment changes. Can you tell me exactly how the food environment changed that caused multiple demographics to, to, to gain weight?

   3. CTDr. Chris van Tulleken11:25

      There are two answers to that. One, the, the sort of proximate reason is, is the invention of ultra-processed food, so the industrialization of, of food supply. And you can, you can talk about why that happened in a lot of different ways. Part of it was to, you know, a, a booming population post-war. Uh, and these products were extremely convenient. They allowed women to continue to be in the workplace. Of course, women had entered the war, entered the workplace in the war. So there were a lot of things that were immediately appealing about these products. TV dinners, Swanson TV dinners appear in the, in the '50s, and by the time of the '70s, these products had become very widespread. So in the same thing, we were a decade behind in the UK, but this, this stuff is now our national diet. Why exactly it took over is the subject of a lot of the research I'm doing at the moment. So now I work much more with economists than nutritionists, and what we see is the financialization...... of the food industry. So the primary, uh, determinants of almost every action that happens in almost every food company that supplies, say, 90% of our calories, all the indicators are financial. They're not to do with public health. And so we can use financial indicators, we can use financial research to, to show that the food industry does these things like buy cheap debt, use that to do, uh, share buybacks rather than generating value. We can show that they vote down, uh, activist investors will vote, and institutional investors will vote down public health proposals at, uh, shareholder meetings. And so part of it is the takeover of the food system from being a system where people would grow a lot of their own food, make food at home, they'd buy ingredients from local shops, to a small number of companies supplying food. So now, uh, 75% of the calories that are consumed globally come from six companies. There are about 15 to 20 companies that make most of the food we eat in the UK, that do, that primarily, th- th- that process the food. So we've got a very small number of agribusiness producers that make more or less 12 things that, you know, we eat broadly. Pigs, cows, and chickens. Those are our meats. We don't really eat other meat. Maybe a bit of lamb, maybe goat, maybe goose, not really. Duck perhaps. So we eat really three meats, and then our main sources of calories come from four or five crops. Corn, rice, wheat, soy, palm, a bit of sunflower. So the human diet, which should encompass thousands, perhaps tens of thousands of different species of thing, has now, because of the pressures of, of commercial efficiency, become reduced to a very small number of companies with enormous power, um, producing, making a very small number of food products and needing to generate intellectual property.

   4. NANarrator14:18

      It kind of, like, sounds like a mafia of sorts, like a food mafia.

   5. CTDr. Chris van Tulleken14:22

      (laughs) I'm gonna let you say that.

   6. NANarrator14:25

      Yeah. Well, in fact, no. Don't say, let me say it. I don't want them coming for me. Um-

   7. CTDr. Chris van Tulleken14:29

      I think it's, I don't mean it to sound malevolent. So the argument I've just made can sound a bit neo-Marxist or anti-growth or anti-capitalist, and I, I really don't mean it to sound like that, but it is important to understand the incentives within the system. And if the incentives are financial, you'll end up with ultra-processed food. So the logic of the food is the cheapest possible ingredients with the longest possible shelf life and maximum intellectual property.

   8. NANarrator14:55

      What is ultra-processed food?

   9. CTDr. Chris van Tulleken14:59

      So broadly, there are three types of food. There's unprocessed or whole food, which might be like an apple or an oyster, or you can drink milk out of a cow. You shouldn't 'cause you'll get brucellosis, but you can do it. That's whole, unprocessed food. Then there's processed food. So there's, uh, butter. So we can take whole milk, we can process it into butter or cheese. Now we've been doing that, so North African pastoralists started doing this in the Sahara region maybe 7,000, 8,000 years ago, started making dairying and if you can make butter you get all the vitamin, fat-soluble vitamins uh, from milk. You get very high calorie and it almost never goes off. It's really long shelf life. Similarly cheese, add a bit, ferment it, add some salt, you get a long shelf life, very nutritional product. So those are processed foods and we've been eating processed foods for over a million years. I mean humans are the only animals that have to process their foods. We, it, you know, food processing has shaped our jaws, our teeth, our guts. So compared to any animal of similar size, we have tiny little teeth, minuscule fragile jaws, very short guts because we've extended our digestive tracts out of our bodies and into our kitchens. We chop food rather than chewing it. We cook it rather than, uh, digesting it. So our food is, is pre-digested. So processed food is good. Tinning, canning, concentrating, fermenting, salting, smoking. All these projects, techniques were invented really by women over hundreds of thousands of years working in caves and huts and shelters and in kitchens, and they produced modern food. And diets from the high arctic to, you know, your sea mammal diets from the high arctic, pescatarian diets in East Asia, vegan diets of South Asia, any traditional diet you point to is basically associated with good health. All of them. They've all evolved in different ways. The same is true of French cuisine, rich in butter and red wine. The only diet that we've studied that really seems to bring health harms is an ultra-processed diet. So that is the American financialized industrial diet. So ultra-processing is about using these commodity ingredients that I just listed, you know, commodity ingredients like soy, corn, rice, and a bit of meat, reducing them into powder form basically. So if you grow corn, the market... I mean, you understand all this much better than me. You, you get money and finance. The market for cobs of corn spread with butter and salt is pretty limited. If you grow cobs of corn, you can sell a few of them. But if you can turn the rest of them into corn starch, which you can modify and turn it so it's like you, you can create any chemical property of that star- starch you want, you can turn it into corn oil and you can turn it into high-fructose corn syrup, suddenly you have the ingredients of every single food product on the planet. So the logic is to take your corn, break it into pastes and powders with an infinite shelf life, then recombine them with additives, texturize them, flavor them, put a brand on it, and then you can add just enormous value. And a lot of the ingredients we see in ultra-processed food are waste products from old food processing. So whey, what, the whey proteins we see in our nutritional powders, I mean this was a waste product from dairying. You know, it, it used to be spread on fields or fed to cows. But now the value you add instead of it being used for fertilizer, the value you add when you turn it into a nutritional supplement is a thousandfold, probably more than a thousand-fold.... um, citrus fiber. You'll see citrus fiber as an ingredient in a lot of bars. Sounds healthy, doesn't it? Like it's, um, you know, citrus fruit, fiber, what could be ... And it probably is reasonably healthy. It's leftover from the juice, the juicing and tinning industries where you have to get the peel off fruit, and if you put it through a set of chemical processes, you, you can extract the fiber, add it to the human food chain, and create enormous value. So the logic of ultra-processed food really is about creating products with intellectual property that use the cheapest ingredients you can.

   10. SBSteven Bartlett19:02

       That will last for a long time. And from what I understood there, the, that last process, sort of step three, so you, you had whole foods, then you had processed foods, then you had ultra-processed foods. And in the ultra-processed foods category, what they're doing is taking the good stuff out and putting some bad stuff in. Is that a simple way to think about it?

   11. CTDr. Chris van Tulleken19:21

       I would think it ... I think that is a very simple way of, uh, uh, uh, that's a straightforward way of thinking about it. The additives are not really the problem. So the problem, I would say, some of the additives we think are harmful. We've got some quite good research around some of the artificial sweeteners, some of the modified starches, uh, xanthan gum, um, the emulsifiers, and some of the colorings and texturants. Then we have some research that says the fact the food is, is mechanically processed so hard, it's generally very soft. So think of any ultra-processed food you can, whether it's a, a burger from a fast-food chain or a breakfast cereal or supermarket bread, um, uh, generally these calories are soft and w- and they're energy dense 'cause they're dry, and so d- dry food is important for shelf life. The softness and the energy density means you consume them very quickly, and so you essentially consume them before you become full. And so that's one of the ways they drive overcons- uh, uh, excess eating.

