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The Dr. Hyman Show
Ultra-Processed People: How Big Food Is Rewiring Our Brains | Chris Van Tulleken
01:24:05
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- [00:00]
Dr. Mark Hyman
Coming up on this episode of the Dr. Hyman Show.
- [00:03]
Dr. Chris Van Tulleken
The ultra processing, which includes the marketing, the coloring, the texture effects, the physical processing, thermal chemical processing, that is the stuff that allows you to eat so much of the sugar, salt and fat.
- [00:17]
Dr. Mark Hyman
In functional medicine, we always start with the gut.
- [00:20]
Chris Van Tulleken
It's at the core of nearly every aspect of health from digestion and immune.
- [00:24]
Dr. Mark Hyman
Function to brain and skin health. Your gut microbiome regulates inflammation, absorbs nutrients and maintains the integrity of your gut barrier. That's why I take and recommend seeds DS01 Daily Synbiotic, a next level probiotic designed to go beyond digestion. With 24 clinically studied probiotic strains and.
- [00:40]
Chris Van Tulleken
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- [00:43]
Dr. Mark Hyman
Gut immune function, gut barrier integrity and even heart health through the gut liver axis.
- [00:48]
Chris Van Tulleken
But here's what's really exciting.
- [00:50]
Dr. Mark Hyman
Research now shows that gut health directly.
- [00:52]
Chris Van Tulleken
Impacts skin health through the gut skin axis.
- [00:55]
Dr. Mark Hyman
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- [01:20]
Chris Van Tulleken
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- [01:21]
Dr. Mark Hyman
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- [01:30]
Chris Van Tulleken
Off your first month of seeds DS01.
- [01:33]
Dr. Mark Hyman
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- [02:30]
Chris Van Tulleken
Now, before we jump into today's episode, I'd like to note that while I wish I could help everyone by my personal practice, there's simply not enough time for me to do this at scale. And that's why I've been busy building several passion projects to help you better understand. Well, you if you're looking for data about your biology, check out Function Health for Real Time Lab Insights. And if you're in need of deepening your knowledge around your health journey, check out my membership community, the Hyman Hive. And if you're looking for curated and trusted supplements and health products for your health journey, visit my website@drhyman.com for my website store for a summary of my favorite and thoroughly tested products. Welcome to the Dr. Hyman Show. I'm Dr. Mark Hyman and this is a place for conversations that matter. Today our guest is an esteemed physician from the UK, Dr. Chris Van Tulleken, who is a physician, scientist and broadcaster known for his expertise in public health. And he has written a book which I think you all will find very interesting, called Ultra Processed People. Why Do We All Eat Stuff that Isn't Food? And why We Can't Stop. It's an incredible book that examines the pervasive impact of ultr processed foods on health and well being. It's had a lot of global conversations sparked around this book around food systems, industry practices and their urgent need for dietary reform. Really pretty, pretty important book. But more importantly, is his work really around changing policy? He's huge advocate for public health initiatives in the UK that address systemic issues in healthcare nutrition and he's really gotten into tremendous work on ultra processed foods and publications around that. He's presented at the Parliament in the uk. He's won many awards. He has found that ultra processed foods are not like other foods in the way they affect our biology. Now we can debate what's the definition, so forth, but we all kind of know it when we see it. You know my professor medical is called the Aunt Millie sign. How do we know it's the Aunt Millie sign? Well, walks like Aunt Millie, it talks like Aunt Millie, it must be Aunt Millie. In other words, when you see an ultra processed food, whether it's a Dorito or a Twinkie or a Cheese Whiz or some weird thing that we don't even know that this food, we know it's ultra processed. So we're going to get into why it's an issue, why we should be concerned about it and what we can do to protect ourselves and maybe some policy issues that also need to be addressed when it comes to how do we protect ourselves as a society from the harms of these foods, which by the way, can comprise about 60% of adult calories and 67% of kids calories and about 73% of everything that's on the store shelves today. So it's, this is an important issue. Listen up, here we go. So, Chris, it's amazing to have you on the Dr. Hyman Show. I've been wanting to have you on for a long time. We had a chat last year. And your work around ultra processed food, your advocacy policy work, your intention to sort of shift consciousness around what's killing us has been tremendous. And I think, you know, this whole narrative around ultra processed food is catching steam. It was sort of invisible until recently and with the Maha movement in America and Bobby Kennedy talking about it and now Trump talking about it, and it's a thing. And ultra processed food has become the new cigarette and the target for a lot of potential policy changes. And yet there's still some controversy about the definition, whether it's the right classification to use, whether or not it's valid, and whether we should be focused on other aspects of nutrition like glycemic load or fiber content or other macronutrient ratios to actually explain what ultra processed food does or doesn't do. And there's a lot of data like that that you've kind of write about in your book Ultra Processed People, which is, by the way, a great book. Everybody should get a copy of it. That kind of outlines a lot of the, the harms that are done. And there's just even more recent studies that showed that ultra processed food is linked to 32 different kinds of health conditions, from heart disease to mental health issues, to type 2 diabetes, obesity, cancer, sleep issues, GI issues, dementia, the weight, the list goes on and on. And if, if that's accurate and these are observational studies, us, which are population studies, don't prove cause and effect. But if that association turns out to be causal, then this is, this is a huge nuclear bomb when it comes to our health. It's kind of the smoking gun of why we're getting sicker and fatter and costing our governments around the world more and more money. And the question is for you is how did you kind of first come to understand that this was an issue and then I'd love you to share your own personal experience because you actually decided not to just research this issue, not just talk about it and write about it. You did something that I would never do is you ate ultra processed food for a month and it's kind of like supersized me, but kind of a little different and to try to see what the consequences were. So I'd love you to kind of unpack, you know, first. What was it that got you kind of started thinking about this because you're an infectious disease doctor and two, you know, what was the experiment like and what happened to you? And we'll start with that and then kind of dive into the data and the research a little bit more.
- [07:10]
Dr. Chris Van Tulleken
I think for a start, anyone who's watching the video, firstly, thank you for your wonderful kind words. That's a lovely introduction. I'm going to find it hard to live up to it, but I'll do my best. Anyone who has any doubt about the effects of ultra processed food need only look at the video feed for the podcast right now and sort of put Mark and my heads next to each other and go, that's four weeks of ultra process. I used to look like it's. I did it because my clinical work is I treat patients with complex infections at the Hospital for Tropical Disease in London, part of University College London Hospital. But my academic work is food systems and nutrition and the two are linked because I many of my patients are from very low income countries where we see that nutrient deficiencies and poor nutrition drives a huge number of poor health outcomes in the global north and in the global South. So there's an overlap. In fact, I did this experiment. The experiment was we filmed it for a BBC documentary but the reason we did it, we got ethics approval because I was the first participant. I was the kind of pilot patient, if you like, in a big clinical trial that I think it's the largest randomized controlled trial of UltraProperty Processed food versus minimally processed food in free living subjects. And where I'm.
- [08:22]
Chris Van Tulleken
And this is in process right now, this is not published, this is in process.
- [08:26]
Dr. Chris Van Tulleken
So I can't. We. I now where are we? My, one of my students is leading it and I think I can't talk about any of the data but it will be the largest randomized controlled trial of UPF done so far in the world in free living individuals and I think at all because it will be the third published randomized control trial of upf because on top of the one you referenced earlier there was a study that replicated Kevin Hall's work in Japan. And now we will be the third. But it's a slightly different trial design. So I was the first participant to go, what changes in Chris? What can we measure? How should we kind of design the rest of the experiment? And I'll be honest, kind of like Kevin hall, who's my now very well known investigator at the nih, who did the first randomized control trial. I was maybe not skeptical, but it seemed to me that eating what is a normal diet for four weeks would not have any big effects on my health. You know, this is. I ate 80% of my calories from ultra processed food for four weeks. This is a diet very typical for an American teenager. This is not a weird diet. So there were kind of three, three big things that happened. I gained weight, a huge amount of weight. Six and a half kilos, more than six and a half kilos in four weeks.
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Chris Van Tulleken
That's like 15 pounds, right? In American pounds, Yeah.
- [09:47]
Dr. Chris Van Tulleken
I would have doubled my body weight in a year if I'd kept doing it. And you reference supersize me. I was not force feeding myself. So I was just eating to appetite. So long as 80% of my calories came from UPF. So I was. The experience of doing it was incredibly educational. I was never full, I was never hungry. I was just sort of eating all day because that's what the food allows you to do. So weight gain is very well evidenced. We then did brain, we did functional MRI scans and looked at connectivity between different parts of the brain. This was sort of the most terrifying bit is we saw a massive increase in connection between that the automatic behavior bits at the back of the brain in the cerebellum, the habit forming bits and the reward addiction bits in the middle of the brain. And these changes were very surprising to all of us. They were very robust and they persisted for eight weeks after.
- [10:38]
Chris Van Tulleken
And what were the changes in your brain?
