The Rise of Ultra-Processed Foods and Why They’re Really Bad for Our Health

Jerri-Lynn here. The next thing I would like to see someone study is the link between declining food security, especially decreased local food production, and the increase in world consumption and availability of these ultra-processed Frankenfoods. Which as we all know are compromised nutritionally, and no doubt contribute to the rise of many lifestyle diseases and the increase of obesity. So that people end up fact but malnourished.

I post this as a reminder of problems we face that aren’t related to the pandemic or climate change

By Phillip Baker, Research Fellow, Institute for Physical Activity and Nutrition, Deakin University, Mark Lawrence, and Professor of Public Health Nutrition, Institute for Physical Activity and Nutrition, Deakin University, and Priscilla Machado, Research Fellow, School of Exercise & Nutrition Science, Faculty of Health, Deakin University. Originally published at The Conversation.

Humans (and our ancestors) have been processing food for at least 1.8 million years. Roasting, drying, grinding and other techniques made food more nutritious, durable and tasty. This helped our ancestors to colonise diverse habitats, and then develop settlements and civilisations.

Many traditional foods used in cooking today are processed in some way, such as grains, cheeses, dried fish and fermented vegetables. Processing itself is not the problem.

Only much more recently has a different type of food processing emerged: one that is more extensive, and uses new chemical and physical techniques. This is called ultra-processing, and the resulting products ultra-processed foods.

To make these foods, cheap ingredients such as starches, vegetable oils and sugars, are combined with cosmetic additives like colours, flavours and emulsifiers. Think sugary drinks, confectionery, mass-produced breads, snack foods, sweetened dairy products and frozen desserts.

Unfortunately, these foods are terrible for our health. And we’re eating more of them than ever before, partially because of aggressive marketing and lobbying by “Big Food”.

Ultra-Processed Foods are Harming our Health

So concludes our recent literature review. We found that more ultra-processed foods in the diet associates with higher risks of obesity, heart disease and stroke, type-2 diabetes, cancer, frailty, depression and death.

These harms can be caused by the foods’ poor nutritional profile, as many are high in added sugars, salt and trans-fats. Also, if you tend to eat more ultra-processed foods, it means you probably eat fewer fresh and less-processed foods.

Industrial processing itself can also be harmful. For example, certain food additives can disrupt our gut bacteria and trigger inflammation, while plasticisers in packaging can interfere with our hormonal system.

Certain features of ultra-processed foods also promote over-consumption. Product flavours, aromas and mouthfeel are designed to make these foods ultra-tasty, and perhaps even addictive.

Ultra-processed foods also harm the environment. For example, food packaging generates much of the plastic waste that enters marine ecosystems.

And Yet, We’re Eating More and More of Them

In our latest study, published in August, we found ultra-processed food sales are booming nearly everywhere in the world.

Sales are highest in rich countries like Australia, the United States and Canada. They are rising rapidly in middle-income countries like China, South Africa and Brazil, which are highly populated. The scale of dietary change and harms to health are therefore likely immense.

‘Big Food’ is Driving Consumption

We also asked: what explains the global rise in ultra-processed food sales? Growing incomes, more people living in cities, and working families seeking convenience are a few factors that contribute.

However, it’s also clear “Big Food” corporations are driving ultra-processed food consumption globally — think Coca-Cola, Nestlé and McDonald’s. Sales growth is lower in countries where such corporations have a limited presence.

Globalisation has allowed these corporations to make huge investments in their overseas operations. The Coca-Cola System, for example, now includes 900 bottling plants worldwide, distributing 2 billion servings every day.

As Big Food globalises, their advertising and promotion becomes widespread. New digital technologies, such as gaming, are used to target children. By collecting large amounts of personal data online, companies can even target their advertising at us as individuals.

Supermarkets are now spreading throughout the developing world, provisioning ultra-processed foods at scale, and at low prices. Where supermarkets don’t exist, other distribution strategies are used. For example, Nestlé uses its “door-to-door” salesforce to reach thousands of poor households in Brazil’s urban slums.

Rising consumption also reflects Big Food’s political power to undermine public health policies. This includes lobbying policymakers, making political donations, funding favourable research, and partnerships with community organisations.