   12. SBSteven Bartlett20:21

       Ah, I see.

   13. CTDr. Chris van Tulleken20:21

       So, so if, if you like ... The laundry list of the ways in which the food harms us is softness, energy density, some direct harms from the additives, a lack of phytonutrients, so it doesn't contain much real food. And real food, real plants and animals should have a, a great variety of molecules and chemicals that we don't understand very well, but vitamins from a plant seem to interact with you very differently from, than vitamins in an extract. But the main thing is the way the foods are developed. So I spoke to so many people in the food industry, who are all wonderful by the way. You know, I- I- I've really enjoyed most of all talking to them. But the food scientists all said the same thing, that the products are generally put through, um, a focus group. So you start with your box of cereal that you've been making for, for decades and you have formulation A, and then you make a new formulation, formulation B. You put it through the focus group. If the focus group eats box B quicker than box A, box B is the one that goes on the shelf, because if they eat it 5% quicker, you'll sell the boxes 5% faster. That's, that's the financial indicator. And so it's not any one aspect of the food that's harmful so much as when the intention is to create products that people will use as much as possible, then you end up with addictive food.

   14. SBSteven Bartlett21:40

       Interesting.

   15. CTDr. Chris van Tulleken21:41

       It ev- The food is put through, if you like, a, almost a Darwinian evolutionary process where every single thing, every dial is tweaked on every product every few months, everything is adjusted from the sweet, salt, sugar ratios to the texture in the mouth to the color of the packet, and everything is dialed up to 11 so that things become irresistible. And y- uh, maybe you don't live with this, but people who ... Many people listening will recognize in themselves that there are products that they cannot stop eating. They fantasize about them, they think about them, and once they start eating them, they will consume five adult portions. And my ... I've got a six-year-old and a three-year-old, and my six-year-old can eat five adult portions of any sugary breakfast cereal in about 20 minutes.

   16. SBSteven Bartlett22:28

       I brought some food along with me today.

   17. CTDr. Chris van Tulleken22:30

       I was looking at it.

   18. SBSteven Bartlett22:31

       (laughs) 'Cause I wanted to get your-

   19. CTDr. Chris van Tulleken22:32

       Not distracting.

   20. SBSteven Bartlett22:33

       (laughs) I wanted to get your opinion on it, so I brought, um, a group of food products on the left here. Now these are things that I- I think growing up I thought were good.

   21. CTDr. Chris van Tulleken22:45

       Yeah.

   22. SBSteven Bartlett22:46

       So ...

   23. CTDr. Chris van Tulleken22:49

       You're very bold with these brands. I mean, you're really limiting sponsorship opportunities here.

   24. SBSteven Bartlett22:53

       Well, you know, you know ... I do think about that sometimes, but I also don't really care. I-

   25. CTDr. Chris van Tulleken22:59

       (laughs)

   26. SBSteven Bartlett22:59

       I think f- like, I'm in the pursuit of truth here, so ... And much of why I do this is to educate myself. And I, I think if I educate myself, then I'll help educate other people.

   27. CTDr. Chris van Tulleken23:08

       Yeah.

   28. SBSteven Bartlett23:08

       That's why I'm also okay being a total idiot on this subject matter 'cause-

   29. CTDr. Chris van Tulleken23:11

       (laughs)

   30. SBSteven Bartlett23:11

       ... that is the truth. So here I've got four products that are typically seen as being quite healthy. Breakfast cereal, Cheerios, I grew up thinking good for me. Um, Actimel good for me. Diet Coke great 'cause there's no sugar in there. And then this is ...
5. 23:44 – 24:11

   🛒 Ultra-Processed Food and Health

   1. CTDr. Chris van Tulleken23:44

      talking about any one product-

   2. SBSteven Bartlett23:45

      Sure.

   3. CTDr. Chris van Tulleken23:45

      ... because the evidence applies to the category of food.

   4. SBSteven Bartlett23:48

      Mm-hmm.

   5. CTDr. Chris van Tulleken23:49

      And this kind of stuff in a sense, I think you're abs- these are such brilliant choices because this is the foundation of our diet. And one of the things that's happening at the moment is, is the food industry exploring painting me as a snob because I'm, I'm critiquing these sort of core things, you know, tins of beans with flavoring or supermarket bread, fish fingers.

6. 24:11 – 24:37

   🚦 Unhealthy Food Marketing

   1. CTDr. Chris van Tulleken24:12

      I think this stuff is at the shallow end of the pool in a way. It's not by any means the worst stuff, but in a way it presents the biggest moral hazard because we think it's so healthy.

   2. SBSteven Bartlett24:22

      Mm-hmm.

   3. CTDr. Chris van Tulleken24:22

      Can I have the diet Coke?

   4. SBSteven Bartlett24:23

      Yep.

   5. CTDr. Chris van Tulleken24:25

      So Diet Coke is my, is my favorite example because this is the ultimate health food according to the way we label food at the moment. It has four ... Where's the camera?

   6. SBSteven Bartlett24:35

      It's all green on the,

7. 24:37 – 27:26

   🍬 Food Labeling and Healthiness

   1. SBSteven Bartlett24:37

      um-

   2. CTDr. Chris van Tulleken24:37

      It's four green traffic lights, right?

   3. SBSteven Bartlett24:39

      What- what is th-, what do they call that, that traffic light system on the food?

   4. CTDr. Chris van Tulleken24:41

      So this is the way we describe healthy, whether a food is healthy or not in this country at the moment. And this system is quite influenced by the food industry and it breaks f-, all foods down into fat, sat- saturated fat, sugars, and salt, and says that, you know, if a... Those are the bad things, and if a food is high in them, it'll- it'll have oranges and greens. So if you look at the Cheerios, they're most- they're mostly on the front. It's on the front. It's optional, by the way, so it's not always on every packet, but the Cheerios are oranges and greens.

   5. SBSteven Bartlett25:11

      Yeah.

   6. CTDr. Chris van Tulleken25:12

      Now, part of... There is a baked-in confusion to this, because what do you do at a traffic light that's orange and green, or red, orange, and green? Do you go?

   7. SBSteven Bartlett25:20

      (laughs)

   8. CTDr. Chris van Tulleken25:20

      Do you stop?

   9. SBSteven Bartlett25:21

      I would go.

   10. CTDr. Chris van Tulleken25:21

       Is it on the Actimel? Is it, is it on there?

   11. SBSteven Bartlett25:23

       It's not on there, no. I couldn't see it on there.

   12. CTDr. Chris van Tulleken25:24

       No, so it may be on the bottom. It's- it's optional, so who knows if... You know, we- we don't, we don't have any way in this country of describing either healthy food or unhealthy food other than these traffic lights. Anyway, this is a healthy food. Now, if we look at the ingredients on the Diet Coke, carbonated water, fine. Now, there's a color called caramel E150d. Caramel makes you think of your traditional... It's- it's a French 19th century invention, burned sugar, crème brûlée. It's like, it's a bit naughty, but it's fine. Caramel E150d has nothing to do with caramel. It is, um, carbohydrate treated with a mixture of acids and- and, uh, and heat to produce, uh, things that contain ammonium and s- sulfite. So it's- it's- it's a food additive color, um, with no- no benefits, nothing to do with caramel. Um, artificial sweeteners, aspartame and acesulfame K. Now, sweeteners are tricky because we know sugar is harmful 'cause it rots teeth and it promotes weight gain 'cause it makes you eat more. The weird thing about sweeteners is they don't seem to help with weight loss at all. They may... Some of them seem to be more metabolically harmful than sugar itself. Humans are quite good at eating sugar. When we eat lollipops con- continuous- continuously as kids or have sugary drinks, it's not good for us, but human societies have, for millennia, existed with a huge amount of honey and refined carbs. So sugar we can handle, although we should reduce our intake. Sweeteners are quite weird because they're a nutritional lie. You put sweet taste on the tongue which says to your body, "Sugar is coming, so maybe put up some insulin, maybe, um, start preparing in other ways physiologically to receive refined carbohydrates." And when that refined carbohydrate, when the sugar never arrives, it seems to be physiologically confusing. So the World Health Organization now says sweeteners aren't better than sugar when it comes to weight loss, and there is- there is an anxiety about aspartame and cancer that I'm- I'm personally not-

8. 27:26 – 34:46

   🍭 Artificial Sweeteners

   1. CTDr. Chris van Tulleken27:26

      not in a big sweat about. There's some- there's some evidence, but not at- not at normal dosage. Then we've got natural flavorings, we've got caffeine flavoring, an addictive drug, and phosphoric acid and citric acid.