- [10:40]
Dr. Chris Van Tulleken
So we just saw huge amounts of increased connectivity between the habit bits and the reward bits. And it was. The findings are best described as if I had developed a new addiction. All of the FMRI data that you generate from any experiment is hard to be really sure of of what's causing what, but we saw very significant changes and it's notable they were between those two regions. And bear in mind, I was, I was 43 when I was, it was a few years ago. I was, you know, I was in my mid-40s doing it. You know, what is, it raises the question of these Kind of brain changes to children who are eating much more UPF over a more prolonged period of time. And then the other. In a way, the change I was most fascinated by, well, there were two others, but the physical change was that we measured my satiety, my hormone response to a normal meal. So this isn't something you can fake. We would. At the beginning of the experiment, I went and I ate a standardized meal and we measured changes in the hormones. You see, you have fullness hormones and hunger hormones, they go up.
- [11:43]
Chris Van Tulleken
So you just didn't rely on your subjective feeling about how hungry or full you were. You actually measured the hormones like ghrelin and leptin that actually tell you whether or not you're full or hungry biologically.
- [11:54]
Dr. Chris Van Tulleken
And what we see is that after eating, eating the same standard meal at the end of the UPF diet, my fullness hormones went up much less and my hunger hormones stayed much higher. So at the end of the same meal. So the diet is modifying your body's ability to feel full after any food. And that to me was, was the most kind of significant thing. It's not just that the food doesn't fill you up, but we think it may be having changes about the whole way you handle food and feel full at the end of meals. Really important to say. I know, I'm one participant. That's why we've turned it into a big registered clinical trial funded by our research council and an independent research trust. And that's why we're doing it robustly with ethics permission. It's a registered trial. Kevin hall is one of them.
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Chris Van Tulleken
How many people are in that trial?
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Dr. Chris Van Tulleken
There are two arms and we're doing. How many have we registered? Somewhere over 30, I think. So it's not a huge trial. It's a bit bigger than Kevin's, Yeah.
- [12:53]
Chris Van Tulleken
Ethically, you know, it's like you're feeding people what you know is hurting them. It's a little tricky, but people are willing to do it. I think for science. That's amazing.
- [13:01]
Dr. Chris Van Tulleken
Well, the, the, of course, in. So the, the way the trial is designed is we're actually feeding. We're trying to feed people the healthiest ultra processed food versus a minimally processed diet. So we didn't feel it was ethical for them to just eat any old ultra processed food. I think the jury is in on that. Ev. So instead we fed people a diet of ultra processed food that is in line with our National Dietary Guidance versus a minimally processed diet of the same thing. So we're trying to investigate the claim that if we make the ultra processed food as healthy as we can, does it still cause negative health outcomes? And especially does it do that in comparison to a minimally processed diet? It's asking the same question in a different and hopefully more ethical way.
- [13:42]
Chris Van Tulleken
That's interesting because I think, you know, people will say, well, it's not, it's not the ultra processing, it's just the crappy food and it's the high glycemic load or the lack of fiber or, you know, the macronutrients that are different and the calories that are different. And if you just ate a high glycemic diet, like sugar and white flour that was organic or, you know, like, you'd have the same problem.
- [14:04]
Dr. Chris Van Tulleken
I think there are two questions. First of all, and this has been very kind of hotly contested between people funded by the food industry and more independent scientists, is, is the definition of ultra processed food useful or is it just describing food that we already think is unhealthy? And there are a number of ways to answer that question. I think the way we currently define unhealthy food isn't working in policy terms. Okay, so whatever definition you're using in the US you have very weak definitions of unhealthy food. You might be able, it's not entirely easy to say how you define unhealthy food. In the United States you have dietary guidance which is fairly good and bits of it are aligned with international guidance, but there's nothing I can see where you go, these are a set of thresholds and criteria by which we will declare a product to be unhealthy. So for a start, when we say is ultra is the definition useful? You have to say, well, is it useful in comparison to what? There's no question it's been incredibly powerful as a research tool and that's what it was designed for. So the definition is set in stone. It went through a revision, but it's been in Stone since 2018.
- [15:10]
Chris Van Tulleken
And this is the NOVA classification developed by Montero from Brazil, which is now part of their Standard Dietary Guidelines, as well as Canada and other countries, right, that are using this as their metric for food.
- [15:21]
Dr. Chris Van Tulleken
France, Israel, Belgium, most South and Central American countries, Canada, give advant advice using the NOVA classification. And it's, it's a nine paragraph definition, but the definition, and it broadly describes modern prepackaged, pre prepared American industrial food. And I'm sorry, I know this is an American audience and in fact, you know, many, many transnational corporations make these products, but we're talking about food wrapped in plastic, made using additives. Now the definition was never designed to be used in law to ban something or tax something. So when commentators say oh, the definition has, it's, it's too vague, you can't use it to define a product. Absolutely. And no one, I don't think anyone sensible is saying we should use this as the way of labeling food or taxing it or banning it. But the definition has had research power because it was testing a hypothesis. It was saying is there something more to harmful food than simple levels of salt, sugar and fat? And is industrially produced food different to the food you cook at home, even when you adjust for that? And so across now hundreds of research studies, I mean you know, just a few years ago there were, for any one health outcome, there were maybe 10 to 15 longitudinal studies. We now have really more than 100 of the kind of prospective studies that we use to link cigarettes to lung cancer. We now have these for ultra processed food and negative health outcomes.
- [16:49]
Chris Van Tulleken
And what's the, what's the sort of hazard ratio? In other words, with traditional like cigarettes it was like 10 to 20 times an increase in risk of lung cancer. So an observational study that, that's a slam dunk. If it's over, you know, two or three, you, you, you usually probably have some causality and that's 2 or 300%. And smoking was you know, 2000%. And so the question is how, how big is the delta on the, is it like a 20% increased risk? 100%, 200%?
- [17:17]
Dr. Chris Van Tulleken
Almost nothing. I can't think of anything other than maybe asbestos that has that same hazard ratio or odds ratio, however you want to calculate in epidemiological terms in terms of it's the magnitude of harm it causes. What we see with upf, depending on the outcome you look at is we see increases of it's times 1.5, times 2, times 3. So big increases in absolutely, in absolute risk. Exactly the kind of risks that we accept for many, many other links between, you know, let's say poor sleep quality and early mortality, for example. So cigarettes we see, we see enormous deltas but we, we, you know, ultra processed food, it's smaller because diet related disease has many, it's very causally dense and there are lots of different ways that dietary patterns affect you. So one of the really important things to say is when we look at those hazard ratios and different studies report this in different ways, almost all of the epidemiological evidence has made adjustments for dietary pattern and for Nutrient profile. So if we look at this was a study, a really well reported study done by one of my PhD students, Sam Dicken. He's now not a PhD student, he's now leading this update trial that I was telling you about. So Sam did a review of the evidence, this is in 2021, and looked across at whether or not the epidemiological studies controlled for dietary pattern, and they almost all do. Going back to your question about how much ultra processed food increases your risk of a particular health outcome, one of the things is that in those epidemiological studies, adjustments are made for salt, fat, sugar, fiber and dietary pattern. Now the logic of doing that is you're trying to go is processing itself playing a role. And we have lots and lots of evidence that factors other than those nutrients now are playing a role. It's not simply a deficiency of fruit and vegetables or, or an excess of salt. But of course, one of the ways that ultra processed food harms you is because it is incredibly high in salt, saturated fat, sugar, energy density, it has a high glycemic index. And so all of those things, when you adjust for them, they dilute essentially the effect, but the overall effect of the food on your body will have all of those different factors coming to bear on your health. So the questions you're asking are really complex epidemiological questions.
- [19:47]
Chris Van Tulleken
And just for those who are not scientists, like, who are not scientists, when you do an observational or population study, there's a lot of things called confounding factors or variables where for example, in the meat studies that I've talked about on the podcast before, it found that, you know, meat was harmful. But the people who ate meat in these large trials, who are just population studies where they follow people over a long period of time, they get their dietary records and, you know, ask them a food frequency questionnaire, which is super unreliable. You know, it turns out that the meat eaters, you know, weighed more, smoked more, drank more, didn't eat fruits and vegetables, didn't take their vitamins, didn't exercise, and that was why they had more heart attacks and disease. It wasn't because of the meat. And another observational study showed that, you know, people who shopped at health food stores who were vegans or who ate meat, both had their risk of death reduced in half. So it's a context of what your over dietary pattern is, your lifestyle is. And so I think that's what these various factors are being looked at in these ultra processed food studies. And they're being Controlled for as best you can. But you're saying even if you take into account all these variables that could mess up the results, you still see a signal for ultra processed food, independent of the fact that it's got high sugar, salt, fat or whatever else has got crap in it.
- [21:00]
Dr. Chris Van Tulleken
You do. But it's really worth saying, Mark, if someone said to me ultra processed food is only harmful because of its salt, sugar and fat content and its energy density, I would go, you know what, I would buy that as maybe 80% of the harms. If you want to say a hundred, we can still do business, no problem. So long as you're enthusiastic about improving justice in the food system, improving the equity of access to food, improving life for disadvantaged populations, about regulating corporate power if you want to do it. Like the thing is, what, what you.
- [21:35]
Chris Van Tulleken
Notice we're going to get into regulations of corporate power. That's a good one.
