Ultra-processed food — what it is, why it harms and how to swap it (UK guide)

By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham, Berkshire

Ultra-processed food (UPF) is the single biggest dietary shift of the past forty years, and there is now consistent evidence linking high UPF intake to obesity, type 2 diabetes, cardiovascular disease, poor mental health and shorter life expectancy. Chinese medicine cannot cure the harm caused by UPF and this article does not claim it can — what it can do is offer a clarifying framework for why UPF taxes the Spleen, generates Damp and Phlegm, and worsens almost every chronic condition my clinic sees. This is the piece I refer patients to when I say "reduce ultra-processed food" during a consultation.

On this page

1. What ultra-processed food actually is
2. How to spot UPF in a UK supermarket
3. The evidence — what the research shows
4. The TCM view — Damp, Phlegm and Spleen strain
5. A practical UK swap guide
6. Conditions where UPF matters most
7. Making the change — realistic steps
8. Frequently asked questions
9. Related reading
10. References

1. What ultra-processed food actually is

Ultra-processed food isn't just "processed" food. "Processing" is broad — freezing peas, milling flour, tinning tomatoes, ageing cheese are all forms of processing that go back centuries and are largely benign. Ultra-processing is a much narrower category defined by the NOVA classification, developed by Carlos Monteiro's team at the University of São Paulo, that has become the standard in the nutrition-science literature and is now used by the World Health Organization, PAHO and multiple national dietary guidelines.^[1]

NOVA sorts food into four groups:

• Group 1 — Unprocessed or minimally processed foods. Whole vegetables, whole fruits, fresh meat and fish, plain dairy, eggs, whole grains, dried legumes, nuts, herbs and spices. Minimal processing includes cleaning, freezing, pasteurising, grinding.
• Group 2 — Processed culinary ingredients. Oils, butter, sugar, salt, vinegar. Used to season and cook Group 1 foods.
• Group 3 — Processed foods. Made by adding Group 2 ingredients to Group 1: tinned beans, salted nuts, home-baked bread, cheese, cured meats, tinned fish. Still recognisable as their base ingredients.
• Group 4 — Ultra-processed foods. Formulations of ingredients, mostly of industrial use only, with additives designed to imitate the qualities of Group 1 foods. Made through industrial processes that don't exist in a domestic kitchen: extrusion, moulding, hydrogenation, interesterification, high-shear mixing, chemical modification.

The key distinction is not "is this good for me?" but "was this made from food by cooking, or assembled from industrial ingredients in a factory?" A homemade lasagne with fresh mince, tinned tomatoes, cheese and lasagne sheets is Group 3 processed. A shop-bought ready-meal lasagne with 30-plus ingredients including modified starches, emulsifiers, flavour enhancers, colours and preservatives is Group 4 ultra-processed — even if the fat, salt and sugar profile looks similar on the nutrition label.

2. How to spot UPF in a UK supermarket

The two-second UPF test used by Chris van Tulleken's Ultra-Processed People and by most researchers in the field: look at the ingredients list; if it contains anything you wouldn't have in your kitchen cupboard, it's ultra-processed. That includes:

• Emulsifiers — lecithin (E322), mono- and diglycerides (E471), polysorbates (E432–E436), carboxymethylcellulose (E466)
• Modified starches — "modified maize starch", "modified potato starch"
• Gums — xanthan gum, guar gum, locust bean gum, carrageenan
• Artificial or "natural" flavourings — the word "flavouring" almost always signals ultra-processing
• Sweeteners — aspartame, acesulfame-K, sucralose, sugar alcohols (maltitol, xylitol, sorbitol)
• Colours — even if labelled "natural colouring"
• Protein isolates — whey protein isolate, soya protein isolate, pea protein isolate
• Hydrolysed proteins, seed-oil derivatives, high-fructose corn syrup or glucose-fructose syrup, invert sugar syrup
• Preservatives — sorbates, benzoates, nitrites (E250, E251), sulphites

Common UK examples that surprise people:

