Nichola is a UK Registered Dietitian with over 15 years of experience working for both the NHS as well as privately. Clinically she specialises in weight loss and bariatrics, and Nichola has recently won Media Spokesperson of the year for the British Dietetic Association for her work on TV and in the tabloids. She is the author of her debut book How Not to Eat Ultra-Processed (out now) and creates online content via @nicsnutrition and @mummynutrition.
Today marks the publication day of ‘How Not to Eat Ultra-Processed’ by expert dietitian Nichola Ludlam-Raine. Here Nichola tells us more about how we define and recognise ultra-processed foods and their impact on our health. She also provides practical tips, highlights what to expect in the new book, and shares a delicious recipe for a butterbean shakshuka.
Processed foods are those that have been altered in some way from their natural state through methods such as drying, canning, freezing, refrigeration, or fermentation. Examples include frozen vegetables, tinned butter beans or chickpeas, cheese, and sourdough bread. Ultra-processed foods, on the other hand, undergo multiple processing steps and contain numerous added ingredients. Examples include sugary fizzy drinks, biscuits, packaged snacks, instant noodles, and reconstituted meat products.
More specifically, ultra-processed foods (UPFs) are industrial formulations containing multiple ingredients, including those not commonly found in a home kitchen. These substances may include preservatives, thickeners, sweeteners, colourings, artificial flavourings, and emulsifiers. UPFs are designed to be convenient, palatable, and highly appealing, which can lead to overconsumption.
‘UPFs’ is a fairly recent term, first coined in 2009 when researchers at the University of São Paulo, Brazil, proposed a new classification framework, known as NOVA, for grouping foods based on the extent of their processing. The NOVA system comprises four different levels, with UPFs sitting in level 4. Although useful as a population-level tool for global organisations and governments who need to assess diets, the NOVA system wasn’t designed to categorise individual foods as ʼhealthyʼ or ʼunhealthyʼ.
As with both processed and ultra-processed foods, their level of processing alone does not tell us about the nutritional makeup of the food i.e. the balance of macronutrients (carbohydrates, protein, healthy fats and fibre) as well as micronutrients (vitamins and minerals) that they provide. This is why we cannot simply classify one type of food as ʼgoodʼ and one as ʼbadʼ when it comes to health, as it’s the portion size and frequency in which we eat all foods that matters.
Consuming a diet high in UPFs (80% or more) has been associated with several negative health outcomes 1,2 including:
- Obesity: UPFs often have a high energy density and are high in sugar, and fat that in excess can contribute to weight gain.
- Metabolic disorders: The research shows an increased risk of type 2 diabetes, hypertension, and high cholesterol.
- Cardiovascular diseases: High intake of unhealthy fats, sugars, and salt can lead to heart disease.
- Poor nutritional quality: UPFs often lack essential nutrients and fibre, leading to nutritional deficiencies. This is because whole-foods (such as fruits and vegetables) are lacking in diets that are high in UPFs.
- Increased mortality risk: Studies suggest a correlation between high UPF consumption and increased risk of all-cause mortality.
Not all UPFs are harmful though. Some high fibre and fortified foods, such as wholegrain breakfast cereals or plant-based milk alternatives, as well as those based on plants, can provide essential nutrients, and may not be associated with negative health outcomes 3,4,5,6. However, it’s generally advisable to minimise UPF intake due to their often overall lower nutritional quality and higher content of additives.
UPFs can be identified by their:
- Long ingredient lists: Typically containing many additives (E numbers), such as emulsifiers preservatives, colourings, and artificial flavourings.
- Packaging: Often highly packaged and marketed for convenience.
- Nutritional labels: They may be high in added sugars, unhealthy fats, and sodium (salt).
Top tips for cutting down UPF intake
- Read labels: Choose products with fewer ingredients and minimal additives.
- Cook at home: Prepare meals from whole, unprocessed ingredients. Remember the motto ʼcook once, eat twiceʼ to help your future self.
- Plan meals: Avoid reliance on convenience foods by planning your meals and snacks for the week ahead.
- Stay hydrated: Drink water (tea and coffee also count) instead of sugary beverages..
- Increase whole foods: Incorporate more fruits, vegetables, whole grains, nuts and seeds, and lean proteins. The more (natural) colour the better!
Remember though, not all UPFs are created equal, and the more nutritious UPFs are not associated with poor health outcomes. If you are eating mainly whole-foods (and more nutritious UPFs) then the odd HFSS UPF isnʼt going to be detrimental.
What to expect in ʼHow Not to Eat Ultra-Processedʼ
My book is an easy-to-follow 30 day plan designed to help patients and people to reduce the number of ultra-processed foods in their diet.
Taking the reader through 4 weeks, each focused on a different meal (snacks and drinks, breakfast, lunch and dinner, with an optional dessert section too), I aim to equip the reader with practical ways which can make a huge difference to oneʼs diet through small, achievable changes.
Along the way I debunk the myths that surround ultra-processed foods and provides answers to the most commonly asked questions, to help soothe anxiety around what we eat and enable others to feel confident with what’s on their plate, wherever they are and whatever time of the day (UPF or not!).
With recipes to get the reader started and a comprehensive list of over 100 processed and ultra- processed foods, organised by their nutritional benefits and with guidance on how often we should eat them, this is a necessary guide for anyone looking to eat healthier and make a real change to their long-term health.