   2. SBSteven Bartlett27:35

      Natural, it said.

   3. CTDr. Chris van Tulleken27:36

      Natural flavorings. I mean, you know-

   4. SBSteven Bartlett27:38

      That's good.

   5. CTDr. Chris van Tulleken27:39

      Well-

   6. SBSteven Bartlett27:40

      (laughs) .

   7. CTDr. Chris van Tulleken27:40

      ... flavorings are flavorings. Flavorings should signal nutritional content. When you eat a tomato, it has flavor not for fun. It has flavor because it signals the nutritional content of the tomato. When you put flavorings out of context, isn't... Even if you extract them from the tomato or the strawberry or the peach, it's very confusing for you physiologically. You've, you have a very sophisticated internal system to link flavor molecules, which are broadly smell, and taste molecules, salt, sweet, bitter, sour, and some savory ones. Y- y- your body has a way of linking all that information with nutritional information that you get from your gut subconsciously. When you muddle it all up in a product like this, it's very confusing. The phosphoric acid will dissolve the minerals out of your bones as well as dissolving your teeth. So what we have here is a solution of flavorings, an addictive drug, an acid that will leach stuff out of your bones, and sweeteners that seem to be metabolically confusing and certainly aren't better than sugar, and yet we think of this as a health product. So that, for me, is the archetypal confused way of thinking about food. I, um... And what we also know is that when it comes to kids the age of my youngest, so the age of three, they're drinking on average one can of artificially sweetened drinks every single day. So we've- we've taxed sugar. Sugar has come out of our diet. We've seen no weight loss, no indication that it's helping health, and what we are doing is consuming huge numbers now of these artificial sweeteners, which we also know affect, uh, our microbiome.

   8. SBSteven Bartlett29:11

      What is a- a better alternative that's popular and on- on the market than... 'Cause it appears to me that all of the drinks in the bloody supermarket have artificial sweeteners and flavorings and-

   9. CTDr. Chris van Tulleken29:21

      They do because of the sugar tax, so it's almost impossible now to buy fizzy tax without sweetener, to buy fizzy-

   10. SBSteven Bartlett29:27

       Because they're not gonna...

   11. CTDr. Chris van Tulleken29:27

       ... drinks without sweeteners.

   12. SBSteven Bartlett29:28

       Yeah.

   13. CTDr. Chris van Tulleken29:29

       Um, but, so for kids, I try and not give any advice to anyone ever, but my kids, um, my kids eat a lot of UPF, but they don't have fizzy drinks. I think, I think fizzy drinks are really quite harmful across the board. So- so kids should just drink milk and water, milk if they can have it, and grown-ups, um, can do pretty well on milk and water if you drink milk.

   14. SBSteven Bartlett29:57

       What about breakfast cereals and Cheerios and things like that?

   15. CTDr. Chris van Tulleken30:01

       So breakfast cereals are really convenient. I mean, let me see the Cheerios. So I think these... Uh, so these- these probably do meet the def- yeah, these do meet the definition. Oh, they are... Yeah. So we've got things like, um, uh, palm oil, caramelized sugar syrup, uh, colors and atanoabixin and an antioxidant and... So this is ultra-processed. It'll have some fiber. You'll have it with ho- whole milk. I don't wanna demonize breakfast cereals. My kids eat, eat, uh, breakfast cereals for breakfast. But i- i- it's not like eating porridge, which is just whole grains, or real bread. This is, this is... And what you will find is if you give this to a kid-... um, compared to porridges. They will be able to eat much, much more of this.

   16. SBSteven Bartlett30:48

       Oh, yeah.

   17. CTDr. Chris van Tulleken30:48

       And there is, there's a lot of marketing that this is a really, really healthy product, and I would say the evidence says that this falls into a category of foods that we actually know are associated with negative health outcomes.

   18. SBSteven Bartlett31:01

       It says on the side there, doesn't it, a list of all the health benefits.

   19. CTDr. Chris van Tulleken31:05

       A really good way of telling if a food is ultra-processed is if there is any health claim on the packet, it's almost certainly ultra-processed. And part of that is to do with this intellectual property thing, that the only food you can make lots of money out of is, is a branded product. So there's no money in broccoli, milk, steak-

   20. SBSteven Bartlett31:21

       (laughs)

   21. CTDr. Chris van Tulleken31:21

       ... eggs. Um, supermarkets quite often make losses on all those things. There's no health claim on broccoli or on plums-

   22. SBSteven Bartlett31:30

       (laughs)

   23. CTDr. Chris van Tulleken31:30

       ... or on milk. There's no health claim on st- oh, steak. It's only the ultra-processed things that you get marketed to you in this way, because there's enough money to do it. The Actimel's interesting as well, the immune support.

   24. SBSteven Bartlett31:43

       Well, it says immune support and it says vitamin D and B6. So that, rich in vitamin D, immune support, that is definitely healthy.

   25. CTDr. Chris van Tulleken31:53

       (laughs)

   26. SBSteven Bartlett31:55

       (laughs)

   27. CTDr. Chris van Tulleken31:55

       I mean, this is, this is, uh, this is where we need... We- we- we should have done the maths and shown how much sugar there was in each pot. These are very high-calorie shots of sugary liquid that will harm teeth and... I don't know why you'd have this if you could just have real yogurt and/or milk.

   28. SBSteven Bartlett32:16

       Hmm.

   29. CTDr. Chris van Tulleken32:17

       And the reason they back-add the vitamins is to be able to make health claims. So, generally foods with added vitamins, um, real food doesn't need added vitamins. And we're, again, we're pretty sure that... And I'm c- I'm conscious who I'm talking to here. I've gotta... I- I'm, I'm, uh, uh, uh, I probably have to tread a bit carefully. Supplementing vitamins into food doesn't seem to have many health benefits for healthy people. So we've got quite a lot of very big data on this, um, and there are lots of studies that show benefits that are funded by people who make vitamins. But broadly, the independent evidence shows that, um, when you get vitamins and minerals in the context of food, they're really good for you, and when you take them in pill or supplement form, they don't seem to have many benefits if you are healthy.

   30. SBSteven Bartlett33:09

       And this food here, this bottle of Coke I've got, a can of Pringles and, uh, Coco Pops s- Kellogg's cereal. This is the stuff that I typically think of as, like, bad, processed, ultra-pro- processed, stay away from.
9. 34:46 – 45:35

   🍕 Impact of Ultra-Processed Diet

   1. SBSteven Bartlett34:46

      not frozen pizza, and I thought, "Surely this pizza here is better for, a lot better for me than this one here."

   2. CTDr. Chris van Tulleken34:57

      So again, the- there's a complexity talking about is one better than the other? Because we've- we've never done a trial-

   3. SBSteven Bartlett35:04

      Mm-hmm.

