Frukt og Grønt 

In Swedish folklore, Frukt and Grönt were the most feared of all trolls. They hunted down children who misbehaved at table, and forced them to eat salad (101).

Frukt lives on as a death sandbox in Steam, where you can maim and kill voxel-based humanoids at will (2). Grönt is a low-level grunt who is defeated by Super64 in Smashtasm Season Two (3). (References 2 and 3 supplied by various grandchildren).

So are the mighty humbled, and so it is with ultra-processed plant foods.

Hailed by the politically correct but morally illiterate thought leaders of our time as the solution to all the world’s problems, from climate change to heart disease to COVID (ie 4-6), they have become a hot potato.

One of the first key pieces of research, which screened 200,000 adults over a 20-year period, was published in 2017 (7).

A Boston-based team showed that whereas basic plant foods were cardio-protective, a diet of processed plant foods (juices/sweetened beverages, refined grains, potatoes/fries, sweets) was associated with an increased risk of coronary artery disease. They did not specify ultra-processed foods precisely, but their working definition overlapped substantially with NOVA class 4 (8).

Plant-based meat alternatives (PBMAs) are ultra-processed plant foods par excellence. Epitomised by the famously exsanguinating Impossible Burger, they are designed expressly to help carnivores transition, and are widely believed to be safer than meat (ie 9). Unfortunately, when you leap from steak to fake, you are likely jumping from the frying pan into the fire.

A recent UK Biobank study showed that consumers of PBMAs had raised plasma levels of inflammatory biomarkers and a higher incidence of hypertension and depression, conditions linked to chronic inflammatory stress (10) and cardiovascular disease.

Against that, a Spanish group conducted a meta-analysis which found that switching from meat products to PBMAs led to a fall in LDL cholesterol (11); but a Singapore team ran a randomised, prospective and generally well-designed trial which found that it did no such thing (12).

A small but perfectly acronymed cross-over trial out of Stanford (n= 36) showed that exchanging meat for PBMAs dropped fasting serum trimethylamine-N-oxide (13). The same team was surprised (disappointed?) to find that the switch did not lower more usual inflammatory markers (14), a null finding echoed by other researchers (15). On a slightly more positive note, an Anglo-Russian collaboration noted an improvement in gut microbiota (16).

Meh.

LDL cholesterol is not a particularly good marker for cardiovascular risk, and single biomarker or even microbiotal results, while interesting, are insufficient. I am more convinced by clinical end-points, and for those we have to go to Paris.

French researchers found that whereas people who consumed whole plant foods were relatively protected against cardiovascular disease, those whose plant–based diets were dominated by ultra–processed foods, including PBMAs, had a substantially raised risk of coronary heart disease and cardiovascular disease in general (17).

I believe this large study (64,000 subjects followed for an average of 9 years, with all the usual variables controlled), trumps the biomarker results. Furthermore, the increased risk of cardiovascular disease was replicated in a second UK Biobank screen (18).

One possible contributory factor is mycotoxin contamination of plant materials (19, 20). Many mycotoxins trigger chronic inflammation (ie 21), and this could explain the British findings of raised inflammatory markers. Increased mycotoxin exposure, inflammatory markers, hypertension and cardiovascular disease (10) all suggest that in the longer term, PBMAs may increase the risk of other degenerative diseases also (22-26).

Some scientists take an opposing view, and claim that PBMAs should be removed from Nova group 4 because they make it easier for meat eaters to transition (27), and they are sooo healthy (27, 28). Lead author of the last two papers Mark Messina works for the Soy Nutrition Institute Global, which is supported by the United Soybean Board, which is effectively a front for Monsanto (now Bayer) and Archer Daniels Midland. This does not in itself discredit his work, but should probably be taken into consideration.

Other scientists take a more neutral and, in my view more scientifically correct position, and concede that there is a lack of robust, long-term evidence on the role of PBMA consumption in health (29).