• Most supermarket bread — the ubiquitous plastic-bagged sliced loaf contains emulsifiers, dough conditioners, preservatives. Sourdough from a proper bakery is not UPF; Warburtons or Hovis Best of Both is.
• Breakfast cereals — even "healthy" ones like fruit-and-fibre or bran flakes have colourings, sweeteners, and industrial processing that make them Group 4. Traditional oats made with milk are Group 1.
• Flavoured yoghurts — Group 4. Plain natural yoghurt with your own fresh fruit is Group 1.
• "Healthy" protein bars, protein shakes, meal-replacement drinks. Almost invariably ultra-processed regardless of marketing claims.
• Plant-based meat alternatives — Quorn, Beyond Meat, most veggie sausages. Ultra-processed by construction.
• Ready meals — virtually all supermarket ready meals are Group 4.
• Flavoured non-dairy milks — oat, almond and soya milks with added flavours, gums and thickeners are Group 4.
• Most biscuits, crisps, chocolate bars, ice creams and confectionery.
• Diet drinks and reduced-sugar sports drinks. Zero-calorie doesn't mean minimally processed.

Estimates suggest UPF makes up around 57% of the average UK adult's calorie intake — higher in children and adolescents. The UK sits second only to the US in the developed world for UPF share of the diet.^[2]

3. The evidence — what the research shows

The evidence base for UPF harms has grown quickly since 2019. The key studies:

• NIH randomised trial (Hall et al, 2019). Kevin Hall's team at the US NIH ran a controlled inpatient trial: same volunteers, alternating two-week periods of ad libitum unprocessed vs ultra-processed food matched for total energy, sugar, fat, salt, fibre and macronutrients. On the UPF diet, participants ate around 500 kcal more per day and gained weight; on the unprocessed diet, they lost weight. Same calories on offer, same nutrient targets, but the ultra-processed foods drove overeating.^[3] This is the study that changed the field — it demonstrated that UPF harms are not fully explained by fat, sugar or salt content.
• SUN cohort (Rico-Campá et al, 2019). The Spanish SUN prospective cohort followed 19,899 adults for a median 10.4 years. Consuming more than four servings of UPF a day was associated with a 62% higher risk of all-cause mortality compared with fewer than two servings a day.^[4]
• NutriNet-Santé (Srour et al, 2019). The French NutriNet-Santé cohort of 105,159 adults, over a median 5.2 years, found each 10% increase in UPF intake was associated with a 12% higher risk of overall cardiovascular disease and 11% higher coronary heart disease risk.^[5]
• BMJ umbrella review (Lane et al, 2024). A landmark 2024 BMJ umbrella review synthesised 45 meta-analyses covering nearly 10 million participants. Higher UPF exposure was consistently associated with increased risk of cardiovascular death, type 2 diabetes, obesity, mental disorders, sleep problems and mortality, with the strongest evidence for cardiovascular and metabolic disease.^[6]
• UK Biobank (Rauber et al, 2022). A UK Biobank analysis of 22,659 adults found that a 10% higher UPF share of the diet was associated with 5% higher risk of type 2 diabetes over 5.4 years follow-up.^[7]
• Mental health (Lane et al, 2022). Higher UPF intake has been consistently associated with depression, anxiety and worse sleep in multiple cohorts.

The proposed mechanisms are converging: displacement of nutrient-dense whole foods; disrupted satiety signalling from soft, energy-dense, quickly-eaten formulations; effects of emulsifiers on the gut microbiome and intestinal barrier; endocrine effects of some additives; and the loss of the food-matrix structure that slows digestion and modulates the glycaemic response. It's not one bad ingredient; it's the whole industrial-formulation package.

