FIXING FOOD - DELIVERING HEALTH

Closing the nutrient gap through ultra-processed food fortification

 Ultra-processed foods (UPFs) now contribute more than half of total caloric intake in many high-income countries, and in the United States, UPFs constitute over two-thirds of most daily diets. UPFs are proliferating globally, driven by the extensive marketing efforts of multinational food companies. Although definitions vary, UPFs are distinguished by their industrial formulation from refined ingredients and by the inclusion of starches, sugars, oils, emulsifiers, and colorants that enhance palatability and convenience. More and more high-quality studies link UPF consumption to increased risks of cardiovascular disease, type 2 diabetes, depression, early death, and several cancers. Mechanisms whereby UPFs cause ill-health include accelerated eating and impaired satiety due to high palatably, post-meal blood sugar volatility due to nutrient density, alterations in the gut microbiota due to the lack of fiber, and chronic low-grade inflammation associated with additives1.

Policymakers have begun to view UPFs through the same lens as tobacco products: designed to be attractive to consumers, priced to maximize consumption, and unequivocally associated with negative health effects. The annual healthcare cost of UPFs, in terms of their contribution to obesity, heart and lifestyle-related diseases, is estimated to exceed $300 billion. This amount does not include the long-term societal costs of childhood and adolescent UPF-associated malnutrition. As concern grows about the health burden of UPFs, there is an increasing impetus for regulation to reduce public exposure. For example, on October 8, 2025, Governor Gavin Newsom signed a law prohibiting the use of UPFs, that he described as “engineered for convenience and profit”, in California’s public-school meal program.2

The public-health response to UPFs, has focused on reducing UPF intake and promoting fresh and whole-food diets. Healthy eating is challenging and fewer than 15% of adults in industrialized countries meet recommended fruit, vegetable, or whole-grain intake targets. Even in Japan, long regarded as a paradigm of healthy eating, 85% of adults do not consume the minimal daily recommended amount of fruits and vegetables. The burden of UPF-related ill-health is greatest in disadvantaged communities, where access to fresh foods is limited, UPFs may be the only available food choice, and diets are already low in micronutrients.

There are historical precedents where industrial food systems inadvertently caused harm. Early-20th century roller mills facilitated large-scale flour production, but stripped grains of fiber and vitamins, causing deficiency diseases such as beriberi and pellagra. Fortification programs replaced what was removed by industrial processing, demonstrating that population-wide nutritional deficits can be addressed effectively through food-system interventions. Similarly, we can look to iodized salt, vitamin D in milk, and folic acid in grain, as successful population-scale nutritional interventions. The benefits of fortifying industrial food ingredients are clear, with examples such as iron and iodine fortification, currently bettering the lives of billions of people. 3

UPFs do not cause classic deficiency syndromes, but they materially reduce the intake of micronutrients necessary for preventing chronic disease and supporting metabolic and neurocognitive health. It is this displacement of a range of nutrients from our diets that is contributing to poor nutrition being a leading cause of ill-health in the United States4.

We propose that nutrient restoration, defined as returning displaced nutrients to UPFs, offers an effective and equitable strategy to mitigate these harms. UPFs constitute the core of industrialized country diets, making them reliable vehicles for delivering vital nutrients. Embedding restorative nutrient profiles into UPFs consumed disproportionately by low-income communities may help reduce disparities in chronic diseases and mortality, and in improving school performance.

 

Nutrient	Function	Effect of Nutrient Loss
Fiber & Oligosaccharides (soluble fiber, resistant starch, inulin-type oligosaccharides)	Slows gastric emptying; improves satiety; supports gut-microbiome diversity; maintains gut mucosal barrier integrity; produces Short Chain Fatty Acids	Faster eating; impaired satiety; increased post-prandial glycemic excursions; reduced microbial diversity; increased intestinal permeability and low-grade inflammation
Electrolytes & Minerals (potassium, magnesium, calcium, zinc, bioavailable iron)	Regulates vascular tone; neuromuscular function; bone metabolism; mitochondrial efficiency; red-cell production	Increased blood pressure; reduced insulin sensitivity; impaired mitochondrial function; anemia; higher cardiometabolic risk
Vitamins & Folate (vitamins A, C, E, K; folate)	Antioxidant defense; epithelial turnover; immune modulation; coagulation; methylation pathways	Increased oxidative stress; impaired epithelial repair; weakened immunity; adverse lipid oxidation; higher risk of neural-tube defects in low-folate contexts
Carotenoids & Polyphenols (β-carotene, lutein, flavonoids, phenolic acids)	Modulates inflammation; protects against oxidative injury; supports cognitive function; influences vascular nitric-oxide signaling	Reduced antioxidant capacity; increased systemic inflammation; diminished vascular resilience; possible cognitive decline with long-term low intake

