Study Spotlight Take-Away with Chef Dr. Mike: Plant-based UPFs

by Michael S. Fenster, MD

“The time has come,” the Walrus said, “To talk of many things:

Of shoes — and ships — and sealing-wax —

Of cabbages — and kings —

And why the sea is boiling hot —

And whether pigs have wings.”

― Lewis Carrol, The Walrus and The Carpenter

When I first started talking about what we now call ultra-processed foods or UPFs several decades ago, the conversation was somewhat more muddled than it is today. In the beginning, the attempt at definition was reminiscent of Justice Potter Stewart’s description of pornography in 1964; “I shall not today attempt further to define the kinds of material… but I know it when I see it.” Or in the case of ultra-processed foods, when we taste it.

Things changed in 2009 when Prof. Carlos Monteiro and his colleagues from the University of São Paulo, Brazil, introduced the NOVA classification. NOVA focused on the way foods were produced, which was quite a revolutionary perspective in comparison to the nutrient-based emphasis that had dominated discussions since the mid-1980s – and, in many circles, still does. NOVA provided a detailed description of what constituted an ultra-processed food or, in NOVA parlance, a Group 4 Classification.

One of the unique things that NOVA introduced was the rationale behind why Group 4 Classification items were manufactured: for-profit. Let me add at this juncture that there is nothing wrong with manufacturing ultra-processed foods for profit; it’s a business. People have been selling or trading food long before there were UPFs. But ultra-processed foods are not simply natural foods sold or traded for profit.

In our modern world, as NOVA correctly identifies, they are complex manufactured commodities specifically engineered to maximize profit. What this means, in practical terms, is that they are often made from the cheapest ingredients available, formulated for reproducibility, and contain additives and preservatives not found in natural foods to maximize shelf life. They are also often layered with additional salt, sugars, and fats in an effort to appeal to our basest sensual pleasures. They are, as Justice Stewart might categorize them, “food porn.”

This distinction is of great importance. With a huge push from various governmental agencies and interests, including commercial interests, directing consumers towards more “plant-based” alternatives like plant-based meat alternatives (PBMAs), being able to sort the options based on ultra-processing or not could be a critical survival skill.

Or is it?

Does it matter if plant-based foods are ultra-processed, or is the benefit of a plant-based approach manifest regardless of whether the comestibles are ultra-processed?

This week’s study spotlight takes a deeper dive into that question.

The Study:

  • The study looked at the role of ultra-processed foods in the relationship between the consumption of a plant-based approach and the potential impact on cardiovascular disease (CVD) outcomes.
  • The study group consisted of 126,842 participants from the UK biobank aged 40-69 years old.
  • The median follow-up was nine years.
  • The foods consumed were grouped as plant-sourced or non-plant/animal-sourced foods and then further subdivided into UPF and non-UPF (nUPF) based on NOVA classification.

The Take-Away:

  • The dietary contribution of plant-sourced nUPF was inversely linked to CVD risk, while plant-sourced UPF contribution showed a positive association.
  • For every 10-percentage points increase in plant-sourced nUPF consumption, there was a 7% lower risk of CVD and a 13% lower risk of CVD mortality.
  • Conversely, plant-sourced UPF consumption was associated with a 5% increased risk of CVD and a 12% higher mortality for every 10-percentage points increase.
  • As demonstrated in previous studies, all UPF was linked to a higher risk of subsequent CVD and a higher risk of CVD mortality.

The Caveat:

The current movement to shift global dietary patterns to a more plant-based approach comes in the form of multiple arguments. These include ethical concerns, environmental concerns, sustainability issues, and health concerns. It is also big business, a consideration that should not be overlooked or discounted. The global market for plant-based meat alone is experiencing significant growth. As of 2023, the market value for PBMAs was approximately $8.8 billion and is expected to reach $17.1 billion by 2028, growing at a compound annual growth rate (CAGR) of around 14.1%​.[1],[2]  Over the last several years, the vegetarian market in Europe has tripled in size. Due to increasing popularity and perceived health benefits, options have increased from both restaurants and supermarkets.

Ultra-processed foods constitute a large segment of grocery store offerings; according to some studies, almost 75% of the items found in the average US grocery store are UPFs. Vegetarian and vegan offerings are amongst the grocery store categories with the largest percentages of UPFs. A review of approximately 25,000 different products comprising 81 different food categories in French supermarkets found that 87% of vegetarian dishes were ultra-processed.[3]

The time has come to recognize that ultra-processed foods, UPFs, or NOVA Classification Group 4 items are not just another grouping on a continuum of what Nature has provided to nourish us—and our gut microbiota, which has coevolved to co-metabolize what we eat—for hundreds of thousands of years. It is an entirely different, industrially manufactured construct.

The current study would support this hypothesis. It would also discount the argument that a plant-based approach is a more healthful approach regardless of whether the comestibles are ultra-processed or not. The findings of the current study are in agreement with the previously published Adventist health study-2 which found no difference in early all-cause mortality whether one pursued a vegetarian or animal-based approach.[4] However, there was an approximately 14% increased risk of early mortality in comparing the highest cohort of ultra-processed food consumers versus the lowest.

The time has come when we can no longer ignore the impact of where our food comes from and how it is made. To do so is to stroll the beach naïvely. And like young oysters be led to our doom with promises of cabbages and (Burger) kings.

[1] (, 2023)

[2] (BBC Research, 2023)

[3] (Davidou, 2020)

[4] (Orlich, 2022)


Fernanda Rauber, Maria Laura da Costa Louzada, Kiara Chang, Inge Huybrechts, Marc J. Gunter, Carlos Augusto Monteiro, Eszter P. Vamos, and Renata Bertazzi Levy. Implications of food ultra-processing on cardiovascular risk considering plant origin foods: an analysis of the UK Biobank cohort 2024;DOI:

Additional Resources:

Babak Ravandi, Peter Mehler, Albert-László Barabási, Giulia Menichetti. medRxiv 2022.04.23.22274217; doi:

BBC research. Plant-based meat: Global Markets.

Davidou S , Christodoulou A , Fardet A , Frank K . The holistico-reductionist Siga classification according to the degree of food processing: an evaluation of ultra-processed foods in French supermarkets. Food Funct. 2020 Mar 1;11(3):2026-2039. doi:10.1039/c9fo02271f.

Market.US. Global Plant-Based Meat Market by Source (Soy, Pea, Wheat, Blends, And Other Sources), By Meat Type (Chicken, Pork, Beef, Fish, and Other Meat Types), By Product Type (Burgers, Patties, Sausages, Other Product Types), By End-User, By Region and Companies – Industry Segment Outlook, Market Assessment, Competition Scenario, Trends, and Forecast 2023-2032.

Orlich MJ, Sabaté J, Mashchak A, et al. Ultra-processed food intake and animal-sourced food intake and mortality in the Adventist health study-2. Am J Clin Nutr. 2022;115(6):1589–1601. Https://

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