- [21:38]
Dr. Chris Van Tulleken
But it's, it's the, it's the people who say, oh, it's all sugar, salt and fat. When you say, well, okay, let's, let's talk about progressive sugar taxation. You don't hear those same voices calling for that. You don't hear those voices calling for strong marketing restrictions on foods that are high in sugar, salt and fat. To some extent, the ultra processed evidence, what it tells us is that food processing is important. I mean, we know that processing affects human physiology. Do we? Are we saying that the only way that ultra processed food harms you is, is not through sugar, salt and fat? I mean, that would be absurd. What I would say the simplest way of understanding it is that the ultra processing, which includes the marketing, the coloring, the texture effects, the physical processing, thermal chemical processing, that is the stuff that enables and allows you to eat so much of the sugar, salt and fat because no one eats sugar, salt and fat from the bowl on the table. It's the process.
- [22:34]
Chris Van Tulleken
It's a different matrix. Yeah, it's a different matrix. Yeah. I mean, I think it's worth stopping for a second and defining what is ultra processed food and the NOVA classification, just briefly, that was developed by Montero and Brazil, that's now used as a standard in many countries for their dietary guidelines. And I think it's a very useful way to think about things because we've been processing food for thousands of years. Making sauerkraut is processing food, making miso is processing food, making tofu is processing food. But these are still relatively whole foods. There's also cooking and food added things you add to your cooking at home. It Sort of makes it more complex. And so the ultra processing is quite different. And it's an industrial process that breaks down the commodity crops, basically soy, wheat and corn, into these sort of chemically different molecules that then are reassembled into what looks like food. But technically, by the definition of food is not really food.
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Dr. Chris Van Tulleken
There is no definition in law in a lot of places that's widely agreed of what food is. But I think the idea that it.
- [23:41]
Chris Van Tulleken
Well, there's a Webster's Dictionary definition I'm going by. It's basically something that supports the health and growth of an organism.
- [23:47]
Dr. Chris Van Tulleken
Right. And should nourish us. Exactly. And the purpose of food should be to support health and growth. And that's not what UPF does. So the definition, you can look it up, it's housed. I've got it in front of me. It's housed on the United Nations Food and Agriculture Organization website. So this is not a definition agreed on by a single academic group promoting their work. This is a definition that UNICEF used, the World Health Organization in some contexts, use the un use, use, many governments around the world use, and then research groups at Cambridge, Harvard, Yale, Princeton, Oxford, ucl, and so on. So the NOVA classification divides food into four groups. Group one is these minimally processed foods. Things like an oyster or an apple, obviously you haven't processed at all. You eat them raw. But minimally processed foods includes things like, you know, rice, you've. You've husked it. Or, or grains, you know, it's gone through a degree of processing. Pastas are minimally processed food, but they're usually single ingredient. And you can eat whole or you can, you can boil them frozen, frozen vegetables.
- [24:48]
Chris Van Tulleken
Can of tomatoes is processed food, which is tomatoes, waters and salt.
- [24:51]
Dr. Chris Van Tulleken
Exactly. So that's minimally processed. Then we have processed foods, which would be tanned or bottled things, tins of fish. They're processed, but these are processed using traditional methods and they haven't been. There's not a lot of financial growth in processed foods. So we have, number one, minimally processed. Nova 2 is kitchen ingredients. So things like vinegar, salt, oil, spices, things like this. And then group four. And then. So processed foods is. Is mixtures of one and two. That's how it's defined. So you take a, you know, you take some broccoli, you pour olive oil all over it and you fry it, you add some salt. Now you've got a group three processed food. So you can make Nova group three foods at home when you bake a cake. That's a NOVA Group three Food, you've combined groups one and two. Nova group four is ultra processed foods. When you say the term ultra processed foods, that is, you mean, and you, you mean a particular definition. So you hear the whole time, oh, the definition isn't agreed on. The definition is agreed on. You may not like it, but it is, it is agreed on. People may not agree about its utility, but it, but it exists. And it's, it's long, but it describes products that are formulations of ingredients that have at least some ingredients that are purely of industrial use and they contain cosmetic additives. So when you cook at home, you don't use artificial sweeteners, colors, humectants, foaming agents, bulking agents, anti bulking agents. You just cook with groups one and two. So UPF can only be made by an industry. And importantly, its purpose is profit and it is marketed. So you, you, even if you go and buy food coloring at home, you're still not making UPF because your purpose isn't to make profit.
- [26:34]
Chris Van Tulleken
For example. I'll just give an example. Like, I, I think, you know, people can go bake a chocolate chip cookie at home from real chocolate, regular flour, butter, eggs, right? But if you go get a Chips Ahoy cookie, the ingredients are unbleached enriched flour. Okay, that's, you could say that's okay, chocolate. But in the chocolate chunks, they have dextrose and soy lecithin, which are not things you have in your kitchen. It has weird things like ammonium phosphate, high fructose, corn syrup, soy lecithin, caramel color, artificial flavor. These are the things that, you know, are kind of invisible. It looks chocolate chip cookie that you make at home, but it's not. And you're saying this is materially different in terms of what we're talking about.
- [27:18]
Dr. Chris Van Tulleken
The definition was invented to test the hypothesis that industrially processed foods affected human health in ways beyond the ways that domestic cooking does. And it's done that robustly. What the hypothesis doesn't say is that that ammonium phosphate or the soy lecithin is harmful. Those things are proxies for ultra processed food. They're a sign that your food has been designed a system that is about profit, not health. So some we can argue there are certain class classes of additives, and I think you've had some very sophisticated thoughts on this and, and have spoken a lot about this. There are some classes of additives I think have quite good evidence for health harms. There are others where, who knows, a bit of potassium sorbate probably doesn't do you any harm. There's lots of things like acetate or propionate your body makes anyway, so the. And the color, a lot of the coloring probably doesn't do much harm. There's natural flavoring. These are signs that food is industrially processed. So taking that definition, the question is then to go, if do, for whatever reason, does that definition of food, do products that meet that definition cause negative health outcomes? And so we then have a set of criteria, as you very well know, to evaluate evidence. Where we go, are we just mistaking food that's eaten by people who live in disadvantage, people with low incomes, people who also smoke and drink? Are we mistaking food that's signifying a poor lifestyle for food that's actually causing harm? And of course, we now have across, I mean, we can go through this in detail, the Bradford Hill criteria. I would say ultra processed food has more than met the threshold for causality, where we can say with confidence it causes negative health outcomes. And we have experimental evidence, we have epidemiological evidence and so on.
- [29:04]
Chris Van Tulleken
I kind of, you know, having you explain all this because I recently read a paper that was published in 2022. It was a debate between Montero, who developed the nova classification, and Dr. Astrup, who's from Scandinavia, who, you know, have opposing views. And the argument from Dr. Astrup was that this is just sort of not a very helpful classification because it can all be explained through other things that we. You now kind of refuted. And I went and actually looked up the conflicts of interest of Dr. Astrup and, you know, he worked for Nestle and other big food companies. And I'm like, McDonald's. And I'm like, oh, okay, okay.
- [29:38]
Dr. Chris Van Tulleken
I wondered if you were gonna. I wondered if you were gonna. I have. I have them. I have them in front of me, actually. I spend a lot of my academic life and my broadcasting life critiquing people who don't declare and who do declare significant conflicts of interest. The interesting thing about that debate is there was very little scientific merit to what Astrup was saying in terms of. The arguments he was making were not good faith. So he would set up propositions that no one else was setting up in order that they would be easy to knock down. So he was. He was setting up straw men. It's not a useful policy instrument. No one is saying we should take the evidence around ultra processed food and just directly apply it to policy, any more than we should say, you know, we have good evidence that alcohol is harmful, so we should Ban alcohol. We should go back to Prohibition. I mean, no, that's, that's not how you use scientific evidence. You use it with nuance. It's a strange debate and it did not feel good faith. He also understood some fairly basic epidemic, misunderstood some basic epidemiology, which I think was embarrassing for him.
- [30:38]
Chris Van Tulleken
Well, this is really important point because, you know, as the world is getting sicker and fatter and America is tanking because of this, I think this is going to be the end of us, literally, because the economic burden of it is huge. We have over 60% with a chronic illness. We have 93% who are metabolic and healthy. We're 48th in life expectancy. We spend 40% of the dollars that are spent on health care from the federal government. That's sort of almost $5 trillion. It's about, about 30% of the entire federal budget. One in three dollars. It's both affecting us from a economic perspective, from a health perspective, from a social perspective. And it's a crisis. And so now recently in America, Trump was elected President Robert F. Kennedy Jr. Is going to be Secretary of Health and Human Services. And he's been all about ultra processed food. And so the question is, you know, when you have the keys to the kingdom and you're trying to make a difference, how do you use the framework of ultra processed food to policy or don't you? And recently the FDA came out with a ruling for front of package labeling and it's not been adopted yet, but it's out there for comment, which is to me kind of a throwback to the past, which is this concept of nutritionism that you talk about, this idea that most of nutrition science has broken down the effects of food based on their individual ingredients, salt, sugar, fat, whatever. And then you can dial it up or down. So we found fat was, was the enemy back in the 70s and 80s. So we basically said everybody should eat low fat. And that led to the rise, I think, of obesity and increased sugar in food. So instead you got snackable cookies and all these foods that were ultra processed that actually had huge amounts of sugar but no fat. And so we kind of can invite food companies by having this new ruling which basically says just the amount of saturated fat, sugar and salt as metrics, high, medium or low. To me, it doesn't go far enough to help educate people. I think it doesn't really tell people the degree of processing or how it's going to affect them. And what you're saying essentially based on the data, is that salt, sugar, and fat are not enough to explain the full impact of ultra processed food. There's something else. There's another element that makes it even worse. And so the question is, how would you take this framework of ultra processed food and use it to help inform policy? Whether it's dietary guidelines, whether it's front of package labeling, whether it's school lunches or what we do with our food stampers or service assistance program. That's kind of where I'm sort of struggling is figure out how do we, you know, because to me it's like if you put, you know, class one to four, four is like really bad for you. That would be an easy thing to do for a front of package labeling. But you're saying it's not really the thing that we should be doing.