Table 1: Replaceable Nutrients Commonly Lost in Ultra-Processed Food Production, their Functions and Effects of their Loss

 

Many of the nutrients removed from UPFs land up as post-industrial waste and most can be recovered. Up to 40% of our food supply is wasted and discarded, into landfills. We can use green technologies to extract and purify oligosaccharides, polyphenols, carotenoids, and fermentable fibers from fruit, vegetable, legume, and grain waste and industrial food manufacturing by-products5. Delivering these reclaimed nutrients back into the UPF production chain is straightforward given the tiny amounts required and their resistance to heat and freezing.

Any UPF nutrient restoration initiative will have to navigate the complexity of multiple stakeholders with differing motivations. Food manufacturers will need to see that nutrient restoration is a viable and marketable default upgrade to our food system, that merits the investment in improving their products. The public will need to believe that the added nutrients are not only safe but also have health and wellness benefits. This requires meaningful standards, clear labeling, and tight regulatory oversight. At a time when confidence in the institutions that are supposed to protect and promote our health, is being eroded, we need to ensure that restoring vital nutrients to UPFs is seen as a “righteous” intervention that aligned with public interest6.

For the food and beverage giants, shifting the UPF debate towards health-promoting innovation will help align industry incentives with public-health goals. Many large manufacturers will regard the nutrient restoration path as more acceptable than both regulatory efforts to limit access to UPFs and growing public disapproval of “industrial food.” For the consumer, as in the case of folic acid fortification driven reduction of neural-tube defects and the virtual elimination of endemic goiter with iodized salt, the changes to the product would be minimal. In fact, UPF nutrient restoration would ride on the wave of growing public interest in extracting the maximum health benefits from what we eat.

UPFs are an unavoidable part of our modern diet constituting up to 70% of what we consume daily. Less than 15% of UPFs meet acceptable dietary guidelines. UPFs cost our healthcare system over $300 billion a year. Our kids eat UPFs at school and then at home, compounding the effects of micronutrient deficiencies over generations. We are not going to get rid of UPFs, so we must find a solution that can retain their affordability and convenience, while contributing to, rather than undermining, our health. UPF nutrient restoration may be one of the most impactful and workable health promotion strategies of the coming decades – the time has come to do it.

References

1.     Office of Governor Gavin Newsom. Governor Newsom signs first-in-the-nation law to ban ultra-processed foods from school lunches. October 8, 2025. Available at: https://www.gov.ca.gov/2025/10/08/governor-newsom-signs-first-in-the-nation-law-to-ban-ultra-processed-foods-from-school-lunches/.

 

2.     Monteiro CA, Louzada MLC, Steele EM, et al. Ultra-processed foods and human health: a global review. The Lancet. 2025;395(10242):e1–e14.

 

3.     Friesen VM, Free CM, Adams KP, Bai Y, Costlow L, Dewey KG, et al.

Impact of large-scale food fortification programmes on micronutrient inadequacies and their implementation costs: a modelling analysis. The Lancet Global Health. 2022;10(4):e573–e582

 

4.     Menichetti G, Barabási A-L, Loscalzo J. Chemical complexity of food and implications for therapeutics. N Engl J Med. 2025;392:1836-1845

 

5.     Zhu Y, Chen L, Wang X, et al. Recovery of functional oligosaccharides from fruit and vegetable by-products: advances in green extraction and applications for metabolic health. Food Chem. 2025;430:137211.

 

6. Marks P. Restoring confidence in public health. N Engl J Med. 2025;393:2075–2078.