   4. CTDr. Chris van Tulleken35:04

      ... testing them against each other. They're both ultra-processed. I know 'cause I've looked at the ingredients. They both contain ingredients that you don't have in a domestic kitchen, like, um, palm fat or dextrose. Um, and they're both made really in a sense by the same company. So both of... They're both made by PLCs who will be owned by institutional investors with requirements for growth. So they come from the same food system with the same incentives about production. And my bet is that you or I would be able to eat the entire pizza at a single sitting, um, and we'd be still licking the pack of both of them. So this is food that, in a sense, is- is engineered to be consumed to excess.

   5. SBSteven Bartlett35:49

      You did an experiment, didn't you? Quite a famous experiment now, uh, where you put yourself on an ultra-processed food diet. Can you tell me about that experiment and the symptoms that you saw when you did... lived off ultra-processed food pretty much exclusively?

   6. CTDr. Chris van Tulleken36:05

      Uh, so I, I ate a diet that's very normal for a British teenager. I ate 80% of my calories from ultra-processed food. So for, for a teenager in- in, you know, the- the- the... my kids' school, for example, it would, this would be a completely normal thing to do. One in five people in this country get 80% of their calories from UPF. So I wasn't really putting my body on the line. Um, I was switching from 20% to 80%. Um, kind of two really big things happened. There were some health effects. So, um, in terms of the physical effects on my body, I gained so much weight, and I wasn't... It wasn't super-size me. I wasn't forcing it in. This was done as part of a, um, a scientific experiment for a big study that I'm now running at- at University College London where I- where I work as an academic.I gained so much weight that in, if I continued for a year, I would have doubled my body weight. We scanned my brain before and after. I work with colleagues at the National Hospital for Neurology and Neuroscience, so ne- neurology and neurosurgery, so this, these were scans done very expertly, and while I'm only one patient, you can, you can subtract the noise. You can be very sure that what you see is real. We saw enormous in- increases in connectivity be- beh- between the, the automatic behavior habit bits at the back of the brain and those reward addiction bits right in the middle of the brain. So we can't exactly say what's happening, but certainly behaviors and rewards are getting much, much more connected. Most significantly, I think, we saw a change in my hormonal response to a meal. So when you eat real food, whilst you're eating, you're chewing, all kinds of hormonal and neurological changes happen in your body that will come to a point they'll say, "Look, you've had enough, Stephen. You're, you're fine. You can stop eating now." And that's called satiety, and we've evolved this mechanism since living things first started eating food hundreds of millions of years ago. And, uh, all animals have it and humans have it too. What we saw is that the, at the end of a standard meal at the end of this month, my hunger hormones remained sky-high. So this is food that is interfering with our body's evolved mechanisms to say, "I am done. It's time to stop eating." But there was, there was this other thing that happened, kind of the most important thing, and it's the core of the book, is that midway through this diet, which I was quite enjoying. You know, if you're, if you're a sort of middle-aged man tryin' to ... you know, the, the quest is always to lose, lose weight. And I could go back to eating the foods of my childhood and I was eating hot wings and all this stuff that I hadn't eaten for years and I was really enjoying it. But I was also doing all this research, partly for the book, and I'm, you know, as a scientist, I study nutrition. And, uh, I was talking to a colleague in Brazil called Fernanda Rauber and she just kept saying, "This isn't food, Chris. It's an industrially produced edible substance." And I sat down that evening to meet, eat a, a meal of, of takeaway fried chicken. I'm like, I could hardly finish it, and she had flicked this switch in my brain where all of this ultra-processed food had become disgusting. But I then had to keep eating it for another fortnight. And so it was a bit like the very famous book, The Easy Way To Quit Smoking, where you smoke all the way through reading the book while you learn about smoking. And by the end of the diet, I, I, I mean I now don't want to eat any ultra-processed products. So the, the gift I'm trying to give the reader is if you're living with addiction, my invitation at the beginning is eat along. Eat while you read. Don't forbid this stuff to yourself. Let yourself wallow in it, immerse it, taste it. And you'll start to r- ... And read the ingredients lists while you eat and you'll realize that all the food is, it has the same flavor profile. It's all equally salty and sugary and sweet. It's all acidic. Um, and you will gradually become disgusted. And I ... That's not a promise, but, um, that seems to be what's happening to a lot of people and that is a very well-evidenced technique when it comes to living with addiction. So the World Health Organization, who I work with, recommends The Easy Way to Quit Smoking for quitting smoking, uh, as, as being as useful as patches or any other technique. So I'm ... For the individual, treating it as an addictive substance may be really useful for some people.

   7. SBSteven Bartlett40:13

      What was the impact on your sort of mental health and how you felt from a sort of psychology perspective? 'Cause I, you know, we've seen th- this huge rise in sort of mental health diagnoses across the board, especially in younger, younger people. But it seems to be pretty consistent throughout different ages and demographics. And I wondered if there's a link between ultra-processed foods and mental health crises that we're living through.

   8. CTDr. Chris van Tulleken40:38

      We've got really good epidemiological data. So we now have hundreds of prospective studies, which are the best, the kind of studies we use to link smoking to, to cancer, that it is not just associated with physical ill health, metabolic disease, inflammatory disease, cardiovascular disease, cancers, early death. It's also associated with anxiety, depression, and also dementia. And, um, my experience of being on the diet was that, um, it, there was a, there was a, there was a thing that I think the research doesn't capture which is because it's salty. I was getting up to pee more at night and I was g- I, I don't know if we can say this. I was getting really constipated and, and uncomfortable because it's quite low in fiber. And so I got in this vicious cycle of sleeplessness and I'd often find myself where, at the fridge at, in the kind of small hours of the morning, and the food felt like the solution to the problem. So I got in this spiral of sleeplessness, anxiety, overeating, and w- we know that stress and elevated cortisol also generally increases your desire for, for low-quality food and makes people overeat. So in a way that kind of middle-age stress, anxiety, the sort of mild mental health symptoms that so many people live with, often it is just driven by, by the food.

   9. SBSteven Bartlett41:54

      I read this, um, stat in your book that according to the World Obesity Federation, 51% of the world or more than four billion people will be obese or overweight within the next 12 years.

   10. CTDr. Chris van Tulleken42:05

       So I like to say they will live with obesity, um, rather than the, rather than use obese as an adjective because I think the biggest problem for people who live with obesity is stigma. It's that being obese is your identity and what we actually know is the, the, the World Obesity Federation are doing some really good work identifying this as the major public health problem. The ticklishness talking about this is it's really hard to say that obesity is a problem without also saying that people who live with it are the problem. And if you're not careful, a war on obesity becomes a war on people who live with it. And I think the evidence is very clear it's just about the food environment. So yes, you can make these very powerful economic arguments that we simply cannot afford to have a food system that's driving this r- rate of disease. Um-I think the moral arguments are much more powerful, that this is stuff that causes human suffering. So I, I would not actually tax ultra-processed food, and I certainly wouldn't ban it. I think, uh, all my arguments are about increasing freedom, increasing choice, increasing opportunity, and that's quite conscious. So, I mean, you, you know this as a, as a skillful communicator, and you talk about kind of doing exactly this in your book, where I'm trying to make an argument that will appeal to the political right that are much more on the side of, of, uh, you know, free market, low regulation. And in fact, we can have regulations completely compatible with huge economic growth, and what I'm asking for is a food system where people with low incomes have access to healthy, affordable food.

   11. SBSteven Bartlett43:49

       Because a lot of people would say, and this is sort of part two of your book, that, okay, so the solution here is really just f- for people to make better choices when they're, I don't know, in their fridges or when they're walking through a supermarket. Why don't we just all make better choices?