- [33:15]
Dr. Chris Van Tulleken
Okay. It's really. You're really good at asking 10 very hard questions at once. Let me, let me. You're too smart.
- [33:24]
Chris Van Tulleken
Mark, I want to talk to you.
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Dr. Mark Hyman
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Chris Van Tulleken
Many people don't realize that when we.
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- [36:15]
Dr. Chris Van Tulleken
Let me try and break this down as I see it. A huge amount of the harm of ultra processed food comes from the very high levels of salt, sugar and fat. Fat and just calories. But here's the thing. When you cook at home, you also cook with salt, sugar and fat. If you make a chocolate brownie at home and you just gave me your, your recipe for chocolate, your, you know the Mark Hyman chocolate cookies. Now let's say we match them. You let's say you really let your hand slip with the salt because you, you understand how food processing works. So you make salty, sugary, fatty cookies because that's what we all love. In fact, they're exactly as salty and sugary and fatty as the big brand and you also mentioned what you aren't able to do is to engineer your cookies. So I'll have three of them even if you cook with as much salt, sugar and fat. Because you haven't put people in MRI scanners in order to develop your cookies. And we know that the big food companies use brain scanners to do product development. You haven't employed 100 PhD nutritionists to optimize every product through a thousand focus groups over over three decades. We also know you won't use as much salt, sugar and flour fat. So it's not, it's per bite of the industrial cookie I get more salt, sugar and fat. But because of the processing, the marketing, the coloring, the texture effects, the glycemic index, I eat more of it food. So I get more salt, sugar, fat per mouthful and I take more mouthfuls. And that's what the, those who resist the definition can't seem to grasp is the salt, sugar and fat are part of the ultra processing. They are, they're part and parcel. So in terms of what it teaches us, look, it tells us the products to regulate. It tells us that the what we see with diet related disease and we see this in natural experiments all over the world when populations start eating an ultra processed diet, that's when their risk of obesity, metabolic disease, kidney disease, dementia, anxiety, depression, cancers, it all starts to go up at the same time. So it tells us the focus of policy needs to be on in industrially processed products. The difficulty is not that it would be wrong to put warning labels on upf. It has a loophole and it would be be legally hard to do. The loophole is this. The companies are getting more and more sophisticated at selling us very high salt fat sugar foods that are very delicious, they're very soft, they're high glycemic index, but they don't contain the additives or they use natural additives. And so it functions like ultra processed food but it doesn't quite meet the threshold. So it's not that the definition is too broad, it's the definition is now too narrow. So we can give, we can give people all dietary guidance should say avoid ultra processed food. And there should be a simple working definition of that. That's what France, Belgium, Israel, Canada, as I said, that's what they all do in order to label a package. My research, where I am at UCL and we've partnered with the Pan American health organization with WHO to do this, we can show that more than 99% of ultra processed food has excessive calories. Saturated fat, salt and sugar in order to regulate the food. You can actually just.
- [39:08]
Chris Van Tulleken
It's like a proxy.
- [39:09]
Dr. Chris Van Tulleken
Yeah, you can, it's fine like, like we're gonna miss 1%. But it's very hard to make addictive food that isn't either very energy dense or fatty or salty or sugary. And most of the time it's all of them. Now the, the front of package label you talk about, the problem is that I am in the weeds of this. Okay, Mark, so I can be boring. We could, we could do like a four hour special. No nutrient profile models and how to best capture unhealthy food. There's no perfect way of doing it, but you use tight levels for salt, fat and sugar and then you put a proper warning label on. So at the moment on your US proposal, there's going to be high, medium, low for saturated fat, salt and sugar. It's not a bad way of doing it. But the low you get low for added. Well, for added sugars and it should be free sugars, but that's a separate thing. But you get low if it's 5% sugar. Now WHO says, and UK governments say you shouldn't eat more than 5% of your calories from free sugar at all. You'll get health benefits all the way down to 5% if you can get it down. So saying that 5% is low when that's at the upper edge of what who recommend for a daily. Daily intake feels right, it feels lax.
- [40:21]
Chris Van Tulleken
Maybe if you take the. On the front of package, you just change the proposed rule. Instead of having you say low, medium or high, you put low as green, you put a medium as, as orange and you put the high as red. Like a stop sign.
- [40:35]
Dr. Chris Van Tulleken
I think, you know what I think about this. So what you then end up with is products that. And we have these in the. So we have the traffic lights in the UK and you have a product with a red, green and an amber. Now what do you do at that traffic light? Is it good, is it bad? In South America, Central America, they've got a really good system, but they just use black octagonal warning labels. Once you're over the stop sign, it's a stop sign. Once you're over the recommended daily maximum, you get a black octagon and the. But the most important thing, right, is the warning labels don't do much. For every policy problem, you need five policies to solve it. And every policy should be solving five solutions. This is the sort of public health maxim. So you can't just stick octagons on if you, if a product has an octagon, the monkey has to come off the box. Okay? If it's got three octagons, it's got to have progressive taxation. You know, you just cited some of the economic data around how much this has cost. So don't, we don't want to make food more expensive for people who, who are disadvantaged. But you have to tax the worst products. If a product has an octagon, it cannot be marketed to children. It can't have an online or TV ad. The warning label does nothing. What you have to do is find a really tight way of defining unhealthy food. The food you are trying to label is ultra processed. You use your fats, sugar, salt, energy thresholds to label the ups.
- [41:52]
Chris Van Tulleken
So you're in charge of the fda, you get to decide how it's going to go. You have full autonomy. What's the solution? Because literally we're in this conversation right now about how do we really change the labeling and what other policies need to happen. And you mentioned ending marketing, you mentioned taxation. These are extremely unpopular ideas in America. And I think free speech and first amendment is about the marketing and I don't agree with it. I think we don't allow smoking advertising anymore. We don't allow Joe Camel on the package front of cigarettes to advertise to kids about smoking. Done a lot to kind of roll those things back, but it's a tough sell. And, and the taxation issue is a very big concern. And what I hear a lot is the pushback from the industry, you know, and there's hunger groups that I, I know you, you know, and talked about are co opted because a lot of big industry food companies are on the boards and fund those organizations. But the talking points are pretty kind of obvious. They go, well, you know, we're going to be taking away safe, affordable, convenient food. We're going to be penalizing the poor. We can't tax the poor. It's regressive. It's, there's all these arguments that seem socially cont conscious and forward thinking and you know, very elevated. And of course, no, we don't want to take away food from people. We don't want to make it hard for them to eat. We don't want to take away safety and food we don't like. Who's against that? Right? So it's sort of, it's very smart and it's propaganda from my perspective. And it's sort of like the old.
- [43:16]
Dr. Chris Van Tulleken
The old Chris Van Tiliken wants to Ban food for poor people is the way the headline gets written. If you put me in charge of the fda, I'll tell you what the most important thing thing. So I'm very careful how I use my voice. I'm ostentatiously a man with, with privilege of a particular age. You know, I'm educated, I'm insulated from the problem insofar as anyone is. The most important thing is the goal of policy is not to reduce people's consumption of a particular product or food. The goal is to improve justice and to improve affordability and choice in the food system. If people want to eat ultra processed food, I, to some extent, I don't care what people do. I'm a big believer in freedom and choice. I like freedom of expression. I do think that corporate free speech, when it's misleading is better characterized as propaganda and corruption. So in terms of how you do it.
- [44:07]
Chris Van Tulleken
So free speech is good propaganda. No, this is not lying.
- [44:10]
Dr. Chris Van Tulleken
No, this is not rocket science. The most important is you want to make things so leave the taxation on the table for a bit. The first thing is warning labels. I think for the most part we actually have a lot of data and the traction that this is getting in the States is. And we're seeing the same thing in the uk. I mean the, my book has been peculiarly popular for, for a kind of almost a, like a quite a detailed science and food policy book I think because people are at a point of maximum fury. So saying, saying this is all about communication. If I was running the fda, I'd say, look, I don't think you want to be predated on by transnational corporations. Many of them aren't even American. It's not like they're all paying loads of tax in America to clean up the plastic and the obesity crisis.
- [44:53]
Chris Van Tulleken
And Nestle's a Swiss company and many.
- [44:56]
Dr. Chris Van Tulleken
Of them aren't even housed in other places if you know, they're not even paying tax in those places. So framing this as protecting people from predatory corporations, as improving democracy and increasing choice and taxation. Yeah, I mean you've got to be really careful. You don't tax the bread and you don't tax ingredients. You know, that's completely sensible. You also need to make sure if you do have to, I mean, food is already taxed. You just need to shift slightly, change the proportions, change the tax on, on the healthy stuff.
