Ultra-processed or Smartly Processed?

By Reed Mangels, PhD, RD

The phrase “ultra-processed food” seems to be appearing more commonly in scientific publications. This phrase was created by scientists in Brazil (1).  They were concerned because existing food categorization schemes considered an apple, sweetened applesauce, and sugary fruit drinks all to be “fruits.” They proposed an alternative system (2); one that classifies foods into four groups:

1. Unprocessed or minimally processed foods. This group includes basic foods that have undergone minimal processing in order to preserve the foods, make them safer, or more palatable. Processes could include drying, chilling or freezing, pasteurizing, fermenting, and reducing fat. Foods in this category include grains, legumes, nuts, fruits, vegetables, fresh meat, and dairy milk.
2. Processed culinary and food industry ingredients. This group includes substances removed and purified from the first group in order to produce ingredients. Processes that these ingredients might undergo include milling, refining, and hydrogenation and radically change the nature of the product. Items in this category are used in the preparation of unprocessed or minimally processed foods. This group include flours, oils, fats, salt, sugars, and high fructose corn syrup.
3. Processed foods. These foods are made by adding salt, sugar, or other ingredients to unprocessed or minimally processed foods. Examples of foods in this category include canned beans and vegetables, unsweetened canned fruits, and salted nuts.
4. Ultra-processed food products. These foods are ready to heat or to eat with little or no preparation. They have undergone processes such as salting, baking, frying, pickling, and canning. They are typically high calorie, high sodium, low fiber foods that are contain little protein, and few vitamins or minerals. Foods in this category include ready-to-eat snacks and desserts, soft drinks, margarine, frozen pizza and other frozen foods, instant soups, candy, commercial breads and buns, and sausages.

I am increasingly seeing articles which classify foods that may be eaten by vegetarians such as plant milks, seitan cutlets, and commercial veggie burgers as ultra-processed foods (3-5). This is concerning because, just as the originators of the concept of the 4 food groups chafed at the idea that both brown rice and packaged snack cakes would be categorized as grain and cereal products, I find it hard to equate a fortified soymilk and a soft drink in terms of nutritional quality.

Ultra-processed foods are thought of as being high in calories, salt, sugar, and fat and are often associated with being the foods we crave, despite having little to recommend them in terms of nutrition. This hardly seems like the correct category for foods such as plant milks or some brands of veggie burgers.

In addition, this scheme moves vegan foods fortified with important nutrients, that are high fiber and low sugar, into a category that people are being told to avoid. And yet, meat and dairy milk are in the unprocessed or minimally processed category which is being promoted. Something doesn’t seem right.

The American Society for Preventive Cardiology has proposed a new category of “smartly processed” foods which includes fortified plant milks and plant protein-based meat and egg substitutes (6). They describe these foods as low in saturated fat, refined carbohydrates, and cholesterol and state that these foods can add nutrition value.  This makes sense to me.

To read more about our take on ultra-processed (and processed) foods see:

Beware of Diets Based on Ultra-Processed Foods

Vegan Processed Foods: Embrace Them? Shun Them?

References

1. Monteiro CA, Levy RB, Claro RM, Castro IR, Cannon G. A new classification of foods based on the extent and purpose of their processing. Cad Saude Publica. 2010;26(11):2039-2049.
2. Monteiro CA, Cannon G, Levy RB, et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019;22(5):936-941.
3. Orlich MJ, Sabaté J, Mashchak A, et al. Ultra-processed food intake and animal-based food intake and mortality in the Adventist Health Study-2 [published online ahead of print, 2022 Feb 24]. Am J Clin Nutr. 2022;nqac043. doi:10.1093/ajcn/nqac043
4. Gehring J, Touvier M, Baudry J, et al. Consumption of ultra-processed foods by pesco-vegetarians, vegetarians, and vegans: associations with duration and age at diet initiation. J Nutr. 2021;151(1):120-131.
5. Lichtenstein AH, Appel LJ, Vadiveloo M, et al. 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation. 2021;144(23):e472-e487.
6. Belardo D, Michos ED, Blankstein R, et al. Practical, evidence-based approaches to nutritional modifications to reduce atherosclerotic cardiovascular disease: an American Society For Preventive Cardiology Clinical Practice Statement. Am J Prev Cardiol. 2022;10:100323.