   12. CTDr. Chris van Tulleken44:03

       I mean, you, you will, you may have a much more profound ... I, I think you're asking this question in a provocative way.

   13. SBSteven Bartlett44:09

       Yeah. (laughs) Yeah.

   14. CTDr. Chris van Tulleken44:09

       I think you will understand it much better than me. I've always had choice, and so when I choose to buy things, like, that are unhealthy, it, it, it is with a degree of choice. Uh, I do it, my, my patients, um, I run a clinic at the hospital for tropical disease where I work, and most of my patients have no addresses. They're very disadvantaged. They're migrants, asylum seekers. Um, they come from very low income families because those are the people who get infections. Now, when I say to them, "Go and eat some healthy food," they all know what healthy food is. They've often got very, they've, very diverse community. They've often got very rich traditions of healthy food from the, the communities or the cultures they've come from. They are completely unable to buy it. In the case of the asylum seekers, they're on eight pounds a day, and they can't work. You can't, you can't say to someone, "Spend your eight pounds a day on apples and broccoli and meat." They haven't got knives to cut it with. Now, we know a million households in this country don't have fridges, freezers, stovetop cookers. So there are a huge number of families that only have a microwave to cook. And fresh food, while there is always a politician willing to advance this argument, like, "But you can buy a bag of lentils. If you go to the cash and carry, you can buy rice or lentils for, you know, a couple of quid for 10 kilos." It costs money to heat it. It costs time, and time is the most expensive thing for, for people with low incomes. They need pots, pans, cutting boards, knives, s- uh, Tupperware. If you're gonna batch cook,

10. 45:35 – 46:01

    🍽️ Economical Home Cooking

    1. CTDr. Chris van Tulleken45:35

       which is the only way to make home cooking economical, you've got to deep freeze the store it in. So saying to people with low incomes, you know, "Make healthier choices," it is, it is nonsense. It's just, it's, it's ... And so a p- I p- feel very strongly, it, the world does not need another person like me saying that, and in fact, no one. I mean, we all ha- people hate being told what to do.

    2. SBSteven Bartlett45:57

       There was a study done on toddlers in 1920 that you write about, which is

11. 46:01 – 46:28

    🧒 Importance of Choice in Food

    1. SBSteven Bartlett46:01

       quite illuminating, where they got to choose their own food from a selection of un- unprocessed foods. And the children instinctively chose their own diet which met their nutritional needs and caloric, calorie intake. What was that experiment, and what does that indicate to us about the nature of this argument, what, as it relates to just being able to control what we eat and choose what we want?

    2. CTDr. Chris van Tulleken46:23

       If we look at the animal kingdom, even if you look at something you might think has quite a simple diet,

12. 46:28 – 47:40

    🦒 Diverse Food Selection

    1. CTDr. Chris van Tulleken46:28

       like a, like a big herbivore living in, you know, any of the big herbivores living on any of the big plains of the world, and you think, "Well, they just eat grass." They don't. We've done loads of experiments where they put, this sounds a bit unkind, but you put a hole in the neck of the animal, and you put a bag on the hole, and you collect the plants they're eating. And you can do this in a way that's relatively humane. And what we discovered is if we study goats or cows, they're eating 50 or 60 different plants a day. Calories are abundant. And what those animals are doing is balancing all their nutritional needs from all those different plants and selecting them and learning about the flavor profile and the mineral content. They're moving to avoid predators in the rains, the different soils. So animals are incredibly sophisticated at f- at perfectly balancing their nutritional needs from their environment. And obesity is, uh, nonexistent in the wild animal kingdom. In urban animals, actually, (laughs) that start to scavenge from humans, there is some evidence of obesity. But in wild animals, there is, there is no obesity. Humans, it turns out, obviously have the same ability. And so a scientist called, uh, Clara Davis, who's an amazing woman. She was, she was a, a, a gay woman, uh, one of the first medical graduates in, in North America. And she did this experiment where she was a, she was taking ki-

13. 47:40 – 51:09

    🧒 Balancing Nutritional Needs

    1. CTDr. Chris van Tulleken47:40

       abandoned kids in, essentially. It was, functioned almost like an orphanage. And each child got access to 34 different whole foods every single day. And it was things like, there was raw bone marrow and cooked rice and yogurt and milk, and they had a little bowl of salt that they could have as much or as little salt as they wanted. And her question was, could the kids balance their nutritional needs? And the best example is a kid called Earl, who she, uh, took in at a few months old, and he came in with rickets. So he had very bad vitamin D deficiency. He had bendy bones. And they did some X-rays, and you could see the rickets on the X-rays. And every single day, he would glug an entire cup of cod liver oil, which at the time was one of the only, really the only source of vitamin D. And he'd drink this every single day, enthusiastically. He always wanted his cod liver oil. And on the day his rickets were healed and he couldn't see them anymore on the X-rays, he stopped drinking the cod liver oil, never asked for it again, and none of the kids without vitamin D deficiency would drink, would touch the cod liver oil. So something in Earl's body was saying, "I will, when I need this stuff, I'll have it. Once I don't need it anymore, I won't have any more of it." And all the kids that she studied over many, many years with access to a full range of foods perfectly matched all their nutritional needs. They all grew really well. They were intellectually well-developed. They're extremely healthy, and they didn't have any of the sort of food refusal problems that, that parents have nowadays.So, uh, and she knew very well that the point was the kids only had access to good food. She wasn't giving them access to, um, industrially processed junk foods, which were still slightly available in, in the '20s. It was a really cool experiment.

    2. SBSteven Bartlett49:22

       For me, I, I take away from that that our bodies can kind of self-regulate what we need if they're in an environment where the options are good. So if I'm a parent, and I'm sure I'll be a parent in the next couple of years, I hope so, um, if I just make sure in my house all the food options are good for my kids, whole foods, all the good stuff you've described, presumably then I can just unlock the cupboards and let them r- run free.

    3. CTDr. Chris van Tulleken49:49

       I love talking to, um, people who might become parents-

    4. SBSteven Bartlett49:53

       (laughs) We're so naive.

    5. CTDr. Chris van Tulleken49:53

       ... about what they think we-

    6. SBSteven Bartlett49:54

       (laughs)

    7. CTDr. Chris van Tulleken49:54

       I mean, I'm like, "Wow."

    8. SBSteven Bartlett49:56

       (laughs) .

    9. CTDr. Chris van Tulleken49:56

       You just... I mean, yeah, g- good luck to you. Let's... Can we have this conversation again in about six years?

    10. SBSteven Bartlett50:01

        Yeah, yeah, yeah. Can you tell me why I'm- w- w- why I'm-

    11. CTDr. Chris van Tulleken50:03

        So, no, well, you're not wrong. You're completely right.

    12. SBSteven Bartlett50:05

        Yeah.

    13. CTDr. Chris van Tulleken50:05

        It will be impossible for you to limit the influx of ultra-processed food into your house. So clearly, I've written a book on this, I study this.

    14. SBSteven Bartlett50:13

        Yeah.

    15. CTDr. Chris van Tulleken50:13

        I would love to do that. I want my kids to be normal. Being normal is really important as a kid. And food isn't just stuff we put in to build our bodies. Food binds us to the people around us. Food is part of our community and our culture. In the UK, our food culture is ultra-processed food. And if you don't eat and drink ultra-processed food, you become a slightly odd person. And so I still eat it when I go to friends' houses because (laughs) otherwise I look like some, you know, uh-

    16. SBSteven Bartlett50:41

        Snob, yeah.

    17. CTDr. Chris van Tulleken50:41

        ... fanatical food snob.

