This came up in the episode. In the United States chicken tenders are traditionally made from chicken breast tenderloins, the little strip of meat on the back of a chicken breast, it's usually removed and sold separately. They're battered or breaded and fried. A lot of restaurants will slice of pieces of chicken breast and do the same thing, but I think that yields less consistent results. Occasionally you'll see long flat chicken nuggets labeled as chicken tenders, usually a cheaper restaurants or concession stands, but I'd still consider them nuggets.

Expand full comment

Absolutely love the show (discovered it last week and have accidentally blasted through every single episode already) and was particularly pleased listening to this episode as all to often with science podcasts you believe them until you hear an episode on a subject you are familiar with and realise a lot has been mischaracterised / poorly represented but that is not the case here.

Really liked the summary and think it's right to focus on the rct data over the observational, but in the case of upf that is particularly true as the data is a nightmare and there are some really quite funny/depressing examples of fudged abstracts that then get published in big journals and press released and hide a lot under the ultra processed umbrella when theres good reason in the results to think another association is driving a significant chunk of the results.

A particularly egregious example of this (although reading upf papers this is not uncommon) is in a lancet paper published last year looking at cancer( https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(23)00021-9/fulltext?fbclid=IwAR1bovMcmMP0OGNIfoWBYyCluVB9yCrmTkGKa0dGf2RbkLWnctMiBnouxn8).

The abstract says: ' The substitution of 10% of ultra-processed foods with 10% of minimally processed foods was associated with a reduced risk of head and neck cancers (0·80, 0·74–0·88), colon cancer (0·93, 0·89–0·97), and hepatocellular carcinoma (0·73, 0·62–0·86). Most of these associations remained significant when models were additionally adjusted for BMI, alcohol and dietary intake, and quality.'

This reads like they controlled for alcohol and it wasn't a big deal. However if you dive into the results you find that, in fact, for a number of the cancers explored, alcohol was a major driver of the observed outcome in a fair number of them, including some in sub categories they said were driven by upf. 'Diets rich in processed foods tend to have an increased energy density, as well as a high contribution of alcoholic drinks, which might have partly explained the association between processed foods and cancer risk in this study. When alcoholic drinks were removed from the Nova classification, the associations between intake of processed food and rectal cancer, hepatocellular carcinoma, and postmenopausal breast cancer became non-significant, suggesting that drinking alcohol probably drove those associations.”

While i understand Toms argument that in general they are bad and most should be avoided, this is a great example of why the tool is bad- cutting down on alcohol is much more actionable than cutting down on upfs, and a lot of people like alcohol so are more likely to cut down on a less cherished upf like fat free yogurt, or fortified breakfast cereal, which may not be what is actually driving the problem and could even be positively impacting their health.

In a lot of the subroup analyses most upf groups aren't associated with bad outcomes (and some like fortified breakfast cereal and wholegrain bread are associated with positive outcomes) but time and time again sugar and sweetened beverages (which includes energy drinks and alcoholic drinks) and foods containing processed meat show strong associations even in the massive messy noise that is the dataset. They seem to have the strong signals. If Upf groups containing Alcohol and processed meat are broadly responsible for driving negative outcomes seen in upf studies, and these things are already well established independently as things strongly associated with poor outcomes, it seems that the overcategorisation of upf is harmful because it dilutes the important take homes of drink less alcohol, eat less processed meat, and eat loads more fibre and vegetables.

Thanks so much for the fantastic show!

Expand full comment