Coke, Twinkies, Skittles, and … Whole-Grain Bread?

The loaf in my fridge is the furthest thing from Wonder Bread. Each slice is made of organic whole-wheat flour and has four grams of fiber and just two measly grams of added sugar. It’s studded with so many seeds that I’m always worried about them getting stuck in my teeth. The only service this bread can provide is as a hummus sandwich; it tastes too healthy for a grilled cheese, an egg sandwich, or any other handheld creation.

But here’s the thing about my whole-grain, seed-coated loaf of bread: Apparently it counts as an ultra-processed food, just like Twinkies, Coke, and sugary cereals. I was faced with this bread conundrum earlier this month, when I attempted to cut down on ultra-processed foods after hearing so much about their harms. Almost every food is processed in some way—milk is conventionally pasteurized; tomatoes are canned—but ultra-processed foods, or UPFs, are typically made in factories with industrial ingredients, such as emulsifiers and artificial flavors. And they seem to be making us sick. A recent review found “convincing evidence” that ultra-processed-food consumption is tied to type 2 diabetes and fatal heart disease.

According to the rubric created by Carlos Monteiro, the Brazilian epidemiologist who coined ultra-processed foods, my loaf of bread was to be avoided: It was mass-produced, laced with an industrial additive, and sliced. In an email, Monteiro confirmed to me that the bread was a UPF primarily because of the industrial additive: wheat gluten. It’s often used to strengthen dough before it is baked. If you get bread from the grocery store, as I did, it’s almost certainly also a UPF. But perhaps that says more about the perplexing, arbitrary criteria for ultra-processed foods than anything about bread itself.

Exactly what qualifies as an ultra-processed food is not always clear. Monteiro’s rubric, called NOVA, separates foods into four categories. “Unprocessed foods” include raw vegetables and fruits. “Processed culinary ingredients” are things like cooking oils and honey. “Processed foods” are things like canned vegetables. And “ultra-processed foods” include Skittles, fish sticks, and other junk food, as well as infant formula and flavored yogurts. Drawing the line between ultra-processed and processed foods is especially tricky. NOVA doesn’t lay out specific criteria for, say, bread versus soda, but it does have detailed descriptions of how to spot an ultra-processed food, such as foods that include ingredients “never or rarely used in kitchens,” such as high-fructose corn syrup and hydrolyzed proteins.

But even when you read Monteiro’s countless papers outlining the NOVA classification, categorizing food isn’t as simple as you might think. NOVA has called out “pre-sliced bread” as an example of an ultra-processed product, but I couldn’t tell if slicing automatically meant that a food was ultra-processed, or if it was just a signal that a food might be ultra-processed. (With my bread, Monteiro told me that the presence of wheat gluten was “the only marker” of ultra-processing.) But added gluten is hardly the same as hydrolyzed proteins or industrial sweeteners. The fact that a single ingredient—and one as benign as wheat gluten—could lump my bread together with Twinkies made me question the credibility of the entire system.

The attributes to look for in bread, like slicing, felt so arbitrary that I started to wonder if I was applying the criteria incorrectly. Nutritionists I contacted struggled too. Marion Nestle, a professor emeritus of nutrition at NYU who has defended the NOVA system, told me she wasn’t sure whether the bread I was eating qualifies as an ultra-processed food, because, despite having an industrial additive mixed in, it was made mostly from actual whole foods. Even Monteiro seemed confused at first. When I sent him the ingredient list, he initially told me that my loaf was just processed (not ultra-processed), until I asked him specifically about the wheat gluten. He then argued that the bread “is much better than the average ultra-processed bread.” But the idea of UPFs is to try to avoid the category entirely.

Monteiro’s team appears to have long struggled with the bread quandary as well. Nearly every paper they write on the system classifies bread as ultra-processed, but they’ve argued that “bread, even in typically cheapened degraded forms, is relatively innocuous.” In 2015, the team classified “french bread” as “processed,” but “sliced bread” as “ultraprocessed.”

Even if I accepted that my bread was ultra-processed, I still couldn’t understand why it was so bad. Much of the research into the health effects of bread has focused on the nutrients—or lack thereof—in certain products, especially white bread. Mostly, researchers fear that particular additives in bread have not been extensively studied, and that processed bread is easier to chew and swallow, thus prompting people to eat more.

I wasn’t even a week into my attempt to cut out UPFs, and I was already feeling exasperated. The situation was made even worse when I went back to the grocery store in hopes of finding a replacement. At first glance, no bread seemed to fit the bill. Although the Real Bread Campaign, an advocacy group focused on reducing consumption of ultra-processed bread, recommends buying natural sourdough from a local baker, or making it yourself, that’s hardly useful advice for the many Americans who don’t even have easy access to a grocery store, let alone a boulangerie. The NOVA system seems, at first glance, like the world’s simplest diet: All you have to do is avoid certain foods. But when that list gets so broad that you can’t eat a slice of whole-grain bread, it becomes unworkable. The same goes for yogurts and cereals—the majority of which are banned too.

The bread debacle can seem like a straw man designed to make the whole system look pointless and unworkable. Some food scientists have criticized NOVA for being overly broad and unfairly maligning some healthy foods, but those arguments are also made in bad faith by big food companies to defend an industry that has made billions off making people sick. Monteiro told me that zeroing in on a single food “focuses on the trees and loses the forest.” But the entire exercise—the confusing guidelines, and the lack of clear articulation for why certain attributes of foods are worth avoiding—was weighing on me.

This isn’t all NOVA’s fault. The clumsy classifications underscore an even deeper problem with our knowledge—or lack thereof—of UPFs. In short, we don’t know why ultra-processed foods are so bad for us. A recent clinical trial, in which participants ate either ultra-processed or unprocessed diets that were matched for certain key nutrients, found that something beyond the nutrient facts in UPFs makes people eat more and gain weight. What that is remains unclear. Until we understand it, advice on which foods to eat, and which to avoid, will always seem arbitrary and, in the case of bread, a bit silly.

I did eventually find some bread in the supermarket that definitely wasn’t ultra-processed. The loaf, if you could call it that, had been imported from Germany. It had just four ingredients, and it smelled like dead grass. There were no air pockets or delectably crunchy crust. When toasted, it didn’t get crispy; it just got hotter and more pungent. For now, I’m going to stick to my regular old healthy bread.