- [45:25]
Chris Van Tulleken
Yeah, I mean the taxation works. You know, they've demonstrated this in California and other states or cities in America where they've actually implemented this and the consumption goes down and health gets better. I mean, there is data about this already, so I think it's unpopular, but, but I think some kind of strategy that progressive taxation based on the framework you talked about makes a lot of sense to me. I think it's, it's going to be a tough sell in America. I think the, the thing I want to dive into now a little bit is we've established that ultra processed food is different than just, just home baked cookies, and that it's these weird ingredients that are not in your kitchen cabinet that are put in food to make it addictive, to make it palatable, to make it easy to consume. Lots of it makes it uniquely different than just regular processed food. And there's something kind of particularly harmful. And I would say I would agree with that based on my experience. And I would also say that it brings up the question that you kind of hinted at of how these corporations are operating in the world and what they're doing and what they know and what they don't know that are producing these foods and how it impacts our health. You kind of touched on the fact that these big companies put people in functional MRI machines to look at the effects of different foods on the addiction centers of the brain in order to optimize what they call the bliss point of food, which is something Michael Moss talked about, actually on my first podcast that I ever did. He really kind of was like wrote this book called Salt, Sugar and Fat where you interviewed all these food intrigue experts and executives and scientists and kind of whistleblowers. And they kind of peel back the sort of the layers of how they, how they do this. And they have taste institutes where they hire craving experts to create the bliss point of food and find out ways to create heavy users, meaning taking people who are already using it and get them to eat more. And it's a very deliberate thing. And there are many other examples of pernicious ways in which the food industry and big ag and other industries like alcohol, tobacco actually push their products. And you introduced me to a gentleman from the World Health Organization that I had a conversation with where they talked about, about this white paper they're creating on the commercial determinants of health, the ways in which transnational multinational corporations subvert public health and privatize profits. And I didn't call it that in my book, Food Fix, but essentially that's what I was writing about, which is the ways in the various ways in which they use funding of research, they use funding of front groups, they use funding of social groups, they use funding of academic centers, universities they fund, they use heavy lobbying. And in every particular tactic they can come up with to undermine our public confidence and to actually confuse us, confound us and kind of make the whole thing messy. When it's really quite simple. These foods are bad for us and we shouldn't be eating them. And there's no argument really to say that they're healthy or safe. And if you eat it once in a while, fine. If you have a bag of Skittles once in a while, it's not going to kill you or Reese's peanut butter cup. But if you consume these things on.
- [48:18]
Dr. Chris Van Tulleken
A regular basis, it's like saying just, just if you have one line of cocaine and one cigarette once a month, once a week, it's not going to do any harm. But you know that the great difficulty about cocaine, cigarettes, alcohol, heroin, they're a little bit moreish. You know, you tend to, tend to want that, that second one.
- [48:36]
Chris Van Tulleken
Well, the super bowl was on because we're recording this just after the super bowl and it was on last night and I was watching and there was a commercial for lay's potato chips. And the whole thing was about this organic farm and looked like this little girl and this potatoes and how, how beautiful this bucolic scene was. And at the end it was for lay's potato chips. And I was like, oh God, it's just like they are so good at just kind of capturing our imagination and they don't really help us understand what's really going on. So I was kind of like, yeah, it's bad.
- [49:07]
Dr. Chris Van Tulleken
You know, you've alluded, and I think you and I can name. There's a community of scientists who have very aggressively opposed what I'm saying. I want to say I sit on two World Health Organization expert working groups, okay. I work at a big university as an associate professor in the uk. I'm not a sort of fringe lunatic. I work with unicef. But there's a community of industry funded academics who violently oppose this concept of upf. What they don't want to come up with, what they never propose, is what is causing the public health crisis. Because we have had salt, sugar and fat in our diet for a very long time. We've been processing food, as they frequently say, for hundreds of thousands of years. What happened in the mid-1970s? We, I went and spoke to Howard Moskovitz, he's in the, in the 70s, designing tomato sauce. And he, they start making lots of different recipes and putting them through focus groups. And it's this, this is adopted. Now I've seen this in big food companies. I've spoken to, I spent, I spent a huge amount of my time writing my book, Ultra Processed People talking to food industry insiders because the industry funded academics critiqued the company concept. But the people on the inside are like, oh yeah, no, we, we design the food to be addictive. How else do you think if the people at Danon are making the food that way, what are the guys at Nestle supposed to do? I mean, this is, this is an arms race for customers.
- [50:26]
Chris Van Tulleken
That's right. Stomach share, they call it stomach share.
- [50:29]
Dr. Chris Van Tulleken
So they know we know two of the most important things they measure are how much food people eat and how fast do they eat it. And we interviewed Francis McGlone, who's head of neuroscience at Unilever, one of the world's biggest ice cream company companies. And he talked about putting people in brain scanners and looking at the meeting ice cream. And he said the orbitofrontal cortex, and I'm going to quote him, directly lit up like a furnace. So when you find, if someone listening to this is eating ice cream out of the tub or you know, they do this later this evening, you know, you get the tub out and you make yourself a little bowl and then you put the tub back in the freezer and then as if drawn by some gravitational force, you find yourself back at the freezer opening the tub again and eventually the whole tub. That's because the ice cream was invented by scientists using brain scanners. Like it's, it's not your fault you can't stop eating it.
- [51:18]
Chris Van Tulleken
So the commercial determinants of health. Yeah. Framework. Tell us like how you see that playing out and unpack that a little bit because I think people don't understand the way in which they're being taken advantage of, the way in which they're being manipulated by both commercials marketing the design of the food, the pernicious ways they subvert policy. I mean, this is not just, oh, we just made these foods and we didn't know that they were problem. They're actively trying to protect their territory and to kind of advance their products in the face of overwhelming research that they're harmful.
- [51:51]
Dr. Chris Van Tulleken
So some of the ultra processing is like how you mix together the flavors. Some of it is the focus group, some of it is the brain scanners. But part of ultra processing is suing the lawmakers who would seek to regulate you is funding the patient group. So if we look in the UK the commercial determinants of health kind of academic framework is just asking, asking, how do profit making entities affect our health in good ways and in bad ways. You know, we try and have a neutral perspective. In the case of food, one of the things they do is they control the entire narrative. So our government Scientific Advisory committee on nutrition, 65 of members have financial relationships with companies like and including Coke and Nestle. We the biggest food companies run breakfast programs and education food programs in schools. They fund our biggest food charity, the British Nutrition Foundation. Their healthy eating week last year, two years ago was funded, was sponsored by Coca Cola. Okay, that's the British Nutrition Foundation. We have our.
- [52:47]
Chris Van Tulleken
What does Coca Cola make that you eat? Only drink?
- [52:52]
Dr. Chris Van Tulleken
You know, you can't credibly claim to have an interest in nutrition and do these kind of things. In my, in my strong opinion, we have our science media center who do the briefings to the press. We have patient advocacy groups, we have social media influencers. You know, there's a tight, I mean, and then from my perspective, after I published the book, the first email that arrived from the food industry was not a lawsuit, it was an invitation from McDonald's to see if I'd become an ambassador for them.
- [53:17]
Chris Van Tulleken
So here's a million dollars, Chris. Would you become an ambassador and shut up?
- [53:21]
Dr. Chris Van Tulleken
Well, I should say I'm proud to speak to you today, Mark, in my capacity as, you know, global menu innovation ambassador for McDonald's. You know, amazing. No, I said I didn't.
- [53:33]
Chris Van Tulleken
I wanted to stick a position with Coca Cola chief science officer.
- [53:36]
Dr. Chris Van Tulleken
Should I, should I have disclosed that before I came on the podcast? I wanted to ask them how much money, but I, I couldn't risk. I can send you the email. You know, I'm not making this up.
- [53:47]
Chris Van Tulleken
Well, I know McDonald's paid a friend of mine who was sort of a healthy eating proponent. A million dollars to be their advisor a year.
- [53:55]
Dr. Chris Van Tulleken
That's so painful. A million dollars. It's so much money to me. But anyway, I did say no. I didn't want them to have an email from me going, going, how much are we talking here? So we used to think that cigarettes was an exceptional industry. You know, this, the tobacco industry made things they know kill people and are addictive and they do it anyway. Then in the mid-1980s, the cigarette industry bought the food industry. So the biggest food companies in the world, and it was Michael Moss again, I think, who did some of the work exposing this. Philip Morris, RJ Reynolds bought General Foods, Cross Nabisco, they used their molecules and the product development techniques and the supply chain to make the addictive foods. And now we see the same is true in automotive. We see it in fossil fuels. A perversion of academic interest, corruption of science, manipulation of policy. So exposing all this is important because once you, because it helps you re. See that super bowl ad where you're like, oh, it's not, you know, it's some, some, I don't know what, some farmer in his kitchen stirring a pot of, you know, vegetable oil with, you know, hand chopping the potatoes. It's, it's not like that. And I, I think the public, I feel the US Public are they, I mean, look, why are you popular? You know, you're not, you, you're saying all this and people are up for this, that you have an asymmetry of power. You, you aren't as powerful as, as, as Nestle Mondelet and, and, and, and Kraft Heinz. But, but, you know, I think truth gives you enormous power.
