Evidence suggests that eating ultraprocessed foods may have a negative effect on bone strength and increase the risk for fracture.1 Osteoporosis is the medical term that describes a loss of bone density and quality of bone as people age. It is a widespread and serious condition that increases the risk of a bone fracture, which is especially problematic for older people.
Evidence suggests that individuals who have an osteoporotic hip fracture have a higher risk of mortality in the following years.2 Researchers have found variables that increased the risk of mortality included age over 75, mild to severe liver disease, heart failure, diabetes and hearing impairment. Statistically, of the people over age 50, about 50% of women and 25% of men will suffer a fracture at some point before the end of their life.3
According to the National Osteoporosis Foundation, “For women, this is equal to the risk of getting ovarian, breast and uterus cancers combined.” There are many factors that contribute to the development of osteoporosis, including age, smoking, excessive alcohol consumption and a suboptimal diet.4 Bone loss is a side effect of some medications or can result from the loss of hormones after menopause.
Other modifiable risk factors include a vitamin D deficiency and a lack of exercise. Eating a diet high in ultraprocessed foods is the very definition of a suboptimal diet. A study5 published in BMJ Open found that ultraprocessed foods made up 57.9% of all calorie intake and 89.7% of calories that came from added sugar.
Not only do ultraprocessed foods increase the risk for obesity,6 but they also raise your risk for other conditions including cancer7 and diabetes. Yet, food manufacturers have discovered that many people eating a Western diet cannot get enough of them. However, the effect ultraprocessed foods have on bone development is a relatively new discovery.
Ultraprocessed Food May Slow Growth and Weaken Bones
In a 2021 study published in Bone Research,8 scientists investigated the effect ultraprocessed foods would have on skeletal development using an animal model. There were two study groups, one which received a diet similar to the standard Western diet high in ultraprocessed foods and soft drinks, and the other, a standard rat diet.
The animals were given unlimited access to food and drink for six weeks, during which the researchers measured body weight and total body, femur and lumbar vertebral length. The animals were 3 weeks old when the trial started, which represented the six-week growth period before sexual maturation.
The results revealed that weight gain was lower, and total body and leg lengths were also significantly shorter, in the group eating ultraprocessed foods as compared to the control group. Although growth was underdeveloped in the experimental group, these animals ate significantly more calories. This suggested to the researchers that an ultraprocessed diet stunts growth, but not because of a caloric deficiency.
The NOVA classification system9 splits food into four different categories beginning with unprocessed or minimally processed foods. These are foods you would typically find around the outside aisle at the grocery store such as vegetables, fruits, meat and dairy products. They are the basis of what you would use to make food at home.
Group 2 includes processed culinary ingredients that you would use to season or add to unprocessed foods. For example, this group includes honey, salt and oils. Group 3 includes processed foods that have two or three ingredients that may be used to season or preserve the product. For instance, they include canned and bottled vegetables, salted nuts, cured meats and cheeses.
Finally, Group 4 contains ultraprocessed food and drink products, which are the majority of foods found in convenience stores. These typically have five or more ingredients and include carbonated drinks, ice cream, chips, breakfast cereals, energy bars, powdered or fortified meals, and ready-to-eat products such as pizza, chicken nuggets and instant soups and desserts.
Exposure in Adulthood May Increase Risk of Fracture
Additionally, the vertebra and femoral bones were scanned to examine trabecular and cortical bone properties.10 They found that the trabecular bone parameters in the experimental group were inferior when compared to the control group.
Bone volume fraction had decreased significantly when measured at six weeks and again at nine weeks during the intervention. The mean trabecular number and thickness in the femoral bone were also lower. Additionally, they found that trabecular separation was significantly higher in the experimental group when measured at six weeks and nine weeks during the intervention.
This number represents the mean distance between the trabeculae. These findings indicated an increased risk of fracture from poor bone development, and interestingly are some of the same findings in aging bone. The role of trabecular atrophy, as indicated by the reduction in number, thickness and increased separation, has a direct relationship on the strength of the bone and the resistance to fracture.11
In one study where researchers evaluated trabecular bone in older adults, they concluded it was “unlikely that treatment would replace trabeculae that have been removed or would restore biomechanical strength to the skeleton.”12 In the human skeleton, the trabecular bone is surrounded by a dense outer shell of cortical bone.
The proportion of the two varies depending on the location in the body. The trabecular bone has a network of rods and plates that are integral to bone strength. In fact, this architecture is “significantly stronger than an equal mass of solid bone.”13
Although the featured animal study demonstrated poor structural development of the trabecular bone in the femur and vertebra during growth before sexual maturity, it is important to note that new trabecular bone formation continues until a peak bone mass is achieved from age 30 to 40 years in men and women.14 This raises the question of how ultraprocessed foods affect the risk of osteoporosis in older adults.
