Jun 07, 2023

Can't stop munching your 'healthy' quinoa snacks or cornflakes? You better read this

New Delhi: Fried snacks like chips and bhujia have a bad rap, driving many snackers towards ‘healthier’ options like quinoa puffs and baked alternatives. But emerging scientific evidence suggests that most packaged snacks, including seemingly healthier alternatives, fall into the category of ultra-processed foods, which have been linked to the rising burden of lifestyle diseases, including cancers.

In a letter to the Union health ministry last week, senior members of Delhi-based think tank Nutrition Advocacy for Public Interest (NAPi) pointed out that increased consumption of ultra-processed foods is among the factors leading to a higher incidence of obesity and non-communicable diseases (NCDs) in India. ThePrint has a copy of the letter.

The group, which comprises nutritionists, epidemiologists, paediatricians, and researchers associated with NAPi, demanded that the government introduce a bill to define "healthy foods". This marked the first time such a demand was raised, with the emphasis placed on the fact that the rise of NCDs represents a silent epidemic.

The evidence for this has been growing. According to a 2018 World Health Organization (WHO) report, non-communicable diseases accounted for over 58 lakh deaths in India annually.

Further, a 2017 study by the Indian Council of Medical Research (ICMR) found that the proportion of NCD-related deaths in the country increased from just 37.9 per cent in 1990 to 61.8 per cent in 2016. Major NCDs include cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes, with major risk factors being an unhealthy diet, lack of physical activity, and consumption of tobacco and alcohol.

The Comprehensive National Nutrition Survey (CNNS), led by the Ministry of Health and Family Welfare in collaboration with UNICEF in 2016-18, also found that one in 10 school-age children and teens in India were pre-diabetic. Similarly, the prevalence of high total cholesterol was 3 per cent and 4 per cent among school-age childrenand teens, respectively.

So, what are "ultra-processed foods", how do they contribute to lifestyle diseases, and how do some of the most popular snacks in India fare on the ‘health’ front? ThePrint spoke to medical and nutrition experts to find out.

Also Read: Like chips & sodas? Big portions may spike mortality risk by 28%, says study spanning 5 continents

The term "ultra-processed food" comes from the NOVA food classification system which was developed by Brazilian researchers in 2009 and has since been cited regularly in scientific literature around the world.

This system places food into four categories based on the extent to which they have been processed during production.

The first category comprises unprocessed or minimally processed foods, such as fruits, vegetables, milk, fish, pulses, eggs, nuts, and seeds. Then, there are processed ingredients or food items like salt, sugar, and oils that are not consumed directly but added to other foods for preparation.

The third category includes processed foods that are made by combining foods from the first two groups and can be altered at home. For example, jams, pickles, tinned fruits, cooked vegetables and homemade breads.

The fourth class or ultra-processed foods, on the other hand, typically have five or more ingredients and tend to include many additives and ingredients that are not ordinarily used in home cooking, such as preservatives, emulsifiers, sweeteners, and artificial colours and flavours. These foods usually have a long shelf life.

According to Dr Arun Gupta, paediatrician, nutritionist and co-convenor of NAPi, the practical way to identify if a food product is ultra-processed is to check if its list of ingredients contains at least one item characteristic of the ultra-processed foods group.

"These are either food substances never or rarely used in kitchens, or classes of additives whose function is to make the final product palatable or more appealing," he told ThePrint.

He also pointed out that such foods are also often "aggressively marketed" and lead to a decrease in the consumption of fresh or minimally processed foods.

Also Read: Your food packet can be ultra-processed if it has more than 5 ingredients. Read the label

The debate around ultra-processed foods and the purported harm they cause has gained momentum over the years, but so has their consumption. Indian studies on the consumption of ultra-processed foods are few and far between, and focus on limited food items.

One such peer-reviewed study, published in the journal Indian Pediatrics in 2020, focused on the intake of ultra-processed foods among adolescents from low- and middle-income families in Delhi. It noted that "adolescents reported regular consumption of a variety of ultra-processed foods, and measures to reduce this consumption and encouraging healthy food choices are urgently needed".