A larger caveat is the unpalatable (for some) fact that there is no convincing evidence that the basic vegetarian diet is healthier than the omnivore diet (ie 30), and little logic; our teeth, viscera, digestive enzymes, micro-nutritional requirements and evolutionary success all whisper ‘Omnivore!’.

So let’s revisit the UK Biobank studies (10, 18).

Omnivores who consumed animal and plant products but avoided ultra–processed foods were no more likely to develop heart disease than those following healthy, whole–food plant–based diets. This finding suggests that food quality and processing matter more than plant vs animal–based, and it forms the rationale of a back-to-basics movement: eat only what you can hunt, fish, farm, forage or find in the produce section of your supermarket.

Learn the joy of cooking!

You don’t have to give up meat and dairy for your health (31) – and athletes and bodybuilders, in particular, should stick with steak. PBMAs appear to be only half as effective as beef in terms of their anabolic effect (32, 33), a finding which dovetails with DIASS protein quality scores (ie 34) and an excellent previous critical review (35).

I am less concerned with dysmorphic bodybuilders than with the elderly, who require a high-quality protein intake to mitigate age-related muscle loss. And this heralds a looming public health disaster.

The elderly, sarcopenia, and sarcopenia-related disability and mortality are all increasing (35, 36). At the same time, there is worrying evidence that middle-aged and older consumers are becoming more addicted to ultra-processed foods (37), which of course include PBMAs.

This is hardly surprising, considering that these food products were designed by tobacco executives to be as addictive as possible (38, 39), and that they are cheap, increasingly omnipresent (37, 39), and ever so easy to prepare and eat. Even by those – especially those – who are sans teeth, sans eyes, sans taste, sans everything except a microwave (37); because today’s elderly and increasingly infirm are the first generation who experienced these addictive substances at a young age, a pattern of exposure which consolidates addiction (40).

The boomers will not be the last, nor the worst affected.

Generation X were exposed to even more ultra-processed foods (38-40), and are metabolically more compromised, less active and less robust to begin with (41). They are also being dosed with increasing amounts of GLP-1 agonists, which drug companies are force-fitting into multiple new indications (42). As many GLP-1 users discontinue and then cycle on and off their drugs (43), with loss of lean mass during each treatment phase, they can lose significant muscle mass over time (44-46); comparable to 10 years of muscle ageing (44-46). This may be more severe than occurs with old-school yo-yo dieters (46).

They will therefore be more afflicted by sarcopenia than were the boomers, and the currently available PBMAs, with their sub-optimal protein quality, exacerbate this problem.

To reduce the growing societal burden of our debilitated elders, PBMAs will either have to be fortified with sulfur amino acids or lysine, depending on the plant source, or derived from genetically modified plants. If public opinion permits. And ideally combined with exercise, or exercise mimetics (47, 48).

I do not say that all ultra-processed plant foods, or all PBMAs, should be avoided. It would be unreasonable to issue a fatwa, because they are simply too diverse (49). If the category was cleaned of mycotoxins, more healthily formulated and still tasted good (a tall order), I would have no problem with these food products. The current offerings do not manage this, but the future – could it be different?

Soy, you say? Soy escéptico!

References:

1. https://en.wikipedia.org/wiki/Codex_Regius
2. https://store.steampowered.com/app/3880400/FRUKT/
3. https://smashtasm.fandom.com/wiki/Gront#:~:text=Gront%20is%20a%20low%2Dlevel,Gront%20plays%20Fox.
4. https://www.technologyreview.com/2021/02/14/1018296/bill-gates-climate-change-beef-trees-microsoft/
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7. Satija A, Bhupathiraju SN, Spiegelman D, Chiuve SE, Manson JE, Willett W, Rexrode KM, Rimm EB, Hu FB. Healthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease in U.S. Adults. J Am Coll Cardiol. 2017 Jul 25;70(4):411-422.
8. https://drpaulclayton.eu/blog/why-nova-doesnt-go/
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