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47 comments

  1. PlutoniumKun

    I think its important not to overlook cultural issues. There is a huge variation in the penetration of ultra-processed foods in Europe – from around 50% of daily calories in the UK to well under 20% in France or Portugal (I believe its over 60% in the US). I don’t believe the food industry is any less malign or organised in the south of Europe to northern Europe – the prime difference is that in countries with a food culture, they are far more resistant to the lure of cheap, heavily marketed industrial products designed to look like food (I like Michael Pollans rule of thumb – if it comes in a package with more than five ingredients listed, its not food, its an industrial product).

    You can see this elsewhere – in parts of Asia (Philippines and Singapore, for example), processed food seems the norm nearly everywhere, among rich and poor, while regular people are far more protective of their local foods in, say, Thailand or Vietnam. Unsurprisingly, people in the latter countries always seem to be far slimmer and fitter looking.

    I do wonder sometimes about which comes first – industry pressure or personal preference. Here in Ireland I’ve long wondered about the very obvious differences in supermarkets in urban and rural (small town) areas. In my local supermarkets, whether discounters or upmarket here in central Dublin, fresh fruit and vegetables and breads are always front and centre – you have to go down the back of the aisle to get the packaged stuff. But when I wander into the exact same chain supermarket in smaller towns or rural areas, its the opposite – I’m faced with racks of biscuits, packaged pastries and confectionary, boxes of ‘cereals’ and so on. The fresh fruit and veg is there, but tucked away and often of much lower quality. And you can see the difference in peoples bodies – when I go to small towns or outer suburbs here I see far more obesity than in the big cities – even independently of whether people look poor or well off. Supply chain distance is of course one possible reason – its far easier to keep fresh food constantly stocked when you are near the centre of distribution hubs – but its also hard not to see customer preference as a stronger driver than the convenience of industry.

    There are all sorts of subtle issues here at work – I suspect work pressure on families is a key determinant on whether people have the time for home cooked foods (its notable I think that countries well known for low rates of working women tend to have healthier diets). I’m not quite sure wealth and education is as important as some say – poor people in Thailand or Vietnam seem to have far healthier diets than rich people in Singapore – but poor people in Philippines have far worse diets than rich people in Japan or South Korea.

    But ultimately, I think this comes down to culture – and culture can be protected and enhanced, even in the face of relentless marketing. In France, children are taught in schools how to appreciate good food. In Japan, mothers are shamed if they send their kids to school with pre-packed foods instead of a home cooked bento. In Italy or Thailand people will happily discuss their favourite food stall or restaurant the way people in other countries discuss their local football team.

    1. DJG

      Thanks, Plutonium Kun. I agree with you that much of the dilemma comes from culture. In U.S. culture, there was the traditional “meat and potatoes man” who has morphed into someone sitting in an SUV at a fast-food outlet, waiting for something sugared and deep-fried for breakfast.

      Further, as many Europeans have pointed out, almost all U.S. food these days is too sweet. This is a combination of a cultural preference and economic issues related to cheap sweeteners. Cheap sugar goes way back in U.S. culture.

      Another economic aspect is that food in the U.S. of A. isn’t cheap. Some friends from Italy remarked on how expensive it is to go to a grocery store in the U.S., and I recall shopping in grocery stores in Italy and France and finding food in general to be much cheaper than it is in the U.S. One byproduct of food being too expensive in the U.S. is that industries have looked for substitutes to feed the masses: Too much food in the U.S. is made from trash like cottonseed oil (many of the “shortenings”) or soybean oil (margarines) or corn oil / corn syrup (just about everything).

      So culture likely governs the tastes that we seek, but there is an economic aspect that links to the trash being produced and sold as food. So you get deep-fried “apple pies” at McDos.

      1. JohnMc

        while the link below doesn’t explain how they compute ‘household income’, their claim that americans spend the least of any country on food is consistent with every other source i’ve seen.

        https://www.weforum.org/agenda/2016/12/this-map-shows-how-much-each-country-spends-on-food/

        ‘industries have looked to substitutes to feed the masses’

        have they? it’s always that ‘industries’ are forced to do such and such a thing to keep the masses from starving. or are they just maximizing profits?

    2. JeffK

      Your pan across cultures made me think about China’s attribution of social value with purchasing habits, where, say, a person buying infant nappies might get a higher social score than a person buying an alcoholic beverage. Taking that scenario to an extreme (possibly not), a person who obsessively reads ingredient labels and avoids ‘industrial food products’ might get a lower social score than people who buy unprocessed food because the practice of purchasing processed food supports state-sponsored industries. I wonder. Are there any NC readers that can verify or refute this conflict of health interest?

