Turns out RFK, Jr. could be called today’s James Delaney, the congressman who gave us the Generally Recognized As Safe, or GRAS, system. Kennedy has been voicing many of the exact same nutritional concerns that Delaney expressed – two years before Kennedy was born. And, in the same way that Delaney struggled with the power of what was to become known as the ultraprocessed food industry, Kennedy is struggling today. Because of the influence of Big Food and the lack of will in Congress to properly fund the FDA, the Delaney Act and its GRAS system in 1958 failed to effectively regulate the addition of chemicals to our food. Given the enormous size and power of the ultraprocessed food industry today, Kennedy has a challenge on his hands in reforming it, as he would like to do, for the benefit of the public’s health.

So what’s going on with the FRESH Act collision in the House? First, I noticed, as did the nutrition watchdogs Center for Science in the Public Interest and the Environmental Working Group, the appearance of Florida Republican Kat Cammack’s FRESH and Affordable Foods Act. Both CSPI and EWG termed the Act not fresh but rotten.

Cammack’s FRESH Act is, in full, the FDA Review and Evaluation for Safe, Healthy and Affordable Foods Act. Cammack and her food industry friends would use it to further eviscerate an already weak food additive safety system. The Environmental Working Group’s Melanie Benesh said, “I did not think it was possible to make our food system even weaker, but this proposal does it.”

Cammack’s draft bill was discussed this past week in subcommittee. There is a large amount of doubt about whether it, or any of the several congressional proposals currently in committee that are intended to reform GRAS in a positive, public health direction, will succeed in this session.

Cammack’s FRESH act was introduced on April 22^nd in draft version. Another Republican, Julia Letlow from Louisiana, an avowed MAHA mom, introduced her own FRESH Act on April 29^th. Representative Letlow’s bill, H.R. 8578, the Food Reform for Effective and Sustainable Health Act of 2026 does just two things. This FRESH Act makes the new inverted pyramid Dietary Guidelines into law, and it requires each new Dietary Guidelines to be approved by a new law in Congress. Letlow’s proposal is not as horrible as Cammack’s law, but it isn’t good. It inserts Congress into a supposedly scientific process that is already thoroughly corrupted by politics.

Cammack’s aberration is the story, but I mention Letlow’s bad idea because it seemed to me far too unlikely to have two Republican nutrition proposals named the FRESH Act coincidentally introduced in the House seven days apart. Perhaps it is just an attractive name for a bill. There was yet a different nutrition-oriented FRESH Act introduced last year.

Maybe I’m just overly suspicious of what goes on in Congress these days, but it seems plausible that the name of Letlow’s bill is meant to be confused and amplified by the anti-MAHA FRESH Act introduced by fellow House Republican Cammack. Letlow is strongly aligned with MAHA and RFK, Jr. and is the deep underdog in a fight for the Senate seat of Louisiana’s incumbent Senator Bill Cassidy. Cassidy, a pro-vaccine physician, is seen as a traitor by Trump and MAHA for torpedoing Trump’s nominee for Surgeon General, MAHA darling Casey Means. With her FRESH Act, Letlow could be undercutting Cammack’s bill and gathering MAHA energy and attention in her Senate fight. Neither FRESH Act is good for public health and science, so another crack in the anti-science, anti-public-health Republican Party is okay from my perspective as a public health scientist.

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Meanwhile, a year ago RFK, Jr. directed the Health and Human Services Department to begin a rule-making process to close the GRAS loophole through which the ultraprocessed food industry has self-certified as safe thousands of chemicals – without providing the FDA or the public any information. However, experts have doubts that Kennedy’s rule-making will be able to circumvent congressional involvement and, in the end, changing GRAS will require a law.

At least RFK, Jr. is acting and some members of Congress have moved to address the GRAS mess. It is an uphill battle against the ultraprocessed food lobby, the biggest in Washington.

The ultimate problem with any proposed solution is that the FDA is and always has been underfunded, and the already inadequate staffing has been slashed by Trump. These cuts are badly affecting food safety in all areas, not just additives. One estimate of the cost of establishing the safety of a food additive is 2.5 to 5 million dollars and thousands of substances have already been introduced which have no published safety evidence.

An obvious solution is to put the cost of this proof on the manufacturers who would profit. If this means we have a much reduced number of food additives, we should consider the effects of that on an individual basis. We humans coped without these added chemicals in our food for thousands of years. We now have the science to create these complex substances, but we should also use our science to truly understand the health effects of these additives and newly imagined foodstuffs before we sell them.

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…the survival of the country, as well as its democracy, depends on the health of its citizens. The shocking number of our young men who cannot meet the … physical requirements of our armed services must make each of us ask the reasons for this reservoir of ill health in the midst of such a varied and abundant food supply.

It wasn’t Abe Lincoln with regard to the Union forces or Franklin Roosevelt at the outset of World War II, although it very much applied then. Nor was it Robert F. Kennedy, Jr. in his run for the presidency.

