You are likely already aware of the hits that ultra-processed food has taken over recent years. This type of food is now recognized as one of the drivers of many common diseases. My friend and colleague Dr. Robert Lustig outlines this process in detail in his excellent book “Metabolical”. Food is considered to be “processed” if it undergoes significant alteration during preparation. But not all processed food is dangerous. The scientific community has broken down processed food into four basic categories which were developed by Dr. Carlos Monteiro at the University of Sāo Paulo, Brazil:
- NOVA Group 1: Minimally-processed and unprocessed food. This group of food includes fruits, grains, vegetables, nuts, and beans. These foods sometimes need to undergo pasteurization, boiling. or roasting to make them safe to eat.
- NOVA Group 2: Processed culinary ingredients. This group includes processed ingredients that come from Group 1 foods or nature. This includes salt, sugar, butter, and oils.
- NOVA Group 3: This group includes processed food that is generally made by adding sugar, salt or other substances from Group 2 foods to Group 1 foods.
- NOVA Group 4: Ultra-processed foods. This group included ingredients that are manufactured with little or no intact foods from Group 1. These processed foods typically contain many chemicals and ingredients that are artificial and are not found in real food.
Robert Lustig described this analog to me–Group 1: an apple. Group 2: apple slices. Group 3: apple sauce. Group 4: McDonald’s apple pie!
The term “ultra-processed food” generally refers to foods in Group 4. It’s often assumed that as you go up the ladder from Group 1 to Group 4, there are more adverse health effects.
Monteiro’s team has shown that only Group 4 foods are associated with disease, although too much added sugar in Group 3 could be a problem because of excess fructose.
The medical and scientific communities have tended to focus on the issue of calories and weight gain. Studies have documented that consuming a diet of highly processed food compared to a diet of whole foods does result in an increase in calories and weight gain. One can then extrapolate that our increase in consumption of highly processed food over the past 75 years or so is directly responsible for our current massive obesity epidemic. That’s the explanation being promulgated by the medical and scientific communities.
Dump the Junk Food
If that’s the case, the solution should be quite simple—convince people to consume less ultra-processed food. After all, even gluttons can understand the danger of consuming this type of food. If that’s the case, nobody seems to be listening, as the incidence of obesity continues to rise. In addition, ultra-processed food has been tied to many common chronic diseases that are also increasing in incidence. Recent studies have also shown that this type of food has a negative effect on the brain. To help understand these worrisome trends, I recommend taking a deep dive into the nature of ultra-processed food.
The Nature of the Beast
It’s clear that ultra-processed food is made up of a long list of components, some of which might be dangerous, while others are likely benign. I would like to focus on these four key ingredients contained in most highly processed food:
- Excessive sucrose or high-fructose corn syrup (HFCS).
- Excessive high-glycemic carbohydrates such as refined grains, white flour, and white rice.
- Excessive omega-6 fatty acids relative to omega-3 fatty acids, including various vegetable oils.
From a scientific standpoint, we know that these dietary elements tend to be pro-inflammatory, and excess inflammation is a key driver of many chronic diseases. My friend and colleague Barry Sears is one of the world’s foremost experts on this topic. He has written many excellent books on this important topic which advocate that factors relating to increased inflammation has many health benefits. I recommend visiting his website for more information about the role of inflammation in health and disease.
Key Neurotransmitters Flushed Down the Toilet
Although the inflammation driven by highly processed food is clearly a part of the pathology of obesity and various brain disorders, in my opinion the complete story is even more complex. I learned some of this information by measuring the body composition of every one of my patients at every visit for decades. At one point I started to experiment with tests that measure urine neurotransmitter levels using tests provided by Gottfried Kellerman, the founder of Neuroscience, Inc. At the time nobody knew exactly how to interpret these tests, but I noticed something very unusual. I gave the tests to some individuals who were undergoing glucose tolerance tests. Shortly after getting a load of glucose, their urine would suddenly fill up with monoamine neurotransmitters like dopamine, serotonin, and dl-phenylalanine. This clearly was not a normal physiological response, because Mother Nature would never easily give up these valuable chemicals. It finally dawned on me that the blood glucose spikes associated with these tests caused a pathological dumping of monoamine neurotransmitters. When these chemical messengers are secreted from cells, they are recycled by the reuptake system. This system didn’t evolve to handle this excessive dumping of neurotransmitters, so some of these valuable chemicals are absorbed into the blood stream and cleared by the kidneys. They were essentially peeing away their monoamines! Over time this would lead to a depletion of these chemicals, leading to a long list of symptoms that overlap with many traditional brain disorders.
A New Disease Model
I noted that this seemed to fit the pattern of a type of food-induced brain dysfunction that had yet to be recognized by the medical and scientific communities. I decided to call this new disease carbohydrate associated reversible brain syndrome or CARB Syndrome. I eventually identified 22 symptoms that are associated with this disease. At the time I was measuring the body composition of every patient at every visit, so I always knew who was gaining or losing excessive body fat. That’s important because the the scientific definition of obesity is excess body fat. Over time I noticed a strange correlation between these symptoms and changes in body composition, and the symptoms always seemed to come first. This suggests that when it comes to storing body fat, the brain rather than just calories call the shots. This certainly makes sense from an evolutionary standpoint.
I gradually realized that if I could somehow suppress the symptoms of CARB Syndrome in patients, their body composition would start to improve regardless of caloric intake. Over time I found that certain medications were effective at suppressing these symptoms. These are drugs that target the monoamine neurotransmitters depleted by eating highly processed food. Fenfluramine and phentermine, the notorious fen-phen were a very effective combination in this regard. I was one of the first physicians in the world to prescribe this combination. I also knew that there was another effective way to boost the levels of these monoamines—by providing the precursor amino acids L-tyrosine and 5-htp. As you probably know, fen-phen was taken off the market due to rare heart valve problems. None of my patients developed this complication, likely because I only used very low doses of the drugs, and once I added the precursors, I could taper them off the medication and patients continued to do well.
My approach also automatically reduced the amount of fructose consumed by my patients, because they were consuming less sucrose and no high-fructose corn syrup. That’s because combining certain medications and precursor supplements are very effective at suppressing the lead symptoms of CARB Syndrome—cravings for sweet and starchy food. My friend and medical school classmate Richard Johnson has led the charge to help us understand the dangers of excess fructose. I highly recommend that you read one of his excellent books on this important topic.
First Deal with the Dangerous Cravings
When managing patients that fit the CARB Syndrome pattern, I never discussed calories or advised them to eat less food or restrict calories. I did recommend that they avoid highly processed food, the trigger of CARB Syndrome. They were finally able to do so because my approach suppressed the number one symptom of the disease—having strong cravings for sweet and starchy food. It’s now clear why people who consume more ultra-processed food gain more weight than people eating food from NOVA groups 1 and 2. It’s because this food puts their brain in a fat storage mode, where they store excessive fat at almost any level of caloric intake. They also sometimes do eat too much ultra-processed food because of their strong cravings for this type of food.
We are now in the middle of rapidly-increasing dual epidemics of obesity and common brain disorders, and there is little evidence that these disorders are being effectively treated using existing disease models. To me the solution seems obvious. The medical and scientific communities need to adopt the CARB Syndrome disease model. That my friend will finally expose the true toxic nature of ultra-processed food. After all, you can’t fix something that you don’t understand.
Note: I would like to thank my friends and colleagues Rob Lustig and Andy Steinfeldt for helping to edit this post.