- [55:25]
Chris Van Tulleken
I think you're right. I mean, just speaking truth to power is key. And I think exposing the nefarious ways in which the food industry acts often can help people understand that this is not their fault. The people and the big talking points of big food has been essentially, it's your fault you're fat. Number one, all calories are the same. It's all about moderation. Eat less, exercise more. And implicit in that, those talking points, which by the way, have been been used by government leaders, by scientists, by doctors that have bought it, is that all food's the same. You could have a thousand calories of Coca Cola or 2000, a thousand calories of almonds, and it's exactly the same. Now, that's true in a laboratory. If you burn them, they release a certain amount of energy, which is what a calorie is, right? It's the amount of energy required to raise the temperature of 1 liter of water 1 degree centigrade. It's just a scientific term, but when you consume them, it's very different. A calorie burn is a calorie burn, but a calorie eaten is not a cal. Calorie eating, to quote my friend Robert Lustig. And when you, when you actually get that, it's like, wow. Well, when you eat a food, it has to go through your microbiome, your, the molecules that regulate your hormones, the immune system, you know, neurotransmitters, all are affected by the kind of food you're eating. And then people don't realize that, you.
- [56:40]
Dr. Chris Van Tulleken
Know, the way your body interacts with A thousand calories of almonds is somewhat different to the way your body interacts with a thousand calories of coke in terms of appetite. I mean, humans don't, we don't just choose to eat the 2,500 calories per day. You know, we're guided to it in the same way we're guided. Our internal physiology guides us to breathe a certain amount and to drink a certain amount of fluid. And it's the same with food intake. So it's. Yeah, it's very odd, this idea that humans can kind of eat, eat to numbers.
- [57:09]
Chris Van Tulleken
It's. What's strange to me also is that the food that they make in the United States is far worse than the food that they make. The same kind of food they make in Europe or even the uk. Like Kraft Macaroni and Cheese is full of artificial dyes and chemicals in the US but it's not in the uk. Or if you look at, you know, the amount of ingredients or additives we have in the United states, it's like 10,000 different food additives, where in European Union it's about 400. Now, maybe 10,000 are somehow more broken down into subclassifications. And maybe it's not 10,000, maybe it's 5,000. But still a lot of things that are unregulated, that are not proven. And by the way, people don't understand this. The way these things get into the food is that the food company goes, hey, this food, food. The ingredient we've found is safe. Fda. And if he goes, oh, great, cool. We'll regulate it as a, not as a safe to eat substance, generally recognized as safe. Whereas imagine if they did that for drugs. Imagine the drug company said, hey, we just developed this new drug, it's safe. And the FDA's, oh, cool, great, let's just prove it. That's exactly what happened.
- [58:07]
Dr. Chris Van Tulleken
We used to do that for drugs and then we realized none of the drugs worked and so we started regulating the drugs. But this is the system of food additive regulation. And so for the. I put a chapter in the book on the US System because someone said to me, food additives are not really regulated. Someone I trusted. And I was like, well, that's, that's not true. Of course they're regulated. You've got an fda. So I, I call up Emily Broadlieb, who's at Harvard, she runs the Food Law Policy center there. And she's like, yeah, no, there's not any real, you know, you have this self determination system where the companies can decide for Themselves. It's established sounding. Yeah. So you do have, no one knows how many additives you have because they're also not all formally registered. So. Yeah, it is. It's a mess.
- [58:50]
Chris Van Tulleken
Yeah. And there's things on the, there's things that are in foods that are ultra processed that aren't even on the label. Like microbial transglutaminase is basically gluten. It's put in foods to make the food hold together. Gluten is like glue. And so they use it in industrial food and they grow it in bacteria and it's a form of gluten. And then we've seen this incredible rise in gluten sensitivity and celiac disease, you know, potentially can create leaky gut. And we know that also ultra processed food has adverse effects in the microbiome, increases inflammation and so forth. But that transglutaminase is something that's not on the label or there's emulsifiers in food that are most of these processed foods that, you know, make the food have a good mouth feel and make it all sort of the right texture. And these compounds have been shown to cause leaky gut autoimmune disease and, and many other inflammatory conditions. And yet, you know, we don't regulate.
- [59:36]
Dr. Chris Van Tulleken
In terms of what, what the industry responds to all that is they say, well, you can't prove harm. The, the data on emulsifiers, okay, you got some animal experiments, you've got a bit of human data, you've got some epiditums, there's actually quite a lot of data on some of these emulsifiers now, but you haven't really proven it. But the burden of proof should not fall to independent academics to say that adding synthetic molecules to food is harmful. The burden of proof should be the other way around. And the molecules should have to go through a proper stringent regulatory process. But we do have a much more stringent process in Europe and the uk, but it's still not very strict. So we don't assess molecules in combination. We don't often assess the right dosage. And when it comes to food additives, we don't look at long term effects. We don't have any assays for effects on the microbiome or obesity, for example. So I think one of the things we, we know is that we can make very good, safe, cheap food without all these additives. And their primary function is to save the company's money. We did a paper last year on financialization of the food industry. So instead of working with nutritionists, I worked with a lot of economists. And we just used the food industry's own financial data and compared it to their claims, because all the big companies will say that they're mainly interested in reducing carbon emissions, cleaning up plastic, improving public health, improving the nutritional profile of the product portfolio and so on. You know, improving women and children's labor rights. And so you just say, okay, well, we've got all these claims. How does this stack up? When they make money, what do they spend it on? They spend it on share buybacks and dividend payouts. So even as Coca Cola claim, for example, to be trying to create a world without waste, that was their kind of strap line for a while. They had been the world's largest plastic polluter for several years in a row. The companies are very, very good at positioning themselves as being the solution to the problems that they've caused. And for me, that the one thing, if you give me this control of the fda, the one thing is to go, you need to be regulated, and regulatory relationships are at arm's length. You know, you cannot be taking money from the people you regulate. That's kind of step one, if there's any progress to be made, is to. Is to stop the flow of. I would describe it as dirty money between the companies that need regulation, whether they're tobacco, alcohol, or food, and those that would regulate them, whether they're formal regulators like the FDA or they're informal regulators like charities and activists and people like you.
- [61:50]
Chris Van Tulleken
I think that getting rid of the conflicts of interest and the reverse incentives that exist is a big part of the solution. I think about this a lot, and I. And you're right, you know, there's not just one policy solution that's going to fix it all. We need to start from the field and how we grow food, what we grow, how we subsidize agriculture, to, you know, how we incentivize companies to make better food, to how we. We educate people about what's in their food, how we warn them with labels. Anybody? My wife was in Mexico. She sent me a picture of, like, some food product and said, you know, here's all the warning labels. This is not safe to eat for children. At the bottom, like, it was all these warning labels. I was like, that's really good. You know, that'll probably stop a mother from buying that food for their kid. And yet, you know, in America, we don't have any of that, and people don't know. And I think this is what's. What makes me so upset, is that people really don't understand. So if you, if you're an individual who's listening and you want to not be caught in the web that the food industry has spun to catch you to eat these foods, what, what are the few things you can do personally to actually empower yourself to stop doing this? And, and how do you sort of, sort of take back control of your diet and simple changes they can make to kind of actually not eat this stuff?
- [62:59]
Dr. Chris Van Tulleken
In my book, I do not advise anyone to stop eating ultra processed food. In fact, at the beginning, there's an invitation to the reader that they should eat UPF while they read the book. I'd say eat more of it almost.
- [63:11]
Chris Van Tulleken
Oh, boy. That was never, I never did that. I read the book.
- [63:14]
Dr. Chris Van Tulleken
I didn't expect you. Well, I, you know, I suspect you read it at a different level to many other readers. But what had happened to me on this four week diet is around week three, I had a chat with a colleague in Brazil. We were designing this study and she kept saying a thing that you. I've heard you say before. It's not food, Chris. It's an industrially processed edible substance. She said this kind of again and again. It was, it was like, it was annoying. Tick. I sat down that evening to eat my favorite fried chicken brand. I got a little bucket of it. I was so looking forward to it and I couldn't finish it. She had made it disgusting. And this is the gift I want to give the reader, is the food will be your greatest teacher. Eat the food, lay it out on a china plate. You know, if you think you really love this, put it on a china plate. Get a knife and fork. This is not food that stands up to scrutiny by the end of the book. I don't promise this. I'm not selling anything. Anyone, a solution. But if you're addicted to something, we have pretty good evidence that this works with cigarettes. That first of all, engaging with the substance, not forbidding it, is helpful, but understanding the incentives of those who are selling you the substance is important. Understanding the tobacco industry massively helps smokers. And understanding the food industry really helps people who are addicted to upf. Mark, you've written some stuff on UPF where I was like, has he copied me? And then I realized you'd written it first. So then I was like, man, he's, he's gonna think I've copied him.
- [64:39]
Chris Van Tulleken
It's okay.
- [64:40]
Dr. Chris Van Tulleken
So you can, you can read. You can, you can read, you can read anything that either of us have written or this other great stuff out there if you can't afford to, to buy a book, you know, read about the food and eat it and you can do little experiments. One of my favorite things is get your tube of, you know, saddle shaped chip. I never, I, I can never mention Pringles. Pringles are similar. So you get your Pringles or other independent media.
- [65:06]
Chris Van Tulleken
This is a podcast. No one tells me what to say or do. I can say whatever I want. I can say any words I want. I can name any companies I want. They might come after me.
