Poverty and diet has everything to do with Covid death rates | Lizzie Wingfield

Poverty and diet has everything to do with Covid death rates | Lizzie Wingfield
There is no overwhelming proof that eating ultra-processed food kills you, but there is proof, too, that being in the income bracket that consumes most of it makes it much more likely that you will die of Covid-19

The recent findings, by epidemiologist Professor Sir Michael Marmot, that Covid-19 death rates are 25 per cent higher in Greater Manchester – and in general, the more impoverished a local authority, the higher the death rate – comes hard on the heels of another revelatory study.

The Zoe Covid-19 research team found that people who ate large amounts of plant-based food were 10 per cent less likely to catch Covid and 40 per cent less likely to need hospital treatment if they did.  

Although, sadly, by “plant-based food” they mean fruit, veg, and pulses rather than chocolate, chips and wine. The magic bullet is to increase your five a day to nine or 10 a day. And the magic is universal: it works regardless of how fat, ill, old or poor you are.

It is not a complete surprise that foods stuffed full of vitamins and minerals are good for your chances of surviving a deadly virus, but having such a large improvement confirmed by a study of more than a million people’s diet and Covid health records do help a person reach for the broccoli and pomegranate seeds.

But it’s no good eating half a kilo of vitamin pills for breakfast and stuffing your face with doughnuts, chocolate, and crisps for the rest of the day. To explain this great misfortune, there will now follow a short look at the “badfulness” of ultra-processed food.

Much discussion revolves over its high salt, fat and sugar content: if we can just bring down the levels, all will be well. But if salt, fat and sugar was all it took to ruin your health, the Italians would all be dead at 40. The nail in a lot of coffins is that the processing strips out all – or nearly all – of the fibre.

If you were feeding your cow on essence of grass, bulked up and made palatable by the addition of lots of fat, sugar and salt, you wouldn’t expect its health to be much improved if you took a few grams of sugar et al out of it.

“The cow needs to eat the whole thing,” you would shout at whatever moron was spouting such nonsense. As a matter of fact, some cows are fed a bovine version of a junk-food diet because it fattens them up in double-quick time. It also makes the meat less nutritious and the cow has to be pumped full of antibiotics to keep it going.  We don’t eat humans, so I can’t comment on their nutritional content, but the rest is bang on the mark.

We are not cows, but we need the structure of food as much as any nutrients it contains, and if you take the fibre out, there are some pretty catastrophic consequences. Firstly, it makes food more calorie-dense per square inch, so you need to eat much more of it to feel full – volume, not calories, fills you up. 

It takes an iron will, possessed by few, to stop eating before you feel full, and research from the US National Institute of Health suggests that people who eat a diet of ultra-processed food typically consume 500 calories more a day than people who eat proper food. And secondly, there is nothing to slow the rate of digestion down, which causes sugar spikes, so insulin has to rush in to store it in fat cells before it damages the body. Both of these cause obesity and insulin resistance – leading to type 2 diabetes, which has been deadly to many people in the pandemic.

But the icing on a lethal hat trick of negative impacts is its effect on the microbiome.

The microbiome is the Johnny-come-lately of our biology, and very du jour. I don’t mean it’s suddenly tipped up in a previously unoccupied bit of our body, but we have finally started noticing that it’s there. It’s a teeming mass of trillions of different types of microbes that live in the bowel. It might not sound much to get excited about but scientists, including those at the Soonchunhyang Institute of Medi-Bio Science, have now realised they are crucial to reducing inflammation – which is at the root of many diseases, including mental illness – and fighting infections, like Covid-19.

I say teeming mass, but in order to teem, they need their human host to consume shed-loads of fruit, veg, pulses and whole grains to give them enough fibre to get their teeth into – nothing else can survive the digestive process in the stomach and arrive unscathed in the bowel. The journal Public Health Nutrition found that 50 per cent of calories eaten in this country are from fibreless ultra-processed food, so there must be a lot of skinny microbes practising social distancing in cavernously empty bowels.

But that 50 per cent of ultra-processed calories is not shared out equally per head of population: if you are poor you are massively more likely to have a diet in which ultra-processed food features heavily. This is usually blamed on the fact that fresh food is expensive – and it is. Or hard to find in deprived areas – and it is that too, at least in some of them. But the thing about ultra-processed food is that it is delicious. In the pursuit of high-volume sales, it has been engineered by flavour-wizards to be hyper-palatable. However bad it is for your body, it is enormously pleasurable to eat.

In a life that’s full of stress and short on affordable pleasures, a few moments of delicious escape probably feels worth the risk to your health.

If you are poor, you are a match made in heaven for food companies wanting to fatten up their profits by peddling nutritionally bankrupt but utterly delicious substances – and they make the most of the opportunity. If you are part of the urban poor, you are rarely a few yards away from the opportunity to buy a deep-fried, sugar-soaked something or other. 

If you are not actually standing next to a shelf full of chocolate bars or outside somewhere selling chips, the food companies will bombard you with messages – on billboards, on the telly, on the radio, on the internet, on the side of the bus – about how much better your life would be if only you ate more of it.

At present, there is no overwhelming proof that eating junk food kills you, but there is evidence that being in the income bracket that consumes most of it makes it much more likely that you will die of Covid-19. There is also evidence that not eating it gives you a 40 per cent higher chance of surviving.

The blame is always put on people for choosing to eat it, not on the companies that do everything in their power to make sure they do.

As we head into the next phase of the pandemic – learning to live with it despite a surging wave from a hyper-transmissible variant – the people most at risk are those living on nutritionally inadequate diets and in crowded housing. The poor.

How many more have to die of Covid before we do something to curb the food giants pushing junk food?