    18. SBSteven Bartlett50:43

        Yeah.

    19. CTDr. Chris van Tulleken50:43

        So... And it's the same with my kids. So, so, uh, grandparents, friends, relatives all bring it round. You don't control what they eat at school. Um, you know, my youngest one's at, uh, a really nice nursery, but she still ultra-processed food from, uh, from the minute she gets there to, to when she leaves. So, um, very good luck to you. But this is why I argue... I, I nod to... I- if an individual wants to read my book,

14. 51:09 – 1:06:37

    🏠 Environment's Impact on Health

    1. CTDr. Chris van Tulleken51:09

       I think they will come away with technical knowledge that they will be able to use. And, and I wish them well with that. The big argument of the book is about this, this is about social justice. You know, it is, it is really appalling that even for people with, with a lot of means, real food is incredibly affordable and unavailable.

    2. SBSteven Bartlett51:29

       As you guys may know, this podcast is sponsored by one of my favorite brands in all the world which is Whoop. AI is a topic I've spoken about various times on this podcast, and it's a topic that I'm pretty obsessed with, but we don't often talk about how it could be used as a force to make our lives even better. Whoop is using the power of AI to drive meaningful positive change. My Whoop doesn't leave my wrist. And their new feature, which is called Whoop Coach, uses the power of advanced AI to synthesize all of your health and fitness data and to provide you with personalized recommendations to support you on your health and fitness journey. You can literally ask it questions like, "Why am I so tired?" or, "Can you help me build a strength training program?" And its advanced AI system will provide you with answers that are unique to you. So if you would like to check it out and level up your health and fitness journey in the process, go to join.whoop.com/ceo to get a free month's Whoop membership. As you'll know, this podcast is sponsored by Huel. And one of my favorite products that they've ever created is their Huel Daily Greens. It actually performed so well when we released it that it sold out completely. And the only thing I'm back here t- to say to you guys is that it's now back in stock. It tastes amazing, and it's actually got 91 vitamins and minerals and whole food ingredients in one scoop. It's nice not to have to think about taking lots of different pills and vitamins in the morning. I can just take this and I know that I'm giving my body a good dose of all the vitamins and minerals that it needs every morning. It's a lot better tasting than having to force down some of the other green powders I've tried. And it's really reassuring to know that I'm looking after my body properly. Unfortunately, and currently, this product is only available in the US. So anyone in the USA, head to huel.com to get it before it runs out again. But anyone that's not in the US and wants it to, to come to their country, please send me a DM, a direct message, and I'll speak to the team at Huel in our board meetings and I'll let them know that you want it in your country. What about the people that say that this is just about calories in, calorie out? The, you know, fitness community, a lot of the weight loss community just say what you've gotta do... And I've actually got a friend that said this to me quite passionately. He says, "What I do is I just measure the amount of calories I'm taking in, measure the calories that are coming out, and I make sure that there's a calorie deficit. And if you have a calorie deficit," he actually said to me one day, he goes, "You can eat whatever you want and you'll be fine."

    3. CTDr. Chris van Tulleken53:52

       Mathematically, he's, he's not entirely wrong. Th- there are a, there are some very, very... There are two very, very big problems with that. The first is that while some people can just eat to instructions, many of us have genes that, uh, have, lead us to engage with food in a more interesting way. You know, I care about food, I love food, I'm driven to it. So you, your friend should come round my house in the morning with a box of Coco Pops and try and get my daughter to eat one adult portion, and good luck to him. I mean, there'll be screaming and crying and she'll be grabbing the box. So the food... It's a bit like saying to smokers, "All you have to do is just smoke one cigarette. Don't smoke the whole pack. Just have like one to be social." Or people who live with addiction to alcohol, "Well, just have one drink and that won't do you any harm." The f- the food really is addictive for many people. But there is this other bit of the equation which is really fascinating which is that when we do more activity of the kind that most of us do, it doesn't seem to have an enormous impact on the calories that we burn. And this is very good robust science going back to the, going back to the '90s. Um, the, the most... Uh, if I tell this as a story which is, I think, is the way you'd do it, um, there was a scientist called Herman Pontzer and he wanted to know how many more calories he'd burn if he went and lived as a hunter-gatherer with the Hadza tribe in Tanzania.So he went and studied them and he put, he, he used a thing called double-labeled water where you can measure very accurately calorie expenditure. And he put them in metabolic hoods and he studied them for months and months. And he came back and he looked at his data, and he thought he'd got it all wrong because the data showed that for, um, essentially if, if you or I went and lived in Tanzania and we walked 15 kilometers a day hunting antelope and digging tubers out of the ground, we wouldn't burn any more calories per day. And he just could not make sense of this. So then he went back and looked at all the data available in the literature. We've studied animals, we've studied different human populations. There are, um, we've studied subsistence farmers compared to secretarial workers in the States. We've looked at miners. The same thing is true in all the studies. When you do sustained activity over a long period, it doesn't massively impact your calories. Now, some exceptions. If you do polar exploration, if you cycle in the Tour de France, if you go to the gym for an hour and a half every day, six days a week, you probably do burn a few more calories. But activity of the kind we all do doesn't seem to. And that explains why exercise is good for us, because if you don't do exercise, I burn 3,000 calories a day roughl- let, let's say with slightly different body compositions, but roughly you and I burn 3,000 calories a day. If you do your hour and a half of exercise every day, you're stealing energy from your other budgets. You're taking it away from inflammation, away from hormones, and away from anxiety. That's why exercise seems to be good for us, because I'm sitting here and I'm relatively s- sedentary with my two kids, so I don't go to the gym for an hour a day. So I spend my calories, but they're spent on inflammation and anxiety and relatively high hormone levels.

    4. SBSteven Bartlett56:55

       And is this what we call the fixed-energy model? I read that in your book, that term.

    5. CTDr. Chris van Tulleken56:58

       Yeah. So that's, that's, um, th- that's, that's the model. And there are lots of exceptions, um, but what that model tells us along with all the other available data is that when we are talking about populations who live with obesity, increasing activity will be really good for them, but it will not have a significant effect on body weight. So when we're talking about the pandemic of obesity, um, activity isn't hugely important. And if people are listening and they want to lose weight, many people have the experience that, um, putting a healthy diet in the context of lots of other healthy things is often really a good way of bringing about behavioral change. You'll feel good in other ways. But the activity and the exercise, if you think that putting in your slog at the gym every ... And most of us can manage 40 minutes every other day tops, and I, I get nowhere near that. It's not gonna have an impact on your weekly calories. E- even if, even if we accepted that, that, e- even if we did think that it increased the number of calories you burn, there's other evidence that says you, you either eat more because your, your body isn't just a mathematical, uh, machine that your, your friend proposes. Um, but also it's g- if you add up the calories and you go to the gym for half an hour four times a week, it's just not very many calories in terms of your weekly calories, unless y- even if you're cycling as hard as you can for the whole thing.

    6. SBSteven Bartlett58:17

       I can, I can definitely relate. I, I work out every day 'cause, just because I, if I didn't-

    7. CTDr. Chris van Tulleken58:22

       You do it every day?

    8. SBSteven Bartlett58:23

       If I did-

    9. CTDr. Chris van Tulleken58:23

       Seven ... You just said, you seven days a week now.

    10. SBSteven Bartlett58:24

        I have a PT every single day. And the reason I do that is purely because I am best disciplined when I have a clear routine.

    11. CTDr. Chris van Tulleken58:32

        Yeah.