    3. Joe Well

      For me, there’s a “Thai Paradox.”

      No country has more 7-Elevens per capita (no source here, just go and see for yourself), and they are filled almost exclusively with highly processed junk.

      Carbonated soft drinks are so well loved that a bottle of red soda is a common offering at the ubiquitous altars to the animistic spirits.

      And yet the average Thai person is thin as a reed.

      My guess is that the portions are just so small of everything they eat. They eat junk, but they eat less of it. And they eat a lot of fruit and vegetables even if they can’t possibly be a major source of calories.

      Like, a common snack is unripe mango sticks dusted in sugar. The calories obviously are coming mostly from the sugar, but at least there’s something substantial in there.

      1. Cuibono

        Thais USED to be thin as rails. Not any more:
        According to WHO, overweight and obesity levels in Thailand have been steadily increasing over the years. The percentage of overweight or obese adults increased from 8.6% in 1975 to 32.6% in 2016.

    1. delacaravanio

      Article doesn’t say.

      As per the NOVA food classification (which categorises foods according to the extent and purpose of food processing, rather than in terms of nutrients), ultraprocessed foods are those foods that go through multiple processes (extrusion, molding, milling, etc.), contain many added ingredients, and are highly manipulated. For example: soda, potato chips, chocolate, candy, ice-cream, sweetened breakfast cereals, packaged soups, chicken nuggets, hotdogs, French fries, etc.

      1. Starry Gordon

        You can make good ice cream with just five ingredients: milk, cream, sugar, salt, and a simple flavor, like vanilla. The process consists of simply freezing it while stirring it continuosly — not too complicated. I think one would have to leave ice cream out of the ultraprocessed category — if it’s actually ice cream. The last condition is the problem.

        1. Chris

          Yes, you (or I) can make ice cream that way. But here’s the list from a local (Oz) supermarket offering picked at random:

          Ingredients

          Dairy Ingrediedients (Reconstituted Skim Milk, Cream, Milk Solids), Water, Sugar, Glucose Syrup, Maltodextrin, Coconut Oil, Vegetable Origin Emulsifiers [477, 471 (Soy)], Flavour, Vegetable Gum (412).

          I think making it yourself removes it from the “ultra processed” category.

        2. ShamanicFallout

          Yep, there a a lot of those available but the ice creams with just those ingredients you will have to pay quite a bit more for.

    2. shtove

      He links a UN definition with examples:

      Ultra-processed foods are formulations of ingredients, mostly of exclusive industrial use, typically created by series of industrial techniques and processes (hence ‘ultra-processed’).

      Some common ultra-processed products are carbonated soft drinks; sweet, fatty or salty packaged snacks; candies (confectionery); mass produced packaged breads and buns, cookies (biscuits), pastries, cakes and cake mixes; margarine and other spreads; sweetened breakfast ‘cereals’ and fruit yoghurt and ‘energy’ drinks; pre-prepared meat, cheese, pasta and pizza dishes; poultry and fish ‘nuggets’ and ‘sticks’; sausages, burgers, hot dogs and other recons tituted meat products; powdered and packaged ‘instant’ soups, noodles and desserts; baby formula; and many other types of product.

      Excluding the alcohol aisle buried down the back of our local supermarket, that’s about 90% of shelf space: the fructose aisle, the seed oil aisle, the soya bean (aka. “healthy” comestibles) aisle, the ground-up-meat-in-a-skin aisle. Leaving some space for a newspaper stand whose headlines blast out “rage”, “fury” and “anger”. And all to the tune of piped music.

    3. Fireship

      From the article:

      Only much more recently has a different type of food processing emerged: one that is more extensive, and uses new chemical and physical techniques. This is called ultra-processing, and the resulting products ultra-processed foods.