4. The TCM view — Damp, Phlegm and Spleen strain

Traditional Chinese medicine describes food not by its nutrient content but by its quality — nature (hot, warm, neutral, cool, cold), flavour, energetic direction, and impact on the digestive terrain. Ultra-processed food, framed in TCM, has three broad clinical qualities:

• Damp-generating. The soft, sticky, easily-eaten textures of UPF — along with the high refined-carbohydrate, sweet-flavoured, low-fibre profile — overwhelm the Spleen's capacity to transform food into clear Qi. What isn't transformed accumulates as Damp: heaviness, bloating, sluggish digestion, mid-body weight gain, brain fog, dull-heavy headaches, viscous stool, thick greasy tongue coat.
• Phlegm-forming. Where Damp is the vapour, Phlegm is the condensed form. Chronic UPF intake concentrates Damp into Phlegm, producing the physical manifestations we see in modern chronic disease: nodules, cysts, atherosclerotic plaque, insulin resistance, obesity, PCOS-type ovarian cysts, breast lumps, thick sticky mucus, sinus congestion, snoring and sleep apnoea. In classical TCM, "the Spleen is the source of Phlegm, the Lung is the storehouse of Phlegm" — the Spleen is where the pathology starts, and long-term dietary Damp-generation is its most common cause today.
• Spleen Qi-taxing. Even when UPF looks light or sugar-free, the artificial sweeteners, emulsifiers and industrial additives are foreign to the digestive terrain. The Spleen has to work harder to process them, gradually leading to Spleen Qi deficiency — fatigue after meals, low energy, sugar cravings, weak muscles, loose stool, easy bruising, poor immune function and a pale swollen tongue with scalloped edges.

The unifying TCM concept: UPF replaces food that supports the Spleen with substances that burden it. The Spleen is the pivot of the middle burner; when it fails, the whole body picture degrades. This is why in my clinic almost every chronic-condition treatment plan begins with a UPF reduction — without it, the herbs and acupuncture are pushing against a permanent uphill.

5. A practical UK swap guide

Reducing UPF doesn't mean elaborate cooking or specialist ingredients. Most of the swaps are boring and cheap — the boring part is the point. A week of the swaps below is possible on a standard UK weekly shop from Tesco, Sainsbury's, M&S or a local greengrocer.

• Breakfast. Swap flavoured cereal, cereal bars or a shop smoothie for —
  • Porridge oats cooked with milk or water, topped with fresh berries, banana, walnuts, a spoonful of honey (Group 1)
  • Plain natural yoghurt with fresh fruit and a handful of nuts
  • Two eggs (poached, boiled, scrambled) on wholemeal sourdough
  • Wholemeal toast with butter and marmite or peanut butter (the peanut-only kind — check the ingredients)
• Bread. Swap plastic-bagged sliced bread for a proper sourdough loaf from a bakery (or the sourdough range in most big supermarkets, if the ingredients are just flour, water, salt, starter). Wholemeal artisan loaves and rye bread are also generally Group 3.
• Lunch. Swap meal-deal sandwiches, ready-made pasta salads and instant soups for —
  • Home-made sandwich or wrap: proper bread, cheese, meat or hummus, lettuce, tomato
  • Salad with tinned tuna, mackerel or sardines, olive oil, lemon
  • Leftover dinner heated up
  • Soup made from fresh vegetables in a batch on Sunday and frozen in portions
• Dinner. Swap supermarket ready meals for one of the four or five family staples cooked from scratch —
  • Roast chicken with potatoes and vegetables
  • Shepherd's pie or cottage pie with mince, tinned tomatoes, mash
  • Sausage and mash (Sainsbury's Cumberland-style sausages with fewer than 10 ingredients are usually Group 3)
  • Fish pie or grilled fish with new potatoes and greens
  • Chilli con carne, spaghetti bolognese, lentil stew, dahl
  • Stir-fried vegetables and prawns with rice
• Snacks. Swap crisps, biscuits, chocolate bars and cereal bars for —
  • Fresh fruit (apples, pears, satsumas, grapes, bananas)
  • Nuts and dried fruit (unsalted, unroasted or dry-roasted with just salt)
  • Cheese and oat cakes
  • Hummus and carrot sticks or wholegrain pitta
  • Plain dark chocolate (70%+ — usually only three or four ingredients)
  • A boiled egg
• Drinks. Swap fizzy drinks, diet drinks, and energy drinks for water, coffee, tea, herbal tea, fresh milk, tap water with lemon or cucumber. If you want fizz: sparkling water with fresh lime.