According to Dr Arun Gupta, paediatrician, nutritionist and co-convenor of NAPi, the practical way to identify if a food product is ultra-processed is to check if its list of ingredients contains at least one item characteristic of the ultra-processed foods group.

Dr V. Mohan, a Chennai-based diabetologist, underlined that ultra-processed foods often have poor nutrient content but are rich in sodium, sugar, saturated fats, and calories. "Additionally, trans fats are frequently added to them to enhance their flavour. The processed foods, which are devoid of nutrients, include a number of unhealthy ingredients," he said.

According to Mohan, highly processed foods cause inflammation and insulin resistance and have also been linked to the development of Type 2 diabetes, cardiovascular diseases, obesity, and even some types of cancers.

Highlighting the risks of consuming ultra-processed foods, Dr. Navneet Agrawal, chief clinical officer at BeatO, a health-tech company specializing in diabetes care, emphasised their high trans-fat content.

"Trans fats are human-made fats that adversely impact the condition of the heart with a one-two punch: Not only do they increase bad cholesterol (low-density lipoprotein or LDL), but they also decrease good cholesterol (high-density lipoprotein or HDL)," he pointed out.

A 2022 meta-analysis of several studies by Indian researchers published by the US government's National Institutes of Health (NIH) had stated that harmful additives and preservatives can lead to health issues such as "asthma, attention deficit hyperactivity disorder (ADHD), heart difficulties, cancer and obesity".

While advocating for the use of natural food additives over synthetic food additives, the authors of the study wrote that "chemical food additives can trigger a slew of serious health issues" and that the "troubles that it creates will vary depending on the amount and duration of the preservatives used".

"Even if some additives do not act directly, they might nevertheless cause or contribute to health problems," the study noted.

According to Dr Arun Gupta, additives "destroy the food matrix, thereby making even the good compounds harmful".

Secondly, he said, they react with the gut biome "and cause inflammation in the intestines and other parts".

What makes most ultra-processed food items even more ‘hazardous’ is how palatable they are.

"They are high in salt, sugar and fat. Studies have also shown that as they are addictive in nature, people tend to overeat while consuming them," Dr Gupta pointed out.

Also Read: Majority of Indian consumers prefer front-of-pack label than FSSAI's star rating, survey finds

Here are some examples of popular packaged foods in India, accompanied by their extensive ingredient lists. The mentioned brands serve as representatives, and the ingredients listed are similar to those found in other products as well.

Chips have a high-calorie count largely because of potato and edible oil in them.

The Lays (American Style Cheese & Onion), for instance, lists the following as ingredients: potato, edible vegetable oil (palmolein, rice bran oil), seasoning (sugar, iodized salt, milk solids, spices and condiments, maltodextrin), flavour (natural and nature identical flavouring substances), cheese powder, hydrolysed vegetable protein, flavour enhancers (627, 631), edible vegetable oil (palm, coconut), anticaking agent (551).

Dr Seema Gulati, the head of nutrition research group at Delhi-based non-profit National Diabetes, Obesity, and Cholesterol Foundation, pointed out that ingredients such as edible vegetable oil, seasoning, flavour and anti-caking agent are the "culprit ingredients".

"In food items like this one, the main ingredient is stripped of fibre or its original nutritional goodness. Taste and long shelf life are the motive and not health," she told ThePrint.

ThePrint reached out to PepsiCo India, which markets Lays, over email but had not received a response by the time of publication. This report will be updated if and when a response is received.

Since most instant noodles are made with maida (flour), they are high in terms of glycaemic index and low in fibre, said Gulati. Glycaemic index is a rating system which specifies how foods containing carbohydrates affect our blood sugar (glucose) levels.

For instance, the Maggi Cuppa Noodles lists the following as its ingredients: refined wheat flour (maida), palm oil, iodised salt, mineral (calcium carbonate), thickeners (412 508), humectant (451(I)) and acidity regulators (501(I), 500 (I)) 330), besides various powdered spices.

Gupta pointed out that additives such as thickeners, humectant (used to control moisture levels), and acidity regulators make this instant snack ultra-processed.