The quote above is from U.S. Representative James Delaney in 1951, the year following the start of Delaney’s House Select Committee’s years long investigation into the glaring lack of safety in food additives.

Delaney is known today for giving us the Generally Recognized As Safe, or GRAS, system of food additive safety assurance or, most would say, lack of assurance. But Delaney’s words sound as though they came from the lips of RFK, Jr. And what Delaney told us was bad in 1951 is still bad, 75 years later.

The congressman, increasingly alarmed about what his Committee was finding, wanted to spread the word to the public and build support for a battle with the increasingly powerful food industry. He wrote an article for American Magazine with scary, but not exaggerated, examples of the public at risk from toxic food additives and unregulated pesticides and of the food industry’s eagerness to capitalize on preferences of the human palate while ignoring nutritional needs. The congressman’s condemnation of the food additive practices of the industry, the lack of regulatory oversight, and the sad nature of the food environment as a whole, could have been written today.

The date I give for the start of the ultraprocessed food era is 1953. Somewhat arbitrary, but it marks the introduction of Swanson TV dinners, Kraft Cheez Whiz, frozen French fries, Tony the Tiger and Frosted Flakes, and McDonald’s franchises. Delaney’s article provides context for that moment and deepens our understanding of the history of today’s food environment and the rise of ultraprocessed food.

First, Delaney told about a peach packer who learned that adding a little of the industrial chemical thiourea would keep his peaches perfect, so he treated a shipment and sent them off. A fellow packer decided to try the same trick except, fortunately, had FDA inspectors test the thiourea first. The rats who were fed it died. When, by lucky chance, the inspectors learned of the first packer’s shipment, a frantic race to find and recall the peaches followed. Fortunately, they were all recovered before any were eaten.

Also in the late 1940s, lithium chloride was put on the market as a salt substitute for people on low-salt diets. Little safety testing had been done, and three people died before the lithium chloride was withdrawn.

Delaney goes on to rail against the national distribution of beer sterilized with poisonous hydrofluoric acid by a Massachusetts brewery and an Indiana manufacturer substituting butter with yellow-colored mineral oil labeled “edible fat” in popcorn sold all over the U.S. The mineral oil was found to be eliminating all the fat-soluble vitamins from people, many of them children, and causing vitamin deficiencies.

Delaney wrote that chickens (and later it was sheep, pigs, and cattle, too) were being treated with a new hormone called “stilbrestrol” to make them fat and faster growing. Then, despite the FDA’s oversight of pharmaceuticals, stilbrestrol was given to pregnant women, to prevent miscarriage and premature birth, up until 1971, when the practice was stopped because stilbrestrol is a strong carcinogen and causes infertility.

Delaney’s list went on. Many chemicals had been newly added to foods in the 1940s. For example, there was a shortage of shortening in 1947, and bread makers began to add emulsifiers and other substances, cutting the amount of shortening by 50% and making the bread softer. 10 million pounds of chemicals like polyoxyethylenes such as Polysorbate-60 were sold to bakers in America in 1949. Delaney was concerned about adding all these untested additives, but he also asked the simple question, ‘Why make the bread white and take out the nutrients?’ That was some far too uncommon common sense for the 1950s.

Delaney saw the increased role of soft drinks like Coca-Cola in our diet and worried about the phosphoric acid in it, citing U.S. Navy research that human tooth enamel is dissolved in 24 hours by phosphoric acid. That story seems like it is out of the way-back-machine, but 75 years later Coke still contains phosphoric acid as a main ingredient and great-grandchildren who inherited the practices of the dentists of 1951 are still filling cavities of people who drink Coke.

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And Delaney worried about the explosion of new pesticides, including the highly toxic chlordane, finally banned in 1988, and DDT. The congressman was concerned DDT was being found in high quantities in meat in supermarkets. Soon, DDT was found stored in the fat of almost all Americans.

From a nutritional standpoint, Delaney could be a golden hero of the MAHA movement. In 1951, the Korean War had started, and the congressman decried the state of our food environment as the cause of so many American men being physically unfit for military service, words echoed today by RFK, Jr., who wasn’t born when Delaney said it. The congressman even wondered if the increased number of people with mental illness was related to the new chemicals in the food supply, far before RFK, Jr. gave voice to that concern.

In my next post, I’ll discuss how Delaney found it hard to translate into law his clear vision of what needed to be done to fix the American food environment. It wasn’t until 1958 that the Delaney Act, officially the Food Additives Amendment to 1938’s ineffectual Food, Drug, and Cosmetic Act, was passed. The Delaney Act made advances in food safety, but industry lobbying created a giant loophole to allow thousands of chemicals - for which the public has no safety information - into the food supply. Nutrition scientists and food safety advocates have long complained about the Generally Recognized As Safe, or GRAS system, in which the ultraprocessed food industry largely self-certifies the safety of food additives. It is in RFK Jr.’s hands to try to close that loophole. However, a law, the FRESH Act, to reform the GRAS system, has been introduced in Congress by a House Republican — but the FRESH Act grossly reforms GRAS to the favor of the ultraprocessed food industry. We’ll see what happens, but first we’ll discuss it next time.