The pattern is simple: if it needs a colour, a flavouring or an emulsifier to make it edible, cook something different.

6. Conditions where UPF reduction matters most

Reducing UPF is a general dietary principle for almost any chronic condition, but there are cluster of presentations where I emphasise it most heavily in clinic:

• Weight, metabolism and inflammation. See our posts on TCM for weight loss, hormonal weight gain, stress belly fat, obesity, type 2 diabetes, gestational diabetes, fatty liver, and artificial sweeteners and weight gain.
• Gut and digestive presentations. See IBS, SIBO, hiatal hernia, constipation, leaky gut — Gu syndrome, endo-belly.
• Fertility, hormones and menstrual health. See fertility over 40, improving egg quality, ovarian reserve, light periods, PCOS, the liver and hormones, HRT alternatives.
• Mental and neurological health. See depression, anxiety, ADHD, insomnia, neurowellness.
• Skin and inflammatory disease. See eczema, psoriasis, acne, hay fever.
• Immune resilience and infection recovery. See cold and flu, immune-supporting herbs, long COVID.

7. Making the change — realistic steps

The transition doesn't need to be all-or-nothing. What works clinically:

• Track for one week without changing anything. Just note what you eat and identify which items are UPF using the ingredient list. Most patients are shocked at the share — often 60-80% of what they were eating without realising.
• Change one meal at a time. Breakfast is the easiest for most people to shift because it's usually a habit rather than a social occasion. A fortnight of porridge or eggs on sourdough resets the palate.
• Set a rule for the shopping trolley. Nothing goes in with more than 5 ingredients, or nothing goes in with an emulsifier / flavouring / colour. Simple filters work better than nutritional-calorie counting.
• Batch-cook two or three staple dinners at the weekend. A pot of chilli, a shepherd's pie, a soup, a curry — enough to cover three or four weeknight dinners. Removes the "there's nothing to eat, get a ready meal" trap.
• Don't chase perfection. Aiming for 80% Group 1–3 and 20% UPF is a genuine, sustainable win. The evidence shows most of the health harm concentrates at the very top of the UPF-share distribution — going from 70% to 30% UPF is huge; going from 30% to 5% is diminishing returns.
• The children in the household matter most. UPF exposure in childhood shapes taste preferences and gut microbiome development for life. If you can reduce it just for the kids, do that first.

8. Frequently asked questions

Is all processed food bad?

No. Home-baked bread, tinned tomatoes, cheese, cured meat, tinned fish, plain yoghurt and frozen vegetables are all "processed" but not "ultra-processed" — and most are nutritionally excellent. NOVA Group 3 processed foods are fine as part of a normal diet. The problem is specifically Group 4.

What about "healthy" ultra-processed foods like veggie sausages or protein bars?

They're still ultra-processed. The industrial process, the additive load and the missing food matrix are what drive the harm; the front-of-pack marketing doesn't change any of that. A homemade lentil dahl or a bowl of Greek yoghurt with fruit is more nutritious than most "healthy" plant-based ultra-processed products.

Is Warburtons or Hovis really ultra-processed?

Yes. Standard supermarket sliced bread contains emulsifiers, dough conditioners and preservatives that classify it as Group 4. Proper sourdough — the kind whose ingredients are flour, water, salt and starter — is Group 3 processed and fine.

Won't cutting UPF cost more?

Usually less. Whole foods — rice, oats, lentils, dried beans, seasonal vegetables, whole chickens, tinned fish — are among the cheapest calories in any UK supermarket. The convenience premium of ready meals, meal deals and takeaways is where the household food budget bleeds.

What about Chinese takeaway or supermarket noodles?

