Ultra-Processed Foods
Ultra-Processed Foods, High-Carb/High-Fat Combinations, and the Modern Epidemic of Cardiometabolic Disease
A Functional Metabolic Medicine Perspective
John Sciales, M.D.
Director, CardioCore Metabolic Wellness Center
"Getting to the Core… the Path to Wellness"
Cardiometabolic disease has emerged as the most pressing public health challenge of our time, encompassing a constellation of interrelated conditions including type 2 diabetes, atherosclerotic cardiovascular disease, stroke, hypertension, dyslipidemia, and metabolic syndrome. These disorders share a unifying pathophysiology rooted in insulin resistance, chronic inflammation, and metabolic inflexibility. Together, they represent the leading cause of death and disability worldwide, robbing millions of quality years from life expectancy and burdening health systems with staggering costs. In the United States alone, the combined toll of heart disease, stroke, and diabetes exceeds $500 billion annually in direct medical expenses and lost productivity (2). This crisis is not confined to the elderly or to those with obvious obesity; it now permeates all age groups, including children and young adults, fueled by dietary patterns that undermine metabolic health from an early age.
The urgency of this crisis is underscored by the latest findings from the Centers for Disease Control and Prevention (CDC). The National Center for Health Statistics Data Brief No. 536 reports that ultra-processed foods (UPFs) now account for 53.3% of total caloric intake among U.S. adults and an alarming 62% among youth (1). This represents a seismic shift from traditional dietary patterns, where whole, minimally processed foods predominated, to one in which industrially engineered products dominate the plate. UPFs are not simply foods that have been cooked or preserved; they are formulations designed for maximum palatability, shelf stability, and profitability, created through industrial processes that combine refined carbohydrates, industrial seed oils, emulsifiers, flavor enhancers, and other additives in configurations rarely, if ever, found in nature. They are, by design, hyper-palatable, calorie-dense, and nutritionally imbalanced. The health implications of this shift are devastating.
Cardiometabolic disease is not a benign condition that merely raises laboratory numbers. It is the precursor to heart attacks, ischemic strokes, chronic kidney disease requiring dialysis, peripheral artery disease leading to amputations, and heart failure that erodes daily function. Less visible but equally catastrophic are the links between insulin resistance and neurodegenerative diseases such as Alzheimer’s dementia, sometimes referred to as “type 3 diabetes” due to its metabolic underpinnings (2). Insulin resistance also fuels the growth of several common cancers, including breast, colorectal, pancreatic, endometrial, and hepatocellular carcinoma (3,4). These associations are neither rare nor coincidental; they are mechanistically linked through shared pathways of hyperinsulinemia, chronic inflammation, oxidative stress, and altered growth signaling.
One of the most insidious dietary features driving this epidemic is the high-carbohydrate/high-fat combination that has become the signature of the Western UPF-dominated diet. In natural ecosystems, carbohydrate-rich foods, such as fruits and tubers, tend to be low in fat, while fatrich foods, such as nuts, seeds, and animal products, are generally low in carbohydrates. Our physiology evolved to handle these macronutrients in separate contexts, using distinct metabolic pathways for each. Carbohydrates raise insulin, a powerful anabolic hormone that promotes nutrient storage, particularly in the form of glycogen and fat. Dietary fats, on the other hand, have minimal direct impact on insulin secretion. But when these two macronutrients are combined — as in pastries, fried sweets, pizza, or ice cream — insulin secretion is driven by the carbohydrate component, and the accompanying fat is shuttled efficiently into adipose tissue for long-term storage.
From an evolutionary standpoint, this combination was rare and seasonal, typically occurring in the form of ripe fruit alongside fatty animal sources during specific times of year. The physiological consequence of such a combination is strikingly illustrated in the behavior of bears preparing for hibernation. In late summer and early fall, bears gorge on high-sugar berries and honey, often alongside fat-rich salmon or nuts, stimulating insulin release and promoting maximal fat storage while simultaneously downregulating metabolic rate to conserve energy. This is a survival strategy for a period of prolonged fasting and inactivity. Humans, however, have no hibernation period. By consuming high-carb/high-fat UPFs year-round, we induce a perpetual metabolic state akin to hibernation — storing fat, slowing metabolism, and impairing energy utilization — without the seasonal reset. Over time, this leads to weight gain, visceral adiposity, and the cluster of abnormalities we define as metabolic syndrome.
This mismatch between our evolutionary design and the modern food environment has been described as an “evolutionary collision” (5,6). For hundreds of thousands of years, humans subsisted on diets dictated by seasonal and geographical availability. Nutrient density, not caloric excess, was the norm. Periods of abundance were offset by scarcity, and physical activity was woven into the fabric of daily survival. The agricultural revolution altered this balance, but it was the industrial and post-industrial food revolution that truly decoupled human diet from its evolutionary roots. Modern UPFs bear little resemblance to the foods our ancestors consumed; they are chemical and structural novelties to which our metabolic machinery has had no time to adapt.
Beyond macronutrient ratios, UPFs inflict damage through their effects on the gut microbiome, the complex community of trillions of microorganisms that inhabit our intestines. The gut is the most direct and continuous interface between the human body and the environment. Every meal is, in effect, an environmental exposure that shapes the composition and function of the microbiome. A healthy, diverse microbiome supports efficient digestion, synthesizes essential nutrients, regulates immune responses, and maintains the integrity of the intestinal barrier. UPFs erode this ecosystem by providing low-fiber, high-sugar substrates that favor pathogenic overgrowth, and by introducing emulsifiers, preservatives, and artificial sweeteners that disrupt microbial balance (7). These disruptions can increase intestinal permeability, allowing bacterial components such as lipopolysaccharides to enter the bloodstream and trigger systemic inflammation — a phenomenon known as metabolic endotoxemia. Chronic low-grade inflammation, in turn, exacerbates insulin resistance and accelerates the development of cardiometabolic disease.(1).
In functional metabolic medicine, diet is not an adjunct to therapy; it is the first prescription. At the CardioCore Metabolic Wellness Center, our approach begins by identifying and removing the dietary triggers of metabolic dysfunction, particularly UPFs. We focus on reintroducing whole, nutrient-dense foods that align with human evolutionary biology, emphasizing natural macronutrient distributions and food combinations that support metabolic flexibility. Restoration of gut health is a central pillar, employing dietary fiber, polyphenol-rich plants, and fermented foods to rebuild microbial diversity and strengthen the intestinal barrier. This is paired with personalized macronutrient ratios tailored to an individual’s metabolic profile, as determined by advanced laboratory testing for insulin sensitivity, inflammatory markers, and lipid subfractions. Hormonal regulation is addressed through lifestyle interventions that optimize circadian rhythms, stress management, and sleep quality — all of which influence insulin sensitivity and inflammatory status. Regular physical activity is prescribed not solely for calorie expenditure, but for its role in enhancing mitochondrial function, promoting glucose uptake independent of insulin, and reducing visceral fat stores. Every intervention is tracked through objective metrics, ensuring that therapy is not static but evolves with the patient’s progress.
The clinical imperative is clear: waiting until overt diabetes or cardiovascular disease manifests is a failure of preventive medicine. By the time fasting glucose rises into the diabetic range or coronary arteries are narrowed by plaque, years — often decades — of silent metabolic damage have already occurred. The CDC’s dietary data show that the substrate for this damage is being consumed daily by the majority of Americans (1). Without intervention, this trajectory leads inexorably to organ damage, disability, and premature mortality. From a public health perspective, reducing UPF consumption is as critical as reducing tobacco use was in the fight against lung cancer. The parallels are striking: both involve industrial products designed for addiction, both generate massive profits at the expense of health, and both require societal as well as individual action to reverse their harm. Education alone is insufficient; environmental and policy changes are needed to make whole, minimally processed foods the default rather than the exception.
In conclusion, the epidemic of cardiometabolic disease is being fueled by a food environment that is incompatible with human physiology. The combination of high carbohydrates and high fats in UPFs drives insulin resistance, fat storage, and metabolic slowdown in a manner eerily similar to hibernation — except that humans never awaken from this state without deliberate intervention. The consequences extend beyond diabetes and heart disease to include cancer, dementia, and a host of inflammatory disorders. Functional metabolic medicine offers a path forward by addressing root causes, restoring gut health, and realigning diet and lifestyle with our biological design. The choice before us is stark: continue down the current path of chronic disease, or reclaim our metabolic health by returning to the foods and rhythms our bodies were built to thrive on.
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References
US Centers for Disease Control and Prevention. NCHS Data Brief No. 536: Consumption of Ultra-Processed Foods Among Youth and Adults, 2015–2018. National Center for Health Statistics; 2024.
Reaven GM. Insulin resistance: the link between obesity and cardiovascular disease. Med Clin North Am. 2011;95(5):875-892.
Giovannucci E, et al. Diabetes and cancer: a consensus report. Diabetes Care. 2010;33(7):1674-1685.
Tsugane S, Inoue M. Insulin resistance and cancer: epidemiological evidence. Cancer Sci. 2010;101(5):1073-1079.
Eaton SB, Konner M. Paleolithic nutrition. N Engl J Med. 1985;312:283-289.
O’Keefe JH, et al. Cardiovascular disease in hunter-gatherers. Am J Med. 2010;123(12):1081-1086.
Sonnenburg JL, Bäckhed F. Diet-microbiota interactions as moderators of human metabolism. Nature. 2016;535:56-64