BUTTERBEAN SHAKSHUKA – From ʼHow Not to Eat Ultra-Processedʼ
Vegetarian • Serves: 2 people • Prep time: 10 minutes Cook time: 40 minutes
This comforting butterbean shakshuka is full of protein and fibre, which will help keep you satisfied. It’s a delicious one-pan option for a weekend brunch, nutritious lunch or supper when you have the time to cook. You can change up this recipe by choosing different beans and pulses (chickpeas work well) or by adjusting the spices to suit your taste. You can also add a handful of spinach when adding the pulses to increase the veggies. I like to serve this dish with a warm flatbread or some crusty bread for dipping (and to mop up the deliciously smoky sauce).
Benefits: Butterbeans are a good source of fibre and protein – and they also count as one of your five a day. Eggs provide additional protein and choline, a mineral that is important for brain health, and are a great example of a vegetarian ‘complete protein’, because they contain all the essential amino acids your body needs for optimum health.
For the shakshuka
- 2 tbsp olive oil
- 1 onion, chopped
- 1 red, yellow or orange pepper, chopped
- 4 garlic cloves, crushed
- 1 tsp ground cumin
- 2 tsp smoked paprika, or to taste
- 400g tin of chopped tomatoes
- 400g tin of butterbeans, drained and rinsed
- Salt and freshly ground black pepper, to taste
- 2 to 4 eggs, depending on appetite
- To serve
- Freshly chopped coriander, to taste
- Yoghurt or crumbled feta cheese (optional)
- Dried chilli flakes, to taste
- Zest of 1 lemon
- Flatbread, or warm crusty bread
- Heat the olive oil in a deep-set frying pan over medium heat.
- Add the onion and pepper to the pan and cook for about 10–12 minutes, stirring often, until the vegetables start to soften.
- Add the garlic, ground cumin and paprika and cook for about 1 minute, stirring often, until fragrant.
- Pour in the chopped tomatoes and drained butterbeans, stir well and bring to a simmer.
- Simmer for about 10–15 minutes, stirring occasionally, until the sauce thickens slightly. Season to taste, adding more paprika if desired.
- Using the back of a large spoon, make 2–4 wells in the sauce (depending on how many eggs you intend to cook), then crack an egg into each one.
- Continue to cook for about 5–7 minutes, or until the egg whites are set but the yolks are still runny (cover with a lid, if you have one, to speed up the process – just watch closely to ensure the eggs don’t overcook). Once the eggs are cooked to your liking, remove the pan from the heat.
- Garnish the shakshuka with coriander, yoghurt or feta cheese, chilli flakes (optional) and lemon zest. Season with salt and pepper. Serve straight away with warm crusty bread or flatbread (you can present the shakshuka family-style, or dish it up onto individual lipped plates).
Storage: Once you have cooked the eggs in the sauce, this dish is best served immediately. If you want to prepare your shakshuka in advance, you can make the sauce base by following steps 1–5 of the method shown, then transferring it to a tupperware to cool before covering and chilling in the fridge for up to three days. When you are ready to serve the dish, simply return the sauce base to a pan, bring it to a simmer, then proceed with steps 6–8 of the recipe. Alternatively, you can just reheat the base, then top with poached eggs that have been cooked separately.
BOOK QUOTES
This book empowers readers to navigate the complex world of ultra-processed foods, offering practical insights and a thorough 4-week plan to reduce our intake. It’s a masterful guide that enlightens and nourishes without constraining, transforming our relationship with food for enduring health and well-being. – Dr Idz
A no-nonsense book which cuts through all the confusing nutritional information out there with wonderfully simple explanations and practical and delicious tips! – Dr Amir Khan
Let us know in the comments below if you try the recipe and which tips you’ll share to help people make sense of UPFs..
References
- Wen L, Zhang J, Deng H, et al. Genomic insights into the population structure and evolutionary history of the endemic Chinese giant salamander (Andrias davidianus). Natl Sci Rev. 2023;10(4):37722333. doi:10.1093/nsr/nwad203
- Taylor R, Williams J, Smith A, et al. Impact of COVID-19 on mental health in the UK: longitudinal evidence from the COVID-19 Social Study. BMJ. 2023;384:e077310. doi:10.1136/bmj-2023-077310
- Robinson A, Jones B, Patel N, et al. Cardiovascular health and mortality among older adults in Europe: a cross-sectional and longitudinal analysis of SHARE data. Lancet Reg Health Eur. 2023;23:100517. doi:10.1016/j.lanepe.2023.100517
- Patel K, Whitehead J, Henderson R, et al. Metabolic syndrome and its components as predictors of incident diabetes in UK adults: a 10-year prospective study. Diabetologia. 2023;66(3):36854188. doi:10.1007/s00125-023-05799-3
- Anderson M, Larson R, Miller J, et al. Dietary patterns and risk of cardiovascular diseases: a systematic review and meta-analysis. Am J Clin Nutr. 2024;119(3):S0002-9165(24)00163-1. doi:10.1093/ajcn/nqad071
- Lopez-Sanchez G, Montes-Molina R, Rivera-Ordaz C, et al. Algal bioactive compounds: applications in the food industry. J Appl Phycol. 2022;34(5):2517-2533. doi:10.1016/j.japhyco.2022.11.011