    12. SBSteven Bartlett58:32

        So knowing that it's part of my habit and that it's actually, today it's in my calendar. Yesterday it was in my calendar. Even ha- I even have lunch in my calendar now. This is ... 'Cause I'm just trying to make sure that I have some kind of routine, um, with my, with my eating, or else I just won't eat. I w- I'll ... I ma- remember on Friday, I, my first meal was at 6:00 PM because I was podcasting, had some stuff with the BBC-

    13. CTDr. Chris van Tulleken58:52

        Yeah. Yeah.

    14. SBSteven Bartlett58:52

        ... and I don't wanna do e- I don't wanna eat before I do anything because my ... I'll slump. My point here though is with my personal trainer every day, if I don't change my diet very little happens with my body. I actually, I end up growing a bit more muscles. I end up getting a bit stronger. But in terms of weight loss, the fat, it just sits there.

    15. CTDr. Chris van Tulleken59:09

        Yeah.

    16. SBSteven Bartlett59:10

        Interestingly though, from a psychology perspective, I've spoken to a lot of scientists and doctors who have said your body will basically overcompensate for what you've just burned if you went f- go for a five or 10-mile run. Your body wants to defend its weight-

    17. CTDr. Chris van Tulleken59:21

        Mm-hmm.

    18. SBSteven Bartlett59:21

        ... because that's defending its survival chances. For me, one of the things that happens is if I go out, go and work out in the gym, because it was so painful, I'll then come home and look at the flapjack or the cookie or whatever, and I'll think, "That's two steps backwards."

    19. CTDr. Chris van Tulleken59:36

        That's interesting. Whereas some people will come home-

    20. SBSteven Bartlett59:38

        Go the other way.

    21. CTDr. Chris van Tulleken59:38

        ... look at the flapjack and go, "I've earned that."

    22. SBSteven Bartlett59:41

        But to counteract my own point-

    23. CTDr. Chris van Tulleken59:43

        (laughs)

    24. SBSteven Bartlett59:44

        ... that also happens sometimes. (laughs) I go, "Well, I can have it because I just ran or whatever." Um, what I, what I might do is I might avoid the flapjack, the obviously bad thing, but then I might eat more of something that I think isn't bad.

    25. CTDr. Chris van Tulleken59:59

        Mm.

    26. SBSteven Bartlett59:59

        Do you see what I'm saying?

    27. CTDr. Chris van Tulleken1:00:00

        You'll have a sort of nutritional bar or something that is sold to you as being part of that kind of exercise.

    28. SBSteven Bartlett1:00:05

        Yeah. And I'll eat four of those. (laughs)

    29. CTDr. Chris van Tulleken1:00:07

        But when you speak to ... One of the really interesting things is when you speak to nutritionists, and I've spoken to a couple who work with really elite sports teams, um, those athletes generally eat food. So they, the, they have chefs that make ... And they might make quite an elaborate flapjack, but it will be a flapjack made with the ingredients you would have in your kitchen. And they will often drink milk while they're cycling or running. And they'll eat pieces of chicken rather than other things.

    30. SBSteven Bartlett1:00:33

        This topic of willpower, again, we kinda started with it.
15. 1:06:37 – 1:07:19

    🧠 Food Industry's Influence

    1. SBSteven Bartlett1:06:37

       autonomy and control, I'm like, "Ugh." And when I hear about this sort of food environment we're living in and the, the big food mafia and the marketing and pinging me left, right, and center, and all the products that are in some of these ultra-processed foods that are making me feel addicted to them, that I just... It's just triggering my brain in a, in a way that I can't seem to control either, I go, "Uh!" I wanted to be able to do something about it on an individual level. I wanna be able to take back control without having to wait for bloody Downing Street or The White House to change things.

    2. CTDr. Chris van Tulleken1:07:07

       I love that. And what, what I try and propose in the book is that you need to make that journey. Probably when you start reading the book, you're, you're in this sort of unconscious stage of you don't think

16. 1:07:19 – 1:09:10

    📚 Advocating for Change

    1. CTDr. Chris van Tulleken1:07:19

       of yourself as either a, a victim or anything. You're just eating your food.And then midway through the bick- book, I think I do propose to you that you are a victim. And that's a hard thing for any of us to listen to. Most of us don't wanna be victims. And I think you have to make the journey from victim to activist pretty quickly. And you can be an activist in your own life for yourself and you can, if you have resources and money and skills, you, you can get rid of ultra-processed food. Lots of people actually can't. I just, I just gotta be really blunt here. Like, there is, there is an anxiety I had writing this book that, um, for the core audience of readers who can afford books, most of them will be able to buy sourdough from a fancy bakery rather than, you know, the loaf of bread we just looked at. But for the people who are most affected by the problem, that it simply won't be a choice. For someone like you, yes, you, you need to take that kind of emotional reaction and turn it into, um... Direct that rage, rather than them directing it inwards, it's directing it out to a food system that controls you. I mean, one of the, one of the political narratives we hear is, is, is that any kind of regulation is nanny statism. It's about government overreach. At the moment, we live in a nanny state. The nannying is done by transnational food corporations. They don't pay any particular tax in this country. They're... You know, they do employ some people, but these, these are not companies that are part of our sort of culture, and yet they are controlling our, our food and what we eat. And I, I think we need to wrest a little bit of control back off those, of tho- of those companies.

    2. SBSteven Bartlett1:08:49

       But that group of people that maybe weren't the majority of people you were speaking to with your book that don't have the privilege that me and you have, to make better choices as it relates to food or to, um, buy the pots and pans and chopping boards or get a chef to cook it for us, whatever. What do you say to them? What do they do?

    3. CTDr. Chris van Tulleken1:09:08

       I mean, this is why I don't give advice,

17. 1:09:10 – 1:15:06

    🚬 Food Addiction Discussion

    1. CTDr. Chris van Tulleken1:09:10

       because there is, there... We are at this moment where we do have to politically treat the companies like the tobacco companies. Now, at the moment, for many people, trying to quit ultra-processed food will be like trying to quit smoking in the 1960s. You kn-

    2. SBSteven Bartlett1:09:25

       Is it really addictive?

    3. CTDr. Chris van Tulleken1:09:27

       The... So the... Do you want me to do a bit on the, the evidence for addiction?

    4. SBSteven Bartlett1:09:29

       Please, yeah.

    5. CTDr. Chris van Tulleken1:09:29

       So the, the, the, the definition of addict... 'Cause people... Food addiction has been really scientifically complex for a long time because baked into the notion of addiction is that the only strategy that ever works is abstinence. You cannot be adic- abstinent from food, and so food can't be addictive. So for a long time we said, "Well, food is a behavioral addiction where it is the, the food behavior's not the food itself." The definition of ultra-processed food allows you to describe the category of substances that are addictive. And when we go and speak to people who say, "I live with addiction to food," and you say, "What do you, what do you feel addicted to?" it's always ultra-processed product. It'll be very different. Some people it's gonna be the dark colors, some people it's biscuits, some people it's pizzas, but it's always UPF. Um, the definition of addiction is continued use of a substance despite knowledge of harms, physical or psychological, and despite repeated attempts to quit. And you and I will both know people in our own lives who continue to, uh, eat this food. I mean, I was definitely one of these people, uh, despite knowing it was harming me and wanting to stop eating it. So that's why I think... I have two groups of readers. Some people are just gonna wanna cut down. You, you might be someone who's maybe eating a little bit more than you want and you just wanna go, "I'm gonna maximize my health and I'm just gonna, I'm gonna have it as a treat on a Friday night." And that's fine. It's like... It can be like booze or, uh, or the occasional cigarette. For some people, that one cigarette, that one glass of wine, for, for many pe- probably 40% of people, I don't know about your audience but across the country, 40% of people will have a, a troubled relationship with it. And for those people, abstinence may be a, an easier strategy. So yeah, I think it's addictive when we look at scans, it's addictive when we do surveys, it's addictive when we, um, look at the profile of genes and the other, um, surrounding factors that lead to addiction. It's caused by the same things. And there's lots of basic science about, um, the s- the speed of consumption and addiction. So addictive things are normally very quickly consumed. Shots, crystal meth, um, tobacco products.