Responding to questions by ThePrint, Nestle India — which owns the Maggi brand — maintained that the quality and safety of its products are a non-negotiable priority for the company.

"All ingredients and additives used by us comply with strict regulatory and safety evaluations. We would like to inform you that the additives added to Maggi Cuppa Noodles are in line with specified standards set by FSSAI (Food Standards and Safety Authority of India)," said a Nestle India spokesperson.

"The additives are added in very small quantities to the recipe," the spokesperson added.

Many Indians, whether in cities or villages, often nibble on bhujia as a go-to snack at home or on the go, especially as an afternoon snack. Gulati said this snack, too, falls into the ultra-processed food category.

A popular brand is Haldiram's Aloo Bhujia, which lists among its ingredients potato, edible vegetable oil, edible starch and salt, apart from various spices, condiments, and flours.

"Ingredients such as salt and vegetable oil make it unhealthy for regular consumption," said Gulati.

ThePrint reached Haldiram's for comment via email but had not received a response by the time of publication. This report will be updated if and when a response is received.

Also Read: FSSAI reconsidering plan to introduce front-of-pack Health Star Rating for packaged food items

While quinoa is considered a whole grain that is rich in protein, its nutritional profile can be affected when it is processed, pushing it in the direction of the ‘unhealthy’ category.

GoodDiet Quinoa Puffs by Big Basket lists among its ingredients corn grit, quinoa flour edible vegetable oil, seasoning (refined wheat flour), edible common salt, sugar, acidity regulator (e330, E510), hydrolyzed vegetable protein, yeast extract, flavour enhancer (e631, E627), and anti-caking agent (e550), apart from salt and flour.

"You can see the number of additives there that are typical of ultra-processed food types," said Gupta.

In response to a query by ThePrint, Big Basket said that the additives in quinoa puffs perform a "technical" function such as improving the product's stability, moisture control, taste, and flavour, ensuring better palatability and consumer acceptance.

"Emulsifiers, anti-caking agents, and flavour enhancers are permitted food ingredients and allowed as per FSSAI in very limited quantities by following the principle of as low as reasonably achievable (ALARA)," said the company.

"The addition of other ingredients and additives are used for a technical purpose and do not affect the goodness of the product," it added.

Biscuits are a staple in the daily diets of many Indian households. One of several popular choices are Oreo Chocolate Creme Biscuits.

Its listed ingredients include refined wheat flour, sugar, edible vegetable fat, palmolein oil, cocoa solids, invert syrup, leavening agents (500(ii),503(ii)), edible salt and emulsifier (322), besides added flavours.

"A lot of these ingredients are used only in industrial production of foods," said Gupta.

ThePrint reached out to Mondelez International, the multinational food company that makes and markets Oreo via email but had not received a response by the time of publication. This report will be updated if and when a response is received.

For many, especially in urban India, cornflakes are their top choice for breakfast — mainly because they are easy to eat and filling. Yet, the ingredients that go into making them are not always good from a health point of view, said Gupta.

A popular product in this segment, Kellogg's Corn Flakes (Real Almonds & Honey) lists among its ingredients corn grits (61.7 per cent), sugar, sliced almonds (9.0 per cent), cereal extract, honey (1.6 per cent), iodized salt, dextrose, vitamins, flavour (nature identical), minerals, colour (INS 150d) and antioxidant (INS 320).

Gupta said that most of these additives push cornflakes into the category of ultra-processed foods.

Kellogg India, however, in an official response to ThePrint, contested this assessment by saying that while corn grits are clearly classified as "minimally processed" by NOVA, the colour used in the product is natural and not artificial.

"The antioxidants used are also natural Vitamin E, not synthetic. We fortify our foods with essential nutrients, this practice of fortification is actively encouraged by the Indian government, especially in light of the malnutrition caused by nutrient deficiencies in the country," it said.

"We also use regular sugar in our product, similar to the one used at home, which is not classified as ultra-processed by NOVA. None of the ingredients fall under the classification of ultra-processed," the statement added.

(Edited by Amrtansh Arora)

Also Read: Nachos over bhujia, chips over kachori — western snacks dominate Indian market, but that might change soon

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