      I missed it too! From the pdf:

      NOVA classifies all foods into four groups (Monteiro et al., 2017a). One of these, termed ultraprocessed foods, is made up of snacks, drinks, ready meals and many other product types
      formulated mostly or entirely from substances extracted from foods or derived from food
      constituents. Ultra-processed foods are made possible by use of many types of additive,
      including those that imitate or enhance the sensory qualities of foods or culinary preparations
      made from foods.
      The processes and the ingredients used in the manufacture of ultra-processed foods make
      them highly convenient (ready-to-consume, almost imperishable) and highly attractive (hyperpalatable) for consumers, and highly profitable (low cost ingredients, long shelf-life) for their
      manufacturers.
      But these processes and ingredients also make ultra-processed foods typically nutritionally
      unbalanced and liable to be over-consumed and to displace all three other NOVA food groups,
      all of which include foods processed in some form. These are unprocessed or minimally
      processed foods, processed culinary ingredients, and processed foods (Monteiro et al., 2017a).
      These other food groups are the basis of long-established dietary patterns, including those
      known to promote long and healthy lives (Sho, 2001; Sofi, et al., 2010; Jung et al., 2014).

        1. Jerri-Lynn Scofield Post author

          Hope that’s helpful Vlade. I was just about to respond but Fireship beat me to it.

    4. TKMAXX

      From the paper (found here

      Formulations of ingredients, mostly of
      exclusive industrial use, that result from a
      series of industrial processes (hence ‘ultraprocessed’), many requiring sophisticated
      equipment and technology. Processes enabling
      the manufacture of ultra-processed foods
      include the fractioning of whole foods into
      substances, chemical modifications of these
      substances, assembly of unmodified and
      modified food substances using industrial
      techniques such as extrusion, moulding and
      pre-frying, frequent application of additives
      whose function is to make the final product
      palatable or hyper-palatable (‘cosmetic
      additives’), and sophisticated packaging,
      usually with synthetic materials. Ingredients
      often include sugar, oils and fats, and salt,
      generally in combination; substances that are
      sources of energy and nutrients but of no or
      rare culinary use such as high fructose corn
      syrup, hydrogenated or interesterified oils, and
      protein isolates; cosmetic additives such as
      flavours, flavour enhancers, colours,
      emulsifiers, sweeteners, thickeners, and antifoaming, bulking, carbonating, foaming,
      gelling, and glazing agents; and additives that
      prolong product duration, protect original
      properties or prevent proliferation of
      microorganisms. Processes and ingredients
      used to manufacture ultra-processed foods are
      designed to create highly profitable products
      (low cost ingredients, long shelf-life, emphatic
      branding), convenient (ready-to-consume)
      hyper-palatable snacked products liable to
      displace all other NOVA food groups, notably
      group 1 foods

      Examples:

      Carbonated soft drinks; sweet or savoury packaged snacks;
      chocolate, candies (confectionery); ice-cream; massproduced packaged breads and buns; margarines and other
      spreads; cookies (biscuits), pastries, cakes, and cake mixes;
      breakfast ‘cereals’, ‘cereal’ and ‘energy’ bars; ‘energy’
      drinks; milk drinks, ‘fruit’ yoghurts and ‘fruit’ drinks;
      ‘cocoa’ drinks; ‘instant’ sauces; infant formulas, follow-on
      milks, other baby products; ‘health’ and ‘slimming’
      products such as meal replacement shakes and powders.
      Many ready to heat products including pre-prepared pies
      and pasta and pizza dishes; poultry and fish ‘nuggets’ and
      ‘sticks’, sausages, burgers, hot dogs, and other reconstituted
      meat products, and powdered and packaged ‘instant’ soups,
      noodles and desserts.

    5. EarlyGray

      Looking at the document that was linked to, it seems they are defined as follows:

      Ultra-processed foods are formulations of ingredients, mostly of exclusive industrial use, typically created by series of industrial techniques and processes (hence ‘ultra-processed’).
      Some common ultra-processed products are carbonated soft drinks; sweet, fatty or salty packaged snacks; candies (confectionery); mass produced packaged breads and buns, cookies (biscuits), pastries, cakes and cake mixes; margarine and other spreads; sweetened breakfast ‘cereals’ and fruit yoghurt and ‘energy’ drinks; pre-prepared meat, cheese, pasta and pizza dishes; poultry and fish ‘nuggets’ and ‘sticks’; sausages, burgers, hot dogs and other reconstituted meat products; powdered and packaged ‘instant’ soups, noodles and desserts; baby formula; and many other types of product.

    6. PlutoniumKun

      I have a longer comment stuck somewhere in mod land, but I paraphrased Michael Pollens comment that if it has more than five ingredients listed on the label and comes in a pack, then its not food, its an industrial product.

