Eat fewer ultra-processed foods (chips, instant noodles, pastries, ready meals)

28. Eat fewer ultra-processed foods (chips, instant noodles, pastries, ready meals)

Cost: There’s no direct monetary cost, but you’ll need to spend time cooking or selecting minimally processed ingredients every day. The real challenge is overcoming the long-standing habit of choosing convenience over health.

In plain terms: People who consume the most ultra-processed foods have a roughly 20% higher risk of dying during the study period compared to those who eat the least, and a 50% higher risk of dying from cardiovascular disease. However, this evidence is rated as low certainty, so these figures should be interpreted with caution.

Benefit: One systematic review combined data from multiple studies, even though those original studies did not group participants by ultra-processed food intake. The results showed that people eating more ultra-processed foods had a 21% higher risk of death (RR 1.21) and a 50% higher risk of cardiovascular death (RR 1.50) compared to those eating less. These findings are classified as “highly suggestive” and “convincing” respectively. Yet when assessed using the standard GRADE criteria, the overall certainty of this evidence is low or very low.

Evidence grade: A

Sources: Lane MM et al. (2024). Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. BMJ. <https://doi.org/10.1136/bmj-2023-077310>

Notes: There are three main points of debate here. First, the NOVA classification groups foods with vastly different nutritional profiles into the same category. Second, ultra-processed foods overlap heavily with sugary drinks and processed meat (see items 7 and 18), so it’s hard to isolate which factor is responsible for the observed effects. Third, GRADE ratings for this evidence are also low. Therefore, it’s unclear how much additional benefit this recommendation provides after following the other two. The opposing evidence comes from the same review’s low GRADE rating; no original studies have produced contradictory results to date. For now, focus on following items 7 and 18 — avoiding sugary drinks and limiting processed meat — before placing much emphasis on this recommendation.