- [65:15]
Dr. Chris Van Tulleken
I also get, I'm getting legal attacks constantly from the food industry. It takes up a huge amount of my time and it, you think it'll be fun and actually I want to talk about.
- [65:24]
Chris Van Tulleken
Oh, they come after you. They pay attention. I mean, they write articles about me. The corn refiners of America sent me nasty Graham letters. I mean, it's interesting.
- [65:33]
Dr. Chris Van Tulleken
It's how, you know, it's one of the ways I think, you know, you're saying the right thing. But get your Pringles, get them out of the tube or other brands, crunch them up into a powder, put the powder in a bowl and eat it with a spoon. And that way you will discover if you really love Pringles. Because part of that ultra processing is the hyperbolic paraboloid shape. Part of the ultra processing is the mythology, the branding on the tube. And once you've reduced them to a powder, it's a really good experiment to do.
- [65:59]
Chris Van Tulleken
That's a great experiment. Actually. Actually, just before we go to the lawsuits, I just want to tell you story. I had a friend of mine who's a work as a nutritionist and he was a psychologist of nutrition and he had a patient who was trying to help lose weight. And the patient's like, I'm really busy, I want to lose weight, but I'm really going so fast in my life and I, I just stop it. Like Burger King, I get my, you know, whatever, Big Whopper every night and I, this is what I do and I have to do it because I can't have time to do anything else. He's like, okay, what I want you to do is you don't stop eating it. But I want you to go in there and I want you to sit down, down in the restaurant and I want you to take each bite and savor it and take like at least, you know, 20, 20 twos on each bite and just experience the, the food you're eating. He came back and he was like, this was gross. I couldn't Eat it after I did that, you know, and he just stopped eating it.
- [66:44]
Dr. Chris Van Tulleken
It is all like that. I've gone back. My wife and I were on a long, long car journey a couple of years ago and we just stopped at a McDonald's kind of, you know, as as many of us are in the habit of doing. I mean, I know I'm embarrassed saying this, I'm a physician. Whatever we did and we were like, oh, now we know about, we just couldn't. I'm embarrassed. We just threw it all away and stopped and got some groceries. But yeah, it's not food that stands up to scrutiny. It's not complex food. It is all almost equally salty and sweet. So the other thing to remember is your breakfast cereal is as salty as your microwave lasagna and your pizza is as sugary as your pudding. It's all like, there's quite a straightforward formula of like acid, salt, sweet fat, plus the additives and strip out all the real food, keep it cheap. It's weird stuff. So I, I'm very conscious as well. I don't like telling people what to do. I'm quite a weak, fallible person myself. So I also don't want to put myself on some pedestal where if I am snapped going into McDonald's, anyone's going to see me. But I, what I can say at the end of my diet, I genuinely do not want any of it anymore. I eat it to be polite. Are you ever in this position where you're at some thing you have probably never at this. I'll be at friend's house and you know, some parents at my kids school and I just don't want to be that guy. So I'm like, yeah, sure, I'll have some chips and dip. Yeah, absolutely. I'm, I'm here.
- [68:01]
Chris Van Tulleken
Yeah, no, I, I can't bring myself to do that unless it's like actually real food and then you know, if it's tortilla chips and some like whatever, it's fine. But it's like I, I, I definitely, it's just, it doesn't look like food to me. It looks like a rock or a piece of wood. Like it would, I wouldn't just eat it, you know, like it's, it's really, my experience has really changed when I go buy like a case of delicious looking processed things. Like you like the window of a Starbucks, you know, kind of at the front of the store. It doesn't look like food to me and I just, I don't, I don't even I'm not even attracted to think about it. And it's because I think I've reset my nervous system.
- [68:36]
Dr. Chris Van Tulleken
It's exactly my experience. And there were two. Part of it was Fernanda going, it's not food. It's industrially produced, edible substance. And part of it was. It was Nicola Vena, who you may have spoken to. She's a food addiction scientist. And she said, it's not that the food would be beige. It's that a lot of this food, if it wasn't dyed, would be gray. And I thought that was amazing. I'm like, oh, it would be, wouldn't it? Once you start looking at the pastes and powders. So that was very powerful. But no, I went cold. I went completely. I just stopped cold turkey.
- [69:09]
Chris Van Tulleken
What happened?
- [69:10]
Dr. Chris Van Tulleken
So there are all these things that people don't report on. The food is so salty that you get very. You know, you eat it in the evening, and then you have to drink all this fluid. So then if you're a man in your 40s, you're kind of up all night peeing as. And then you're exhausted and you get constipated. I mean, you get your salt and your life start, and you're angry and tired and stressed. And so you get up in the middle of the night, and then you're eating more because you're tired, and your cortisol level goes up within 48 hours of stopping. I felt massively better. Losing the weight took me two years, and in the end, I just fasted it down. I mean, it was. It was grim. But if people are. I mean, many of you, your listeners, will be struggling with weight, I'm sure. I just want to say, I want to reach out and hug all of you. Losing. I had to lose six kilos, and I have every possible advantage doing it. And it was really, really, really hard. So the injustice of this is, it is really not people's fault. It is. It is this food that is engineered to get around your fullness system.
- [70:10]
Chris Van Tulleken
So this has to get fixed. And if it doesn't get fixed, the consequences are pretty grim for society, for the world. I'm not just America, but everywhere, which. Which is now being the receptacle of the inventions that happen here and elsewhere. And it's like America's created the worst diet on the planet and exporting it to every country. You know, it's our biggest export. The countries. There's a few countries that don't have fast food. I don't know if it's like Myanmar Myanmar or like what used to be.
- [70:37]
Dr. Chris Van Tulleken
Burma or it's North Korea.
- [70:41]
Chris Van Tulleken
North Korea, right. Like they don't have any of these problems is quite interesting. Right. Like we've, we've, we've embargoed them and had sanctions on them and we don't allow them to trade with us. And so they can't get all this stuff that is in all over China, by the way now. And you've got, you know, I remember when I went to China in 1984 and there wasn't anybody overweight and then I went back, you know, a few years ago and it's like, wow. And now they've gone from like, you know, 1 in 150 people with type 2 diabetes to 1 in 10, which is almost approximating what we have in the U.S. and it's because we've basically exported our western diet. Same thing in the Middle East. You know, they were nomads, you know, healthy, fit, drinking camel milk and you know, eating camel meat and herding their sheeps and goats. And then within a generation they had enormous wealth and they were able to purchase a lot of the things that we have in the west, just how genetically adapted to that. And they have now one in four people there have diabetes.
- [71:33]
Dr. Chris Van Tulleken
You're putting this so powerfully. And one of the things people who object to the UPF evidence, I'm left going, just what do you think it is? This. We are living not just in a crisis, this is an emergency in the sense of something that needs immed action. We can't wait to deal with this. You know, we always like, oh, this will end up costing, it's like, no, in the UK it already cost the economy 100 billion a year and we have a tiny economy compared to the US economy. It's all red, it's unaffordable in terms of its effects on the planet. Plastic, pollution, carbon, all the rest of it. So it's an emergency. But we've been living in the emergency for well over a decade. The sort of, oh well, we need to fiddle around the edges of policy and kind of make a, you know, put a salt fat sugar warning on foods. It's like, no, there has to be a spectacular kind of revolutionary thinking and really imaginative policy proposals. I have to say lawsuits are going to be the way forward. So we've seen and I think you, you've helped with this. There's been a complaint, a 16 year old boy, he was 16 at the time, now he's 19. It's not a class action yet against Some of the biggest, all the major food companies you can name, brought by a small group of lawyers who I've been speaking with. I think you've spoken maybe with them too. Lawsuits are going to force discovery and that's going to expose documentation that whatever all the conflicted academics say about the evidence around upf, it's just going to be the company documents that are like, yeah, no, we invented all this stuff so that people couldn't stop eating it. It's all, it's all going to be there black and white. So the lawsuits.
- [72:59]
Chris Van Tulleken
Yeah, well that's really important. I mean because that's how tobacco was stopped. Wasn't through legislation and regulation. It was these class action lawsuits that brought them down.
- [73:06]
Dr. Chris Van Tulleken
And it painted, painted the industry as acting in a corrupt and criminal way. And I, in the, it's astounding to me in the US we don't have to have a.
- [73:16]
Chris Van Tulleken
There was a cigarette. Was the boogeyman. Is ultra processed food the boogeyman we should go over and attack or is it something else?
- [73:23]
Dr. Chris Van Tulleken
I mean the complaint you can download. I'll send you a link that your listeners can, can download because it's, it's a great, great, great summary of the evidence. You know, lawyers are incredible at assimilating evidence. I was surprised they decided to, to pick ultra processed food. To me the easy case to start with would be sugar. That it is an obscenity that a can of high sugar cola doesn't have a warning about tooth decay on it. So I'd keep it to that straightforward. You know, no one disputes that sugary drinks rot teeth. In the US and the UK it is.
- [73:55]
Chris Van Tulleken
Let's go to Appalachia where Mountain Dew is this beverage of choice. It's like these kids, none of these.