      His Seven Rules are pretty good I think. He doesn’t say it outright, but he essentially sees highly processed food as the enemy, and I think he is right.

      As a general rule, I think a food is over processed if you look at the ingredient list and there is nothing that seems to match with the photo on the pack.

      1. vlade

        I’m wary of the “x ingredients” advice, TBH, as then one could not eat much ;). It’s similar with the “evil Es” (Es being the additive markings). E300 being vitamin C for example. As usual, the truth is more complex, with some Es being truly evil, while some are needed.

        But I see what he means, and generally agree.

        1. grayslady

          Ditto. Especially regarding the number of ingredients, although I suppose it depends on what counts as ingredients versus seasonings. I can’t think of a really good Indian curry that doesn’t have at least 7-10 spices.

          1. Joe Well

            But are those packaged pre-made Indian curry dishes you get at the grocery store actually good for you? That’s the contention.

            1. vlade

              I can buy a very good glass-jar lecso – sunflower oil, peppers, tomatoes, salt, ground pepper, garlic. I am actually pretty sure it’s better for me than home-made fat dripping fries that have just oil and potatoes as ingredients.

              but to sn extent, that’s the point PK was making above. It depends where you shop.

        2. Joe Well

          What is an example of a packaged food product with more than 5 ingredients that I can trust to be good for me?

          I can’t think of one.

          Even seasoned nuts don’t usually get to 5 ingredients unless they’re mixed nuts.

          I *enjoy* packaged foods but I just can’t think of how to make the more adventurous ones healthy. I’ll stick to nuts, seeds, popcorn…maybe dried fruit.

          1. vlade

            one of my favourite sausages is pork, beef, venison, paprika, garlic, pepper and salt. Not smoked.

            being meat, you’d argue it’s not good for me, but I’d say it’s better than a mars bar

            so for healthier food, say pickled cucumbers. cucumbers, water, salt, vinegar, dill, mustard seeds (can have more seasoning too)

  2. Ella

    Timely. It’s birthday time for my family. Our young daughter likes to see a cake, candles, singing. Just last night we had cake mix cupcakes. My teeth ached overnight and my eyes are puffy this morning. Poison!

    1. jr

      I used to host private events and we would have kids birthdays etc. We offered a free cake in the deal which we would go buy from Baskin Robbins. An “ice cream”cake.

      Except this ice cream cake wouldn’t melt.

      For -hours-.

      Once I left one sit out, at three hours the center sagged slightly. It was all emulsifiers and sugar. The kids never ate the things and I’d bet the rats took a pass as well.

      1. Ella

        So gross! My birthday is the last one in this one month span, in early October. I told my partner, no cake, bake me a fresh apple pie or gallette (from the apples we collect apple picking).

  3. Lou Mannheim

    This may seem apropos of nothing, but I spent a year as a career coach at an expensive east coast university a few years ago. I was on a conference call and a hiring manager for a big corporation was describing their undergraduate hiring strategy. “We’re not looking for critical thinkers.”

    I really think that’s the whole problem. I eat anything made by a company and wonder what would be so bad about cutting the sugars/saturated fat/sodium by a third – but it’s that extra third of badness that drives sales.

    I think at some point we may need to choose between the big brains we are given and our programming to compete for survival. The competition is deadly.

    1. a different chris

      > wonder what would be so bad about cutting the sugars/saturated fat/sodium by a third

      No the cutting of said basic ingredients and replacing them with crap (sugar->HFCS, saturated fat->trans fats) is one of the problems. Not saying that the doses aren’t way too high nowadays, but it’s non-food that is the problem described in the article.

      On a personal note, I was sick of explaining to doctors concerned about my bp that I haven’t touched a salt shaker since my sophomore year of college. Suddenly it isn’t so clear-cut, so I don’t have to do that anymore.

    2. Off The Street

      John Gatto warned us about the issues. That hiring manager said the quiet part out loud, providing a type of confirmation.

      Somewhere, some food industry (a curious word combination) flack is working on a press release or other screed or missive or propaganda about the following: We’re workin’ ‘ard ta provide what da people demand, and if ya object, yer just elitist denyin’ people their choice.
      (Now ignore those food deserts and don’t read our labels as you’d need a dictionary, anyway.)

  4. Michael

    Gawd! So many good alternatives, esp for children. Parents and grand parents have to make the effort. We are the g-ps who don’t offer junk food and all you can eat like the other half. Both following what we did when raising our own kids.