Ultraprocessed Foods Impair Your Gut Microbiome
Ultraprocessed foods are aggressively marketed by food producers as they are highly profitable. Yet, as outlined in The BMJ following the release of two studies finding an association between ultraprocessed foods and the risk of death and cardiovascular diseases:15
“… packaged baked goods and snacks, fizzy drinks, sugary cereals, ready meals containing food additives, dehydrated vegetable soups, and reconstituted meat and fish products — often containing high levels of added sugar, fat, and/or salt, but lacking in vitamins and fiber … account for around 25-60% of daily energy intake in many countries.”
Past studies have also linked this food group to an increased risk of metabolic syndrome, obesity, high blood pressure and cardiovascular diseases.16 These are comorbid conditions that increase your risk of severe disease with COVID-19.17 The basis for these metabolic and health changes may reside in the gut.18
Science continues to reveal the vital effect that your diet has on your gut microbiome, and your gut microbiome’s ability to ward off disease.
Gut microbiome diversity with healthy microorganisms is better able to support your immune system. This has become increasingly important according to Tim Spector, professor of genetic epidemiology at King's College in London, as COVID-19 has spread across the world. Writing in The Conversation, Spector says:19
“The immune system is complex and highly responsive to the world around us, so it’s not surprising that many factors affect its function. What’s important to know is that most of these factors are not hard-coded in our genes but are influenced by lifestyle and the world around us.
As well as mounting a response to infectious pathogens like coronavirus, a healthy gut microbiome also helps to prevent potentially dangerous immune over-reactions that damage the lungs and other vital organs. These excessive immune responses can cause respiratory failure and death …
The fine details of the interactions between the gut microbiome and the immune system are not fully understood. But there seems to be a link between the makeup of the microbiome and inflammation — one of the hallmarks of the immune response. Gut bacteria produce many beneficial chemicals.”
Mexico Uses a Unique Strategy to Lower Obesity Risk
As I mentioned, individuals with cardiovascular disease, diabetes and obesity are at greater risk of severe COVID-19 illness. And, the evidence clearly indicates that a diet rich in ultraprocessed, convenience foods contributes to those conditions. In late 2020, parts of Mexico took an unprecedented stance in protecting their youth.
Lawmakers in several states pushed legislation that would ban the sale of junk food to anyone under 18. The first legislature to pass the ban was in Oaxaca, followed closely by Tabasco.20 Magaly López, a lawmaker in Oaxaca's Congress, commented on the move to a reporter from NPR,21 “I know it can sound a bit drastic, but we had to take action now. The damage of this kind of diet is even more visible because of the pandemic.”
It’s interesting paradox that an infectious disease that disproportionately affects those with obesity and cardiovascular disease is what may lead to better recognition and action against ultraprocessed foods when these same conditions have contributed over the past decade to many of the top 10 leading causes of death.22
Mexico also instituted a food warning label on packaged foods that are high in sugar, trans fats, saturated fat and calories. Businesses had only until December 1, 2020, to add those warning labels to avoid fines.23
As Reuters reports,24 these new warning labels and bans on junk food met with “super-sized opposition” from the U.S. and EU. Mexico consumes more processed foods than any other Latin American country and is the fourth largest consumer in the world.
Mexico took the labeling law one step further, saying that any product “containing caffeine and sweeteners must bear warning labels that they should not be consumed by children, and products with warning labels cannot include children’s characters, animations, cartoons, or images of celebrities, athletes or pets on their packaging.”25
Ultraprocessed Foods Raise Risk of Death
In the first of two studies26 published in The BMJ that linked ultraprocessed foods with an increased risk of cardiovascular disease and death, researchers concluded that consuming four or more servings of ultraprocessed foods daily was independently associated with a 62% relative increase in the risk of death from all causes and for every additional serving the risk rose again by 18%.
In the second study,27 data revealed eating ultraprocessed food increases your risk of cardiovascular disease, even after adjusting for known confounding factors and second analysis.28 Through a variety of mechanisms, junk food can destroy your metabolism and affect your appetite control.
As detailed in “The Extraordinary Science of Addictive Junk Food,” your body is designed to naturally regulate how much you eat and the energy you burn. However, manufacturers have figured out how to override your intrinsic control by engineering foods that are hyper rewarding.29
This stimulates such a strong response in your brain that it becomes easy to overeat. Some of the most addictive junk foods on the market are potato chips, which hit all three bliss points: sugar from the potato (and sometimes from added sugar), salt and fat.30
It is likely not a coincidence that as ultraprocessed foods have become a norm for many Americans, so have chronic illnesses. The food you eat is a key factor that determines health and longevity. I believe that eating a diet of 90% real food and 10% processed foods is achievable for most and it could make a significant difference in your weight and overall health, including your bones.
To help you get started, you'll find more information and suggestions in “Processed Foods Lead to Cancer and Early Death.” To address your gut microbiome, in addition to eliminating ultraprocessed foods and eating primarily whole foods, traditionally fermented foods and probiotics are the best routes to optimal microbiome health.
Healthy fermented choices include lassi (an Indian yogurt drink), fermented, grass fed organic milk (kefir), fermented soy or natto and different types of pickled fermentations of cabbage, turnips, eggplant, cucumbers, onions, squash and carrots. For more information and tips on how to make fermented foods at home, see “Flavorful Fermented Foods Have Healing Properties.”