- [74:00]
Dr. Chris Van Tulleken
Kids have teeth and it's a tragedy and we think oh, it's only teeth. But it's like this is a major cause of sickness and suffering offering in, in low income communities and across the United. I mean we, my country is famously struggles with its teeth and has for a long time because of our sugar intake. So that to me would be the, the easier avenue. But the complaint as they've made it is very persuasive. Whether it will win, I don't know. I mean the first cigarette lawsuits didn't win either. But eventually, you know, there's a drip, drip, drip. And I think, I think there's more and more attorneys general that are focusing on this.
- [74:33]
Chris Van Tulleken
Yeah, no, I've been, I've been involved with talking to some lawyers who are doing class action lawsuits against ultra processed food and these companies. And I think the discovery is key. And I think as I was researching my book Food Fix, I got a lot of FOIA requests for documents which you can get from the government. So in other words, all government documents, unless they're classified or available to the public. A bit of a pain in the ass. You have to go through the Freedom of Information act and ask for them. But for example, you can get emails from the CDC with Coca Cola. Like Coca Cola is not going to give you their emails, but the CDC has emails from Coca Cola and you can read their. And they have to release them. And they're like, yeah, where we're funding you and we're doing this, we're doing that. It's like, it's kind of crazy. I think when people start to understand that they're being taken advantage of, that they're being used, that they're being manipulated, that they're being controlled, that their health's undermined, that their well being is undermined, their financial security is being undermined. Because if you're sick, you can't work and be a productive member of society, both on an individual level and on, also on a societal level, what we're doing to society, you know, with this burden of chronic disease. You know, I've been a doctor for 40 years. This has all happened in my lifetime. I graduated from medical school, there was not a single state with an obesity rate over 20%. Now there's not one under 30 and most are over 40.
- [75:44]
Dr. Chris Van Tulleken
It's astounding. You've been a doctor for 40 years. I've been a doctor for over 20 years. And it looks more like 40 years, but it's almost kind of in the UK it's almost within my time. I mean, you ask this great question.
- [75:57]
Chris Van Tulleken
40 years, a long time, like, wow, I'm old, but that's okay, I'm still kicking.
- [76:03]
Dr. Chris Van Tulleken
But you asked this great question, is it the boogeyman? And you kind of threw that question away. But it, it, it's such an important question because it's like I, sometimes I duck and dive on this because that's the question. I don't want to be a UPF purist. I don't think anyone's saying like, it's the only thing, but when you ask it that starkly, it's like, yes, yes, ultra processed food is the boogeyman. And anyone who says now, some people say, oh, the mechanisms of harm are disputed. Here's the difficulty with the way in which ultra processed food harms you? The barrel is so full of fish, it's hard to hit the right one. Is it the softness? Well, it's all soft. Is it the energy density, the salt, the fat, the sugar? Is it the emulsifier content? Is it the marketing? We know marketing drives excessive consumption. Is it the trans fats? Is it some other property of the RBD oils? Is it? And on and on and on. It's like it's every aspect of every product has been optimized so you can't stop eating it. So I, I want to be clear. It is I, it is the boogie man. And it's just, it's the thing that needs to be tackled.
- [77:03]
Chris Van Tulleken
I mean, there are problems with the definition and there are arguments and, you know, often will get disputed by the food industry. But I think if you're going to have a catalyzing concept for Americans or for the world, I think it's useful. And I, and I think it somehow has to be embedded in, in the way we think about policy and how we shape policy. And we'll have an offline conversation because, you know, I'm involved in some of the policy conversations of what do we do next in America? Because we have this opportunity, whether we like who's in power or not to actually do something. And with people who are very aware, like I know the commission of the FDA very well. You know, I know Robert F. Kennedy very well. I know Dr. Oz, who's head of Medicare very well. We've been friends for 22 years. Like all of a sudden the kids have the keys to the candy store. What are we going to do? And how do we, how do we do the right things and not do the wrong things, which is, you know, it is fraud. It's a land, landmine kind of covered territory where we're trying to navigate to the right policies that make the biggest difference with the most leverage, that have the greatest impact on the health of the population and not be too punitive or too oppressive to the population or to taxation. So it's a very interesting moment. And this concept has been around for a while, but now it's sort of like it sort of caught the national imagination here. And I think I'm happy for that. I'm a little concerned that, you know, the food industry is so big, so powerful, they're so on target. I mean, they're so deliberate about their, their messaging, they're so good at their, their propaganda to confuse and confound people and to sort of discredit People who are making these claims like you or me, you know, so it's pretty interesting, the framing.
- [78:40]
Dr. Chris Van Tulleken
You know, my, my sister in law, Dolly is, is an academic in the UK at Cambridge and she's all about, she's a food systems academic, she's about how you frame the problems. So she's aligned in the uk. She has been with the political, political right, unusually for a public health academic. And she's all about, look, if you frame this stuff as justice, as freedom, as choice and also as creating business opportunities for small and medium sized businesses so that the political economic right hate monopolies, you know, monopolies are terrible. They're terrible for the economy, they're terrible for everyone. And at the moment you've got oligopolies of food producers. You've got really a huge amount of global grain being traded by a tiny handful of companies. This very small number of crops traded by a very small number of companies.
- [79:26]
Chris Van Tulleken
I think it's like nine, nine big food companies really control almost all the market and they own all the other companies that you might think are healthy brands and they buy them up. Like General Mills for example, bought up, you know, Epic Meat Bars which are, you know, you know, regenerative, organic, you know, grass fed, you know, bison bars. Right. So they're like, they kind of have.
- [79:46]
Dr. Chris Van Tulleken
This buying innocent smoothies, you know, so, and this is something, this comes up a lot in the discussion is going well, a lot of vegan food is ultra processed. Do you want to ban that too? And it's like, whoa, whoa, whoa, no one, no one's saying we're going to ban all ultra processed food. No one's saying it's all. That's another really important thing. It's not all equally bad, but it is all almost without exception bad. And the vegan stuff is often made by the same companies that are producing enormous quantities, quantities of meat, often in quite inhumane, unethical, unsustainable ways.
- [80:22]
Chris Van Tulleken
Like Tyson has just, you know, bought huge amounts of these alternative meat company stocks and shares.
- [80:28]
Dr. Chris Van Tulleken
If you, if you're kind of really concerned about the ethics and you want to eat a good vegan diet, eating an ultra processed food that's made by Cargill or Tyson, even if it's vegan, it will probably be made, can only exist because it's made from the byproducts of the animal feed industry. So it's not, I feel those, those arguments don't have heft. There's a way of eating ethically and sustainably. If you want to Be vegan if you want to eat meat. None of it requires ultra processed food.
- [80:52]
Chris Van Tulleken
Amazing. Wow. Chris, I could talk to you for hours about this. We haven't got to do it again. You know, it's an exciting moment because I think both in the uk, around the world, governments, people are starting to sort of pay attention. I'm very interested when this report comes out on the commercial determinants of health, if it'll sway governments to change their behavior. But we can see across South America, they've been extremely forward about this. Canada, countries like the UK already are doing things like banning a lot of marketing. They're already kind of doing better food labeling. So we have a lot to learn from what's going on around the world. And I think you're right about the political framing of this as a choice. As, you know, autonomy, freedom of speech, all these things that people care about. You can actually kind of frame it in the right way so that it actually makes sense. And again, nobody's talking about banning anything. It's about how do we tell people what's what so they make a choice that's good for them.
- [81:46]
Dr. Chris Van Tulleken
I love that. Yeah. If you want a strong military and a good football team, you've got to fix the food system. You know, it doesn't matter where you're. But if you care about social justice, you got to fix it. It all points that everyone's on the same team here. We all live on the same planet. It's such a joy speaking to you, Mark. I feel so full of energy after we communicate on email or anything. So I'm. It's. It's such a delight.
- [82:09]
Chris Van Tulleken
Yeah. Thanks, Chris. Yeah, Keep up the good work. Let's care notes. Let's talk about policy more. Let's talk about lawsuits. I'll get you offline. And I want to talk to you about the right strategies going forward because we have this very moment that's both filled with possibility and fraught with danger. So I think it's an interesting moment and we're kind of at the precipice of potentially doing something that could shift things. And we'll see.
- [82:34]
Dr. Chris Van Tulleken
I'm very pleased you're in the discussion and thank you so much for having me on today.
- [82:38]
Chris Van Tulleken
And everybody. Definitely check out Chris's book, Ultra Process People. Hopefully that's not you. If it is for sure, you want to read the book and keep up with his academic work and his policy work. Do you have a place where people can find you or learn more about what your work is?
- [82:54]
Dr. Chris Van Tulleken
Instagram Dr. Chris Dr. D O C T O R like spelled out Chris VT I guess. Or I'm on Twitter ox on the same handle. Rchhrisvt okay, great.
- [83:07]
Chris Van Tulleken
We'll put that on the show. Notes. Great to talk to you Chris and we'll see you soon.
- [83:11]
Dr. Chris Van Tulleken
Mark it's such a pleasure.
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Dr. Mark Hyman
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Dr. Mark Hyman
If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels. R Mark Hyman Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review and subscribe to the Dr. Hyman show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness center, my work at Cleveland Clinic and Function Health where I am Chief Medical Officer. This podcast represents my opinions and my guests opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other quality qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness center at ultrawellnesscenter.com and request to become a patient. It's important to have someone in your Corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public. So I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening.