What Does the Term “Processed Food” Mean to You?

by Bettina Elias Siegel on August 9, 2011

A while back I said I had a big question to ask Lunch Tray readers.  I’m a few weeks late in posting, but here it is:

When we talk about “processed food,” what do we really mean?

As someone who writes daily about food and healthful eating, this is a question I think about often.  I toss out the term “processed food” on this blog with abandon, holding it up unfavorably to “fresh” or “whole” foods, berating my school district for serving too much of it, blaming its widespread availability, in part, for our rising obesity and disease rates.  But even as I use the term freely, as a writer I recognize with some discomfort how imprecise it is.

“Processing” could mean everything from washing, peeling and slicing a piece of fruit to turning it into this:

We may be fine with the former and recoil from the latter, but you have to admit that somewhere in the middle things do get a little fuzzy.  Is it “processing” to squeeze a lemon over the apple slices to keep them fresh?  Is it “processing” to use ascorbic acid as a preservative, which is what makes the lemon juice effective in preventing browning?  What about drying the slices into apple chips?  Is an apple “fruit leather” the result of too much processing?  What about these organic green apple “twists”?


When we cook down apples into a delicious applesauce at home, we might feel good about our efforts, yet the end result is not so different from this product, which many parents might spurn as “too processed”:

And even as we struggle to define what we mean by “processed” food, there are those who argue that processing (however that is defined) should not be feared but instead embraced.

For example, several months ago I shared with you an article by historian Rachel Laudan entitled “In Praise of Fast Food.”  In it, Laudan takes issue with the prevailing ethos that “[m]odern, fast, processed food is a disaster.”  She writes:

For our ancestors, natural was something quite nasty. Natural often tasted bad. Fresh meat was rank and tough, fresh fruits inedibly sour, fresh vegetables bitter. Natural was unreliable. Fresh milk soured; eggs went rotten. Everywhere seasons of plenty were followed by seasons of hunger. Natural was also usually indigestible. Grains, which supplied 50 to 90 percent of the calories in most societies, have to be threshed, ground, and cooked to make them edible.

So to make food tasty, safe, digestible, and healthy, our forebears bred, ground, soaked, leached, curdled, fermented, and cooked naturally occurring plants and animals until they were literally beaten into submission. They created sweet oranges and juicy apples and non-bitter legumes, happily abandoning their more natural but less tasty ancestors. They built granaries, dried their meat and their fruit, salted and smoked their fish, curdled and fermented their dairy products, and cheerfully used additives and preservatives—sugar, salt, oil, vinegar, lye—to make edible foodstuffs.

Eating fresh, natural food was regarded with suspicion verging on horror; only the uncivilized, the poor, and the starving resorted to it. When the ancient Greeks took it as a sign of bad times if people were driven to eat greens and root vegetables, they were rehearsing common wisdom. Happiness was not a verdant Garden of Eden abounding in fresh fruits, but a securely locked storehouse jammed with preserved, processed foods.

More recently I came across an interview with Fergus Clysedale, Distinguished Professor and Director of the Food Science Policy Alliance at the University of Massachusetts Amherst, that’s likely to raise a few eyebrows with this readership.  He laments the fact that health professionals and governmental bodies are reluctant to promote processed foods as a means of stemming the obesity epidemic.  He believes such foods provide an excellent means of “controlling portions, providing low-caloric density, decreasing waste, increasing safety and decreasing preparation time,”  and he questions consumers’ “paranoid distrust of anything ‘artificial,’ ‘unnatural,’ ‘mass-produced’or ‘industrially-’processed.’”  Interesting.  (I did note that Dr. Clysedale’s department has received significant endowments from large food manufacturers, although it’s unfair to assume bias here without more information.)

And then there are the socio-political ramifications of processing food.  A month or two ago, Michelle Hays, blogger at Quips, Travails and Braised Oxtails, shared a link on Facebook that introduced me to the extraordinary work of artist Judith Klausner.  Klausner has created a series of pieces entitled “From Scratch” in which she juxtaposes the traditionally female handicrafts of old — embroidery, sewing, and the like – with modern, processed foods.  Believe it or not, this “mold” was actually embroidered by the artist onto commercially produced bread:

 

“Toast Embroidery,” copyright Judith Klausner, photo by Steve Pomeroy

(Be sure to look at Klausner’s other works in this series, including some astonishing Oreo “cameos” and a sampler stitched onto Corn Chex cereal.)

Klausner tells us that her intent in creating these pieces is to remind us that in our nostalgia for our culinary past, we fail to take into account the freedom such processing has bestowed upon all of us — but particularly women, who previously struggled under the considerable burden of cooking three full meals a day from scratch.

[T]he temptation to romanticize the past is strong. Yet, the availability of packaged foods is what allows us the time to pursue careers, to develop new technologies, to create.

The food on our tables may not be as tasty as it once was. It may not even be as wholesome. But it is important to take a step back and recognize the trade that has been made, and that what we have gained is not to be undervalued.

My work is about choice. As a woman in the twenty-first century, I can choose to spend my day baking a loaf of bread, or to grab a package off a grocery store shelf after a long day at work. I can choose to spend my evenings embroidering. I can choose to combine these things and call it art.

If you agree with any of these positions, then you recognize that there are at least some aspects to processing food which are beneficial to us as individuals and as a society.  Yet we still haven’t defined with precision how much “processing” is too much.

The best analysis I’ve seen is found in this piece by Marion Nestle published last year, summarizing Journal of the World Public Health Nutriton Association article written by University of São Paulo professor Carlos Monteiro.  As Nestle summarizes Monteiro, there are three types of food:

• Type 1: Unprocessed or minimally processed foods that do not change the nutritional properties of the food.

• Type 2: Processed culinary or food industry ingredients such as oils, fats, sugar and sweeteners, flours, starches, and salt. These are depleted of nutrients and provide little beyond calories (except for salt, which has no calories).

• Type 3: Ultra-processed products that combine Type 2 ingredients (and, rarely, traces of Type 1).

Quoting now from the journal article itself, Moneiro writes:

The issue therefore is not processing as such. It is the nature, extent, and purpose, of processing, and in particular, the proportion of meals, dishes, foods, drinks, and snacks within diets that are ‘ultra-processed.’ . . . .

Ultra-processed products are characteristically formulated from ‘refined’ and ‘purified’ ingredients freed from the fibrous watery matrix of their original raw materials. They are formulated to be sensually appealing, hyper-palatable, and habit-forming, by the use of sophisticated mixtures of cosmetic and other additives, and state-of-the-craft packaging and marketing. Further, ultra-processed products are ‘convenient’ – meaning, ready-to-eat (or drink) or ready-to-heat. . . .

From the public health point of view, ultra-processed foods are problematic in two ways. First, their principal ingredients (oils, solid fats, sugars, salt, flours, starches) make them excessive in total fat, saturated or trans-fats, sugar and sodium, and short of micronutrients and other bioactive compounds, and of dietary fibre. Taken together this increases the risk of various serious diseases. Second, their high energy density, hyper-palatability, their marketing in large and super-sizes, and aggressive and sophisticated advertising, all undermine the normal processes of appetite control, cause over-consumption, and therefore cause obesity, and diseases associated with obesity.

Does Monteiro’s three-tier classification of food “processing” work for you?  How do you personally draw the line when buying “processed” foods for yourself and your family?  Do you believe that all processing of any kind should be avoided and, if so, do you find it hard to live out that principle?

I’m so interested in hearing what Lunch Tray readers have to say.

 

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{ 28 comments… read them below or add one }

Bri August 9, 2011 at 8:50 am

Whew. It IS a hard problem, isn’t it? I think I fall somewhere in the realm of having the goal that about 80 percent or more of our food will be Type 1, and less than 20 percent Type 2, with little to no Type 3. (That’s clear as mud.)
What I mean is this: I make just about everything we eat, including a lot of our breads/grains/cereals. However, since I have to use flours and oils to make those grain products, by definition I’m using “processed” foods. I’m okay with that. I don’t think I need to mill my own grains, though I know many do; I don’t think I need to assiduously avoid ANY white sugar or flour in our diets, though I limit it. I’m thrilled that someone else “processes” my beloved extra-virgin olive oil for me, and in the wintertime, if I have no lovingly preserved farm-fresh tomatoes in my freezer, I’m just as happy to seek out a high-quality “processed” tomato — in a can, jar, or box, with nothing added to it — to make my marinara sauce.
And as to things like applesauce? I make my own, but I can’t keep up with the demand in my house. Also, there is a good applesauce mixed with berries that my children love; it’s made by a company, not by Mom, so it’s “processed” food for sure. It comes in single-serving cups. It’s perfect for their lunchboxes. And I’m totally okay with tucking one of those little cups in alongside their homemade hummus on homemade whole-wheat pita, organic yogurt, and spinach. God bless the manufacturer of that applesauce.
Where do I draw the line? When there are ingredients added to the food item that I cannot pronounce. When there are highly refined and processed additives like HFCS and hydrogenated oils. When there are loads of stabilizers and preservatives to keep what should be a perishable food from rotting. But is there going to be a bag of “processed” pretzels in my pantry? Heck, yeah — with ingredients carefully read, of course. That’s called balance…and sanity.

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Karen Frenchy August 9, 2011 at 9:02 am

Thanks Bri for your comment. Once again, I agree with you. I also want to add that I buy cheese because I doubt my HOA will allow us to keep a cow and/or a goat to make our own cheese…

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Bri August 9, 2011 at 9:16 am

*giggle* That made my morning. Good point!

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Bettina Elias Siegel August 9, 2011 at 8:24 pm

Bri – this sums up very nicely how we eat, too, although I’m not nearly as good as you are about making most of my staples (breads, hummus, cereals, etc.). I still have that tortilla recipe you shared and have yet to use it – LOL! :-) For us, totally ruling out all white flour and sugar and other, similar foods would just be too restrictive. As regular TLT readers know, we love to eat out, we love to explore new foods and I think it’s hard to eat outside one’s home if you are always going to avoid every type of processed food (although I support and applaud people who do live that way.) As with all things, I think moderation is key and my rule of thumb is to hew as closely as possible to whole foods in our house, for the most part, and allow for more leeway outside the home.

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Kim M. August 10, 2011 at 6:58 am

Bettina, what’s your definition of “moderation?”

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Bettina Elias Siegel August 10, 2011 at 9:50 am

Hmm . . . how does one quantify that? Moderation means something different to everyone, of course, and there’s a reason BIg Food loves to tout “all things in moderation” as a fig leaf while they sell us lots of junk we don’t need to be eating!

Not sure if you want me to really get into the nitty gritty about how how we eat, but here are some general parameters: Artificial colors, flavors, HFCS and other mysterious chemical ingredients are all steadfastly avoided, although if an occasional candy with such ingredients or something small like that slips in, I don’t freak out.

I don’t make my own bread on a regular basis but the bread I buy is 100% whole wheat and free of the aforementioned ingredients. (I will note, though, that we do eat a traditional challah on Friday nights and sometimes that carries over in the form of toast for a few mornings after that. I don’t love that, since my kids would happily fill up on challah toast and nothing else, and i keep meaning to try a whole wheat challah recipe that a TLT reader once generously shared with me.) Similarly, I don’t make my own pasta but what I buy is also 100% whole wheat. There, too, though, I do make exceptions if the sauce is very delicate and WW just isn’t going to fly, or if my kids simply beg too much and I cave. :-) In those cases I might use a white flour pasta with boosted fiber (totally “processed,” I know!). Cereals are also store-bought but are whole grain. Dessert is officially sanctioned on Friday nights as part of our Shabbat meal and it most definitely involves refined white sugar/white flour – ice cream, cobblers, pies, etc.

Dinners make use of whole foods — lean proteins (generally turkey, chicken and fish — I only very rarely cook red meat at home and we don’t have pork or shellfish because I no longer eat them) or vegetarian (tofu, grains and legumes, etc.). We’re leaning toward more and more vegetarian dinners lately. I make liberal use of fresh vegetables in our dinners, both in the main dishes and as sides, but I do also use canned tomatoes for sauces and canned beans to save time. I’m concerned re: BPA and for that reason have tried to switch from canned tomatoes to those in boxes or bottles (when I’m not using fresh) but I still make use of canned beans and just feel worried about it. I’ve vowed to try to soak/cook my own beans more often but haven’t lived up to that vow yet.

So as you can see, we try to adhere to a baseline diet of whole foods, or foods that are “processed” by someone else but which haven’t strayed terribly far from their original state, with some wiggle room for foods that are less than ideal. That’s my definition of “moderation,” but I’m sure others would take issue with it and/or have their own. What do you think?

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Kim M. August 10, 2011 at 2:32 pm

I read recently that Muir Glen is in the process of switching their canned products to BPA-free cans if that helps you (apologies, I don’t recall the source).

I think “moderation” is a pretty vague word and it’s different for everyone as you said. I think when big food uses it, they’re hoping their customers think of moderation the way your kids think about challah, i.e. moderation means filling up on it 3x a day if only Mom would let you.

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Lenee February 29, 2012 at 4:35 pm

Where can I find Bri’s recipe for tortillas?! I have a couple recipes I’ve used and am always up for more to try. Bri? Bettina? Help? :)

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Bettina Elias Siegel August 9, 2011 at 11:16 am

Since not everyone who reads TLT is also a fan of its Facebook page (but if not, why not? :-) ), here are some interesting responses to this question that have come in on Facebook:

“anything not out of my garden or farmers market. Prepackage. Mostly preservatives then actually consumables. Blah!”

“Anything made with names I can’t pronounce, anything with chemical food coloring, anything made with preservatives…examples are plastic cheese, margarine, ‘fruit’ snacks. etc. Anything not HOMEMADE!!!! :)”

“Anything in a bag or box.”

What do you think about these?

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Kim M. August 10, 2011 at 7:28 am

All of those are good rules of thumb. I always read ingredient lists and think about what ingredients I would use to make the product from “scratch.” If the product contains even one ingredient I wouldn’t use, back on the shelf it goes. If the item is bread or cereal, the first ingredient must be whole grain. Once every month or two, I’ll buy a loaf of rustic Italian or French bread that’s made from white flour. I relax the rules when I eat out (2 or 3 times a month) but I don’t throw them out entirely.

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Kim M. August 10, 2011 at 2:44 pm

Also, I use Michael Pollan’s 5-ingredient rule. If a product contains more than 5 ingredients, I won’t buy it. I don’t count water or salt when I count ingredients.

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Michele Hays August 9, 2011 at 11:44 am

First of all, thanks so much for the shout-out, Bettina!

I’ve long felt like the lone voice out there promoting minimally processed food as a way to address poor eating habits: I think that when we insist on fresh, we are turning our back on all kinds of good foods, and people who can’t afford fresh foods then just throw in the towel and go for junk.

Frozen, canned, dried foods: all these are perfectly legitimate ways to ensure we don’t waste food (think of how much spoilage there is of fresh foods) and to extend the growing season. Especially when it comes to school lunch and other large-scale feeding operations, I think these foods are important.

Maybe the word we should use to indicate foods of minimal nutritional value is “refined,” instead of “processed.”

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Bettina Elias Siegel August 9, 2011 at 8:20 pm

Michele – I totally agree on that point. When Jamie Oliver did that tie-in with Green Giant this season on Food Revolution, there was a lot of negative chatter, but to my mind, frozen vegetables are an excellent entry into healthier cooking, especially among those who feel pressed for time and are scared off by the prep work in using fresh vegetables.

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Kim M. August 10, 2011 at 7:41 am

Frozen vegetables also are often far more affordable than fresh and are an especially good option for people with budgetary concerns. For example, fresh green peppers were going for $1.49/lb. and red peppers for $2.49/lb. at supermarkets and farm stands here yesterday (Hartford, CT area). A 1-lb. bag of store brand frozen pepper strips (mix of red, green, and yellow) was 99 cents. I think plain frozen vegetables (no sauces or salt) are one of the biggest bargains in grocery stores these days.

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KathieW August 9, 2011 at 12:10 pm

Very eloquently put Bri – I am in your camp. I too am interested in what other readers have to say.

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Maggie August 10, 2011 at 7:09 am

We probably need new words! It’s frustrating when a discussion becomes confused by terminology rather than being focused on the original topic.

As I thought about this, I realized that the term is part of the recipe for home canning – “process the tomato sauce in a boiling water bath…”. Also, I remember the term “processing” being used to define taking the chickens to the local butcher for slaughter, plucking and cleaning.

Honestly, I’m not sure how to define the term clearly, but I guess in the end, I realize that the less a food item has been changed, it’s probably “better” for me. And, quite likely, if I’m the one doing the changing (like home preserving, or grinding own grains) it’s also probably “better”. But, like lots of other things, there is that trade off of time and ability and so on.

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Louise Goldberg August 10, 2011 at 11:28 am

I just read this post after the food safety post caught my eye on FB. Brilliant Bettina! Really something to think about.

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EdT. August 10, 2011 at 4:11 pm

Processed, like moderation, is one of those things I will recognize when I see it. Some rules of thumb for me:

If I have to go to Beilstein’s to find out how to pronounce the ingredients in what I am eating… it is processed.

If I have to buy a new pair of pants as soon as I finish eating… I probably ate too much.

That being said: I do eat “processed” food. There is the convenience factor, and there is the fact that such food is by its nature portion-controlled. I certainly will eat frozen fruits and veggies (I just love to “visualized whirled peas”.)

I try to avoid (or at least limit) the amount of HFCS in my food: I have noticed a direct correlation between the amount of HFCS I consume and the stability of my blood-glucose levels. I will consume cane and beet sugar (including “refined” sugar), but in moderate (i.e. small) quantities.

I now try to limit the amount of salt I eat, and avoid adding extra to my food.

I also consider much of the product of modern farming (read: Tomatoland) as “processed” as what is contained in a Lunchable (which I will admit to having eaten on occasion.)

People love to decry “chemistry” in food: however, food is NOT a thermodynamic source of fuel (hence my annoyance at the obsession with calories), and in fact our bodies “burn” the energy we get from food in a series of chemical reactions (at least, this is how my endocrinologist explained it.) So, I am not opposed to chemicals in food, though I want to know what they are, so if I don’t handle them well, I can avoid them in the future.

BTW, did anyone hear about Paula Deen being in hot water with her local zoning board, on account of her keeping chickens on her property?

~EdT.

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Kate September 4, 2011 at 11:25 pm

Processing means a variety of things to me. Obviously a Dorito is something that is more highly processed than homemade applesauce.

To me though, even homemade applesauce is processed though. Most people peel the apples before making applesauce, thus taking away some of the fiber content of the original fruit. Cooking the fruit is also processing it again. One can certainly ingest and digest 70 calories of applesauce more quickly than one can eat a small apple that might have 70 calories.

I’ve flirted with vegetarianism before…..there are plenty of processed vegetarian products…somehow people don’t count tofu or veggie burgers as processed though.

I don’t strictly avoid processed foods. Some processed foods I might prefer over their slightly less processed counterparts. For instance I prefer regular pasta over whole wheat pasta. Might the whole wheat pasta be better for me perhaps. In terms of managing by blood sugar(for me) though the results are negligible, and the most important thing is controlling the actual portion.

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Bettina Elias Siegel September 5, 2011 at 11:47 am

Kate – I laughed with recognition about veggie burgers and tofu. I was sort of giving some of those products a free pass, like the Morningstar Farms products, until one day I woke up and said, hey, wait a minute, that’s a REALLY, REALLY long ingredient list!

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Adam December 10, 2011 at 12:57 pm

I really enjoyed this post, and the comments that followed. I recently got in a heated debate with some “hippy” friends who insist anything “processed” is “evil” (overuse of quotes, I know :)), even as they snacked on their tofu (laughable) and drank a glass of wine (equally laughable, but FAR more delicious!).

The only thing that I’m concerned about is the recurring trend that if an ingredient can’t be pronounced then it falls under the “evil” category. This is quite simply bowing down to ignorance.

There are so many things under this sun that one person can’t possibly be familiar with everything, and then simply labeling anything you don’t understand as “evil” is one of the most destructive things that our species can do. This has led to countless wars, pain, and depths of despair that can’t even be reproduced on film because of the sheer depravity of it.

I suggest instead that if you see something you can’t pronounce, don’t buy it – but write the name down, go home and read about it. Understand the “process” involved in creating it, and then make a truly informed decision about whether you want to avoid it, instead of allowing fear of the unknown to rule your world.

P.S. I’m not a lobbyist for “evil” manufacturing corporations, just a man who agrees with every one of you in principal, but loves above all else, knowledge.

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Bettina Elias Siegel December 10, 2011 at 3:34 pm

Adam – That’s a very good point. “Ascorbic acid” sounds like an troubling chemical concoction, but “vitamin C” sounds great. And conversely, “yeast extract” sounds benign but it’s a synonymous term for MSG, a substance many try to avoid. Thanks for commenting here, and I’m glad you enjoyed the post!

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mommm!!! May 1, 2012 at 1:54 am

After a few years of being immersed into what I can live with as far as processed foods go, I’ve gone the way of certified organic. This way I get the best of both worlds….I get my processed foods, like cereals, because frankly I’m more inclined to bake a loaf of bread than I am to sit down and try to actually MAKE cereal. I have to draw the line somewhere lol! However, I’m raising a soon to be teenage boy and the kid has hollow legs. He scoffs at a loaf of bread. But with certified organic processed foods I’m guaranteed no offensive chemicals and certainly no GMOs, which tend to be highest in grain heavy products. I get the certified organic wheat bread at Costco because it’s two loaves for 5 bucks and I can toss one loaf in the freezer. Sure, I have to shop at like 3 different stores to get my grocery shopping done but for me it’s worth my peace of mind.

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Alex May 4, 2013 at 7:46 pm

this about sums it up right here:
blog.teen-recipes.com/processed-food

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Sharon Badian June 4, 2013 at 5:12 pm

The best definition I’ve seen is from Melanie Warner, author of Pandora’s Lunchbox. If you can’t make it at home (meaning it doesn’t require any industrial processes/equipment) with ingredients you can easily obtain, it’s processed. There are many things that you could make at home (cured meats, sauerkraut, brined olives, bread, even soy sauce) but most folks have a life to live. If you are willing to spend the money, however, you can find “like-at-home” versions out there easily but you got to read those labels!

I think the “processed vs. not” is only part of the story. I have made croissants. Real, full of butter croissants. Takes some skill but they can be made at home. Same thing applies to many baked goods. And potato chips (my personal weakness). That doesn’t mean you should eat these things everyday!

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Bettina Elias Siegel June 5, 2013 at 2:13 pm

Sharon: I think that’s a very workable definition. And I loved Pandora’s Lunchbox – if you haven’t seen it, my interview with Melanie Warner is here. Thanks for commenting on TLT!

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Darius October 1, 2013 at 12:46 am

I consider as processed foods those that are produced under very high temperatures and/or pressure (thus destroying vital nutrients) with additional additives included, such as refined sugars and flours or artificial additives. I do not consider as processed such foods as naturally fermented dairy or vegetables, cured meats or sourdough breads.

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Alberta July 23, 2014 at 3:45 pm

Nearly all food, except for fresh fruits and vegetables, and probably many “natural” meats, is processed to some extent. What I buy is minimally processed: dried beans, shelled raw nuts, wild caught and cleaned fish, pasta, whole grain breads without other ingredients, dried grains of all types, and whole grain flours. Some of our “party” foods use processed ingredients: sugar, vanilla, etc. but we eat these things extremely rarely, several times a year.

My son was raised on huge quantities of freshly-washed raw vegetables and fruits, whole-grain breads, roasted or pan-fried meats and fish, steamed grains of all types, eggs, nuts, and seeds. He developed a taste for Domino’s pizza, which I certainly allowed on special occasions and sleepovers, and one semester at college he lived on McDonalds food for a solid month a la “Supersize Me”. (He gained 25 pounds, looked pasty and was trembling a good part of the time, which I pointed out and which he refused to admit. However, that was quietly the end of McDonalds for him, I believe.)

I was a stay-at-home mother so I had time to spend, but after I started working, I continued to spend 3 hours a day washing vegetables and fruits, so I know it’s possible if you’re truly committed, and if you are used to a healthy diet and feel awful once you start on the chemicals, GMOs and pesticides again. This type of eating is also expensive, but anyone middle-class should be able to afford it. We own no house, drive a tiny car and walk everywhere, including 2 hours to get to the dentist, so it can be done if you choose priorities such as ours.

I recommend this way of life. But others may feel it’s too much trouble. I get that. But for me, it’s a matter of health, so it’s trouble that’s well worth it. It’s also quite a withdrawl process to get off the chemicals and flavors. It’s no secret that processed foods are specifically designed to be addictive, and it works! I put in my time with diet soda, cigarettes, sugar, and white flour, decades, in fact, so I know all about addiction. What I’m simply saying is that it can be done!

Now, the only problem I have is that while traveling, I have to make a lot of trips to grocery stores, spend time in hotel bathrooms washing vegetables, and always book rooms with refrigerators. It can be a pain. But the benefit to me is that I come back from vacation having eaten what I love, not being sick, and not having gained weight. It’s worth it to me.

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