Supermarket instant noodles and most Chinese takeaway are ultra-processed. A stir-fry cooked at home with fresh vegetables, prawns or chicken, garlic, ginger, soy sauce and rice is not. If you eat Chinese food at home, cook it — don't buy it in a tin or a pot.

Are dairy-free milks Group 4?

Most flavoured or shelf-stable non-dairy milks are Group 4 because of emulsifiers, gums and added flavourings. Simple oat milk (oats, water, salt) and unsweetened almond milk with a short ingredient list are Group 3.

What TCM foods do you actually recommend to eat more of?

Cooked, warm, gently spiced meals from Group 1 whole foods, framed in British and Mediterranean cuisine: porridge, roasts, stews, casseroles, soups, shepherd's pie, dahl, fish and vegetables, whole grains, seasonal fruit. See our post on Spleen Qi deficiency for the constitutional dietary framework and gluten and dairy for how those two common triggers fit in.

Does reducing UPF help everyone?

The evidence base is population-level; individual responses vary. That said, reducing UPF is one of the safest, most evidence-backed dietary interventions available. Even people with genuine food intolerances or restrictive dietary needs benefit from moving what they DO eat toward Group 1–3.

9. Related reading

• Artificial sweeteners & weight gain (TCM)
• Spleen Qi deficiency — diet and recovery
• Gluten and dairy: Spleen damage (TCM)
• Fertility diet: egg & sperm quality
• Pregnancy diet: what to eat
• Why salads can be bad (TCM view)
• Type 2 diabetes: TCM diet-first view
• Carnivore diet & TCM
• Keto diet through a TCM lens
• Intermittent fasting & TCM
• Fermented foods and TCM
• Chinese food therapy — the classical dietary framework

10. References

1. Monteiro CA, Cannon G, Levy RB, Moubarac JC, Louzada MLC, Rauber F, Khandpur N, Cediel G, Neri D, Martinez-Steele E, Baraldi LG, Jaime PC. Ultra-processed foods: what they are and how to identify them. Public Health Nutrition. 2019;22(5):936-941. PMID: 30744710.
2. Rauber F, da Costa Louzada ML, Martinez Steele E, Millett C, Monteiro CA, Levy RB. Ultra-processed food consumption and chronic non-communicable diseases-related dietary nutrient profile in the UK. Nutrients. 2018;10(5):587. Data on UK UPF share of the diet.
3. Hall KD, Ayuketah A, Brychta R, et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell Metabolism. 2019;30(1):67-77.e3. PMID: 31105044. The landmark NIH inpatient trial.
4. Rico-Campá A, Martinez-Gonzalez MA, Alvarez-Alvarez I, Mendonca RD, de la Fuente-Arrillaga C, Gomez-Donoso C, Bes-Rastrollo M. Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study. BMJ. 2019;365:l1949. PMID: 31142450.
5. Srour B, Fezeu LK, Kesse-Guyot E, Alles B, Mejean C, Andrianasolo RM, Chazelas E, Deschasaux M, Hercberg S, Galan P, Monteiro CA, Julia C, Touvier M. Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé). BMJ. 2019;365:l1451. PMID: 31142457.
6. Lane MM, Gamage E, Du S, et al. Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. BMJ. 2024;384:e077310. Umbrella review of 45 meta-analyses across 32 outcomes.
7. Rauber F, Chang K, Vamos EP, da Costa Louzada ML, Monteiro CA, Millett C, Levy RB. Ultra-processed food consumption and risk of obesity: UK Biobank prospective cohort study. European Journal of Nutrition. 2021;60(4):2169-2180. UK Biobank data.
8. van Tulleken C. Ultra-Processed People: Why Do We All Eat Stuff That Isn't Food … and Why Can't We Stop? Cornerstone Press, 2023. Accessible general-audience overview by a UCL researcher and BBC broadcaster.

This article is for general information and does not constitute medical advice. Dietary changes should be discussed with your GP or a registered dietitian if you have a diagnosed medical condition or complex nutritional needs.