    6. SBSteven Bartlett1:11:35

       Mm.

    7. CTDr. Chris van Tulleken1:11:35

       If you chew tobacco, if you have slow-release methylphenidate, it's a treatment for ADHD, it's not addictive. Um, if you have weak session beer, it's not addictive like tequila shots are. So the speed of hit seems to be important, and that may be partly to do with the softness of UPF. You get a, you get a very quick hit of your nutrition.

    8. SBSteven Bartlett1:11:55

       Is there a link between ultra-processed foods and neurodiversity? You know, ADHD, those kinds of things? 'Cause-

    9. CTDr. Chris van Tulleken1:12:03

       There's some emerging evidence about ADHD. I'm speaking to, um... There's a working group at the Royal College of Psychiatrists who are really interested in the links between, uh, binge eating disorders and other eating disorders and, um, and ultra-processed food. Um, I think we, we are only at the very beginning of discovering the health effects. But remember, from, from very early on in childhood, a huge number of kids in this country are on a diet of ul- almost pure ultra-processed food. But that's often in a situation where there is also other sources of, um, trauma, of, um... Uh, there'll be other health factors. There'll be poor housing. Um, it will go hand in hand with lots of other things.

    10. SBSteven Bartlett1:12:42

        Mm-hmm.

    11. CTDr. Chris van Tulleken1:12:42

        So as an adjunct to other, other problems, I would think there will be a link but teasing it all out is gonna be complicated.

    12. SBSteven Bartlett1:12:50

        A high UPF diet is linked to more deaths globally than tobacco, high blood pressure, or any other health risk. 22% of all deaths. That's the stat I got from your book. And also increased consumption of UPF, ultra-processed foods, is linked to the following diseases: all cause mortality; cardiovascular disease; cancers; high blood pressures; fatty liver disease; inf- inflammatory bowel disease; depression; worse blood fat profile; irritable br- bowel syndrome; dementia; and I can't even say that other one, ferti- f-

    13. CTDr. Chris van Tulleken1:13:21

        Frailty.

    14. SBSteven Bartlett1:13:21

        Frailty.

    15. CTDr. Chris van Tulleken1:13:22

        Just-

    16. SBSteven Bartlett1:13:22

        Fertility.

    17. CTDr. Chris van Tulleken1:13:22

        ... being weak and old.

    18. SBSteven Bartlett1:13:28

        Hmm. Ch- part five of your book is what am I supposed to do about it, and I've kind of answered it. I wanna make sure I'm really clear in my own life here. I can, because I have the privilege of doing so, I can make better food choices. The first part of it is awareness, knowing what ultra-processed foods are, and I believe I've got that definition from you. Step two is, I really need to do an audit of the things that I'm consuming frequently to make sure that I'm at least intentional about-

    19. CTDr. Chris van Tulleken1:13:55

        Mm.

    20. SBSteven Bartlett1:13:55

        ... my consumption of ultra-processed foods. And then, I can make better choices to bring in more whole foods into my d- into my diet. Um, because you're right. There's so many things that I'm consuming that I thought were good for me. I mean, I, I drank bloody orange juice for, for ******* Sunny D for 20 years 'cause I just thought it was great for me-

    21. CTDr. Chris van Tulleken1:14:13

        Yeah.

    22. SBSteven Bartlett1:14:13

        ... vitamin D or something, I can't remember.

    23. CTDr. Chris van Tulleken1:14:15

        Yeah, because they're sunny.

    24. SBSteven Bartlett1:14:15

        Yeah, exactly, and it was, it was marketed at me. Um, awareness is step one. Making, making more informed choices, I guess, is step two for me. Um, and then there's a broader point, which is about trying to change the system for others, which I-

    25. CTDr. Chris van Tulleken1:14:30

        Yeah.

    26. SBSteven Bartlett1:14:30

        ... I can do by having these kind of con- conversations, I guess.

    27. CTDr. Chris van Tulleken1:14:34

        The, I love that the, those steps are coming from you, that-

    28. SBSteven Bartlett1:14:38

        Yeah.

    29. CTDr. Chris van Tulleken1:14:38

        ... I d- I don't have a, I, I honestly don't care what people eat. I l- I like freedom. I don't like being told what to do, and so I am not prescriptive about what anyone should eat. Nowhere in the book do, do I say, "You should," like as a normative statement, "You should eat less UPF." So if you want to, knowing what you know, that's up to you. I don't think anyone has a duty to be healthy to generate economic growth. I just think y- no one asked to be born.

18. 1:15:06 – 1:29:28

    💡 Reasons for Optimism

    1. CTDr. Chris van Tulleken1:15:06

       You're born, you should be able to live your life as you want. What I do think is what I want for, for everyone is that they can, they have agency so that they are not subject to constant predatory marketing and they have true choice. So m- all the policies that I'm proposing, and I'm part of a big group working on this, are about making real food affordable and available. So in terms of the, the hierarchy of what needs to be done for everyone, the number one thing is tackle poverty. Poverty is a political choice. There is enormous wealth in this country and, uh, and people born into disadvantage should not have a different childhood than people who are born rich. And, and, and it feels kind of almost revolutionary to say that, but it's really obvious to me, like what, why... I mean, I can talk about this all day, but, but health outcomes are so different for people born in poverty, for people who live across the road from, from, from my kids. So that's the number one thing. The second thing is, um, some very light regulation. I don't wanna tax things. I don't wanna ban things. We need to appropriately label unhealthy food, and at the moment the labels are so confusing as to be unusable. We need to put in our national nutrition guidance that there is good evidence linking ultra-processed food as a category to all these poor health outcomes, and we should recommend, uh, the government should recommend that people do try and consume less. Now, there will be a real problem for the government doing that because the government creates a food environment, and it's really hard for a government to say, "Look, on the one hand, don't eat all this," and then go, "On the other hand, that is all you can afford to eat." So that's gonna create a real political problem, and that's sort of what we're up against. Um, the most important policy step is to get industry out of the room when it comes to making policy. So this is, so the, uh, I just, uh, spoke at the World Ova- Obesity Federation in New York. Um, they're a UN-aligned, WHO-aligned group. Outside of the UK, there is no discussion about the role of ultra-processed food, that pandemic obesity is primarily due to this Western industrial diet. Everyone agrees on this. Countries like Argentina, a can of cola has three big black hexagons on it bigger than the logo of the company that makes the cola. Same with most of the breakfast cereals. You know, there are warnings in the national guidance. So globally, people are very, very aware of this. In the UK, um, there is real control of the public health nav- narrative by the f- by the food and drink industry. So as an example, all our major charities that influence policy, and a lot of policy comes from charity, they're all paid by companies that make bi- u- UPF. So if we look at the British Nutrition Foundation, it is majority funded by all the major food companies you can name, Coca-Cola, Nestle, Cargill, all of them. Um, Cancer Research UK, Diabetes UK, the British Dietetic Association, all of them are funded by companies that make ultra-processed food. So we need, we need to start treating the companies like the tobacco industry and say, "No, no, your money is, is not good and we won't take it because it influences food policy." That's kinda the most important step. And so part of being an activist in this area for me is, um, not taking food industry money myself. And so that, that is a very painful weekly process because if you write a book about food, you get offered, you know, I mean, enormous amounts of money to go and, to go and work for the food industry.

Episode duration: 1:39:51