    Our g-kids both love sugar but also eat baby dill pickles, plain yogurt with frozen blueberries, cherry tomatos, carrot cake muffins, edamame, fresh fruit like pears and frozen grapes.

    Get the kids sectioned plates for portion control. Try it and if you don’t like it you don’t have to eat it. Treat “I wanna help” as a positive and add a little good health propaganda while they mix and stir and make a mess.

  5. The Rev Kev

    Jamie Oliver once said that when you go to buy food, look at the ingredients on the side of the package. If they sound like the sort of things that you might have in your grandmother’s pantry, then go ahead and buy it. But if it sounds like something whipped up in a chemist’s lab, then put it back. That is good advice that. And it aligns with Michael Pollen’s advice.

    Maybe a good test is what I call the bacteria test. You leave a sample of that food out in the open. If bacteria go to work on it, then you have food. But if bacteria don’t touch it, then you know that they do not recognize it as food. So when you have stored McDonalds burgers that are twenty, twenty-five years old, then you have to wonder just what it is that you have been eating.

      1. rtah100

        For unrelated reasons, I have been reading the UK technical guidance on sizing sewage treatment systems. Some of it was quite interesting – for example, installers must assume 50% more water usage per person in luxury hotels over other hotels. Some of it was predictable, e.g. The need for grease traps on commercial kitchens. And some of it was alarming: fast food restaurants often have failed sewage treatment because the protein content of the kitchen and toilet effluent is too low! That’s right, too low. God knows what is in the burgers. Even feathers are protein. Seed oils and moo?

  6. Cas

    There’s big $$ in processed food. The marketing and creation is similar to drug dealers–develop an addictive product. An oldie (from 2013) is a deep dive into the manufacturing and marketing of junk food. One interviewee from CocaCola relates his “I can’t do this anymore” moment when they targetted the poor in Brasil. The idea being even poor people have a few pennies in discretionary income, so they created mini-bottles of CocaCola. His conclusion after visiting the favelas in Rio, these people need a lot of things, but a Coke isn’t one of them. Lots of examples of creating meals, lunch packages, snacks, that cause cravings.
    https://www.nytimes.com/2013/02/24/magazine/the-extraordinary-science-of-junk-food.html

    1. Ella

      Money and profit. The easiest way to approach food is the closer to the natural source it is, the better. Mostly plants, in moderation and variety. I think this is Michael Pollen?

  7. LilD

    I highly recommend
    Dr Greger. “How not to Die”
    And evidence based nuggets at nutritionfacts.org

    Moving a large fraction of the population back to plant based especially organic diets (what our great grandparents called “food”) might reduce factory farming with a number of benefits

    Better health thus less demand for healthcare services and better quality of life

    Reduced contamination

    Reduced need for wuhan style wet markets thus fewer novel viruses and fewer pandemics (SARS2 is not going to be the last one)

    Reduced pressure on the ecosystems

  8. Shleep

    I left a very processed carrot cake treat, packaged in cellophane, on a shelf at my cottage. 3 years into the experiment, gently squeezing the package, it still felt soft to the touch, and showed no signs of age or spoilage.

    That the mice which get into *everything* else had 4-5 months of each of those years to have a go at it, and never did, was telling.

    1. Yves Smith

      I once took a weekend course for trainers that included a lecture by a professor of nutrition who was also a practicing MD. He had very critical things to say about nutrition science.

      At one point, he looked around and said: “Does anyone here have some cookies?” A woman guiltily raised her hand. He asked her to bring them to him. It was a small package of the fake healthy kind.

      The prof said, “I guarantee hydrogenated fat will be the #2 or #3 ingredient.” It was #3.

      He continued: “You know what that stuff is? It is so far removed from food you could leave it on your counter for a year. It won’t change. And roaches won’t touch it either.”

  9. Andrew Thomas

    The grim list of deadly maladies caused by ultra-processed foods at the beginning of the article reminds me of the rapid-fire list of side effects that constitute 5 seconds of every prescription medication ad on television. My favorite is ‘don’t take____ if you are allergic to it.’ Another favorite- ‘if your eyes bulge out of their sockets/ your toes fall off/ your____ goes boom, stop taking it and call your doctor.’ Thank you, Jeri-Lynn.

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