chris van Tulleken suggested we meet at his local pizzeria, Sweet Thursday, in Hackney, East London. If the choice seems counterintuitive for a man on a mission to improve our national diet, he agrees with me as we sit down. “Pizza has become the symbol of junk food,” he says, “but real homemade pizza is very healthy.”
On Sweet Thursday, purist Italian chefs work their fresh sourdough base in an open kitchen (rumor has it that they are so purist in this profession that they draw the line at salad making). But it’s not just authenticity that counts, it’s also community. Van Tulleken lives around the corner; the owner grew up in the area and this is where local families often come to catch up or celebrate. “Above all, a restaurant should never just be a way to collect money in exchange for food,” says Van Tulleken. ‘Or for paying dividends to offshore investors. And I think these things are actually obvious, even if you don’t live, like me, in a world of food studies.”
Van Tulleken’s distinctions go to the heart of his research into the damage that ultra-processed foods (UPFs) do to our physical and mental health. The thesis of his best-selling book Ultra-processed people is that foods developed by companies with additives, emulsifiers and modified starches essentially “hack our brains” and disrupt normal appetite regulation. It tempts us to eat more because it is softer, slicker, saltier and sweeter than whole foods. His evidence suggests that it is this trillion-dollar fact that is driving the obesity epidemic. Over the course of his in-depth research, he serves as a guinea pig for these theories (with the occasional help of his twin brother Xand, also a doctor, and, because they share a genetic makeup, his built-in control group). His months of poor eating revealed that what he was consuming was not food but, as an academic colleague kept emphasizing to him, “an industrially processed edible substance.” Or “food that lies to us.”
While we order on Sweet Thursday – rustic crostini of chicken liver and fried zucchini for me, spring risotto for him and pizza of the month – with artichoke and asparagus – for me, he makes a small prediction: “You won’t finish it. your pizza here.” That is, it won’t slide down like a deep bowl of a Domino’s and leave you wanting more. It may take some good chewing and digestion, and it will leave you full.
As we share our starters, Van Tulleken apologizes in advance for any ambiguities in his thinking – his third child is six weeks old and sleep is a memory. As well as promoting the paperback of his book, there’s also the daily task to think about – he’s an infectious disease specialist at University College London – and episodes of his latest podcast series (with Xand) to think about. He spent the morning writing his submission to the Lords Select Committee on nutrition, diet and obesity.
In the year since the book came out, there has been a lot of criticism of its claims. In an afterword to the paperback edition, he offers a quite devastating rebuttal to those criticisms, a significant portion of which, he reveals, comes from academics whose research has been sponsored by several multinational food conglomerates. ‘Tentacular’ is the word he uses to describe the involvement of these companies in the committees that deal with the debate over their regulations.
He has experienced that reach firsthand. “When the book came out, I half thought I would be on the witness stand against Nestlé or whoever,” he says. “But the way they do it is more subtle.” For example, a large food company asked if he would be interested in delivering a half-hour talk to the senior team for a fee of £20,000. He said he would, but he would pay his own costs and give the money to a food charity.
When the contract came through, he changed his mind. It contained a clause requiring him not to disparage the company in public statements, “throughout the universe and forever.”
Van Tulleken makes two recommendations to combat the harmful effects of UPFs. Firstly, ban conflicts of interest in UK scientific and advisory bodies. And second, create effective warning labels on foods.
Much of the criticism of the idea of UPFs is that they are difficult to define and therefore difficult to regulate. Van Tulleken argues that better enforcement of existing UK dietary guidelines on fat, salt and sugar could “catch 95% of UPFs”, and that a black octagon warning on these foods would mean they could not make health claims and nor could they target children in their marketing. “Take Coco Pops,” he says. “Pick up a box in a supermarket and there are half a dozen health claims on it. But if there were a cautionary octagon, it couldn’t make these claims; there couldn’t be a happy cartoon monkey on the front; it could not be sold in hospitals or schools.”
The route that led him to this evangelization is instructive. He grew up in Hammersmith, West London. His early plan was to become a fighter pilot – he had been watching Top pistol – but his first solo flight put him off. He then trained as a surgeon, but eventually followed Xand into research into tropical diseases.
When he worked in Central Africa, he saw many children dying from infections. “And the reason they died,” he says, “wasn’t because we didn’t have antibiotics. It was that they were fed baby formula formulated with filthy water…Milk formulation was sold directly to families as aspirational.” The more he witnessed this tragedy, the clearer it became that “the solution should be to try to limit corporate (marketing) power, rather than needing more antibiotics. What we now call the commercial determinants of health.”
His research has led to him exposing how food multinationals are working hard to get us to eat more and more ingredients that have less and less nutritional value. He shows that their tests focus on the speed and volume of consumption. It is no coincidence, he suggests, that tobacco giants Philip Morris and RJ Reynolds acquired Kraft and Nabisco respectively in the 1980s: “They knew they had a set of technologies that they could apply to food.”
In recent weeks, much of the discussion about UPFs has come down to our daily bread. I wonder what he made of it Guardian article by Cambridge genetics professor Giles Yeo, who, while acknowledging the evidence linking UPFs to 32 adverse health effects, also appeared to argue that “apart from the taste, supermarket bread is no worse for you than fancy bread”.
“I have a lot of time for Giles,” he says. “But for me that article was very confused. If we are looking at a basic bread from the supermarket, versus a real bread, nothing special, the supermarket bread will be extremely high in salt and generally high in sugar, above the recommended level. It will have a high energy density because it is very dry, to promote shelf life – and we know that energy density, the number of calories per 100 grams of food, is very important for weight gain. And then the supermarket bread will be extremely soft, which means you’ll eat it faster and consume the calories before you get full.”
Yeo’s broader argument against the inaccuracy of the UPF label touched on that other persistent claim, that whole foods are an elitist concern; a four pound loaf is all very well, if you can afford it. Van Tulleken has two responses to this. The first is that the obesity crisis is costing the NHS billions of pounds a year – why not tax elements of UPFs and use them to subsidize healthier, local food production? And second, much of the “snobbery argument” about good food is, he believes, “industrially generated” by vested interests.
“I mean, the British Nutrition Foundation (whose members include businesses such as McDonald’s, British Sugar and Mars, with funding from companies such as Nestlé, Mondelēz and Coca-Cola) had the following quote: ‘We believe it is important not to stigmatize people in poverty (by advising them what not to eat).” I totally agree! The real source of shame and stigma should be directed at governments that refuse to regulate this stuff…’
While he’s been telling me all this, I’m slowly working my way through my fantastic pizza of the month. It’s far from a double-blind trial, but his prediction is correct; in fact, it’s so satisfying that I can’t finish it. But how about a scoop of homemade gelato, he asks.
Oh, then go ahead.
Ultra-Processed People by Chris van Tulleken is now available in paperback (Penguin, £10.99)