Dining with the stars

Can we trust the health advice provided by the Healthy Star Rating process to help us choose healthy food?

The image below appeared on my social media feed recently, posted by Dr David Gillespie.

Can it really be that butter is bad for us, a food that has nourished generations of our forebears, and a highly processed alternative, the main ingredient of which was discovered about 30 years ago, gets 4 stars out of a possible 5?

These non-butter butters are mostly canola oil, extracted from canola seed.

That’s before it’s processed further into a ‘spread’. Part of this process is hydrogenation. This is where oils (liquid) are made solid at room temperature.This process enhances taste, texture, and shelf life. This process also forms trans fats, which are bad for your health in many ways.

Humans have been processing food since we became humans. We have been making butter for thousands of years. It goes way back to the earliest days of agriculture. Back then, processing was to make food more digestible (eg. cooking) or last longer (eg. fermentation). 

These days some food processing has a different purpose.

Next level processed or ‘ultra-processed’ foods are recognised as being bad for our health in a number of ways and a system of classifying processed food called NOVA has been created and is used by the Food and Agriculture Organisation of the United Nations (FAO) in a publication discussing their place in a healthy diet.

This system of classifying processed foods has four levels. These ‘spreads’ are in Group Four that the FAO describes as “…ultra-processed foods are designed to create highly profitable products (low-cost ingredients, long shelf-life, emphatic branding), convenient (ready-to-consume) hyper-palatable products liable to displace freshly prepared dishes and meals made from all other NOVA food groups”.

But, I hear you say, butter contains saturated fat, also bad for our health.

Saturated fat is what is behind the low star rating for butter in the image.

Butter is about 70% saturated fat, humans have been eating saturated fat for a long time. Fat from animals is suggested as the dietary ingredient that led to our large brain. This cerebral advantage was a key factor in our success as a species.

After many years of demonising saturated fat for its perceived role in cardiovascular disease, more recent studies are finding little evidence for this link. The idea that seed oils might be a better alternative is also challenged.

Butter, minimally processed and as we have eaten for centuries, is clearly better for us than these ‘spreads’.

Seems like the answer to my question is: no we can’t trust the health advice provided by the Healthy Star Rating process. In fact, that the Healthy Stars labelling is voluntary adds to the potential for it to be used selectively. This means that if the product scores low, the manufacturer gets to omit the star rating from the packaging.

The Healthy Star Rating system not only fails to steer us toward healthy food, it is promoting food that is bad for our health.

Manufacturers of ultra-processed foods, by focussing on particular nutrients (eg. saturated fats) rather than foods (eg. butter) can infer a health benefit from their products without explicitly making one. While nutrition science and public health nutritionists have shifted their focus to the foods we eat and the food environments and social pressures that influence diets, food corporations cling to this promotion of particular nutrients.

It seems that clever marketing is being conflated with advice for healthy eating.

Useful evidence

Astrup, A., Magkos, F., Bier, D. M., Brenna, J. T., de Oliveira Otto, M. C., Hill, J. O., King, J. C., Mente, A., Ordovas, J. M., Volek, J. S., Yusuf, S., & Krauss, R. M. (2020). Saturated Fats and Health: A Reassessment and Proposal for Food-Based Recommendations: JACC State-of-the-Art Review. Journal of the American College of Cardiology, 76(7), 844–857. 

Dickie, S., Woods, J. L., Baker, P., Elizabeth, L., & Lawrence, M. A. (2020). Evaluating Nutrient-Based Indices against Food- and Diet-Based Indices to Assess the Health Potential of Foods: How Does the Australian Health Star Rating System Perform after Five Years? Nutrients, 12(5), 1463. 

DiNicolantonio, J. J., Lucan, S. C., & O’Keefe, J. H. (2016). The Evidence for Saturated Fat and for Sugar Related to Coronary Heart Disease. Progress in Cardiovascular Diseases, 58(5), 464–472. 

Hamley, S. (2017). The effect of replacing saturated fat with mostly n-6 polyunsaturated fat on coronary heart disease: A meta-analysis of randomised controlled trials. Nutrition Journal, 16(1), 30.

Scrinis, G. (2020). Ultra-processed foods and the corporate capture of nutrition—An essay by Gyorgy Scrinis. BMJ, 371, m4601.

Souza, R. J. de, Mente, A., Maroleanu, A., Cozma, A. I., Ha, V., Kishibe, T., Uleryk, E., Budylowski, P., Schünemann, H., Beyene, J., & Anand, S. S. (2015). Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: Systematic review and meta-analysis of observational studies. BMJ, 351, h3978.

Modified from photo by Nathália Rosa on Unsplash