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Yes, I know it is Eating in America, not “Smoking in America”, but today’s news is important, and I had to cover it, given the conclusion this week of EiA’s four-part series on cannabis. Think of this as a little bonus, since I already wrote this post for the Notes social media-ish stream of Substack. (If you are not familiar with Notes, you can find EiA’s Notes collection on the website EatingInAmerica.co. Many of my Notes extend or synopsize EiA posts and podcasts and there are thousands of worthwhile Notes from other authors.)

Cannabis has been reclassified today to a Schedule III drug for medical purposes. The Drug Enforcement Administration within the Department of Justice made the change, presumably on the basis of a scientific finding from RFK, Jr.’s Department of Health and Human Services. All of this avoids the further exasperation of Donald Trump, who expressed frustration a few days ago that the rescheduling had not yet occurred after he had ordered it in December.

From the public health perspective, the two major benefits of reclassification are the greater ease of doing medical research on a Schedule III substance and the potential for the FDA to regulate cannabis products. The direct health benefits of national regulation could be huge.

Today’s ultra-high potency products are linked to increased health risks including cannabis use disorder, cannabis hyperemesis syndrome, and psychosis. Any national regulation at this moment would apply only to medical uses, since recreational cannabis will remain fully illegal in federal law. However, according to Reuters, the Department of Justice has scheduled hearings to begin June 29 with the aim of reclassifying cannabis for all purposes.

Too bad Trump rescheduled cannabis for medical purposes without first putting together a coordinated program of research and FDA regulation, but as usual he appears to be acting in response to personal appeals and the widespread opinion of potential voters, and not from a public benefit (health and safety, in this case) perspective. If, following the hearing process beginning in June, recreational cannabis is reclassified, that is another moment the administration could embrace setting up national regulation of cannabis and pumping up the research.

However, stocks for cannabis-related companies rose sharply yesterday with leaked word of the rescheduling. A windfall of tax savings will occur as medical dispensaries will, for the first time, be able to take tax deductions for their expenses, including rent and payroll. The cannabis business is likely to be suddenly much more profitable.

A portion of those profits are certain to appear in increased lobbying power in Washington, D.C., almost certainly fighting against needed national regulations, like potency caps, that could help reduce the risk of harms such as cannabis use disorder. Following the tobacco, opioid, and ultraprocessed food playbooks, Big Cannabis is likely to fight hard and with lots of cash lubrication against regulatory control of qualities of its product, like high potency, which are linked to the tendency of frequent users to use even more frequently than they might want.

Rescheduling and any other step to federal legalization offers an opportunity to provide a carefully designed, scientifically-based policy framework for cannabis’s place in our society, including limits on product potency along with testing, labeling, and safety requirements. A smart strategy, one that has been tested country-wide in Uruguay, is to allow a reduced-risk level of cannabis potency that is still satisfying to recreational users, with the goal of displacing cannabis sourced from criminal enterprises in favor of standardized and more trustworthy products from legal dispensaries and pharmacies.

From my public health point of view, national cannabis legalization for both recreational and medical use is a step I hope will happen, but only in coordination with ample support of rigorous research and a well-designed and closely monitored program of regulation based on that research.

Thanks for reading. I would love to read your thoughts, opinions, and experiences, if you care to share.

There’s more on the interesting and unfolding story of cannabis in America with my new four-part series on the subject on Eating In America.

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This week Eating in America has ventured out the kitchen door to the living room to explore something that might be on the coffee table of 44 million Americans in the last month. That is to say, cannabis.

Cannabis has become widely legal but also highly potent, and regulations are loose and vary by jurisdiction. Enforcement is sometimes loose. There is increasingly good evidence about the risks of cannabis use while at the same time it has become highly accepted as a mostly safe part of our recreational landscape, joining alcohol in that regard. It is also felt by millions of Americans to provide medical benefit that is mostly not available to them from the traditional medical system.

What should be medical cannabis look like going forward when each state that has medicalized it has a different system? How big is the money around cannabis today, and how is that influencing policy and public perceptions? And what are some policy changes that would help address safety and public health issues while aligning cannabis use and regulation with both science and public attitudes?

And what role does the continuing black market play as regulations are created and refined?

POTENCY

Higher levels of potency are linked to higher rates of cannabis use disorder, where an individual’s control over use begins to slip while some facet of life – health, relationships, work - is being negatively affected.

Growing technique boosted black market cannabis strength from 2% THC content, THC being the high-producing chemical in cannabis, in the 1960s to 17% by 2017. But it was the legalization of recreational cannabis in 24 states and Washington D.C. that spurred the creation of ultraprocessed cannabis now available in legal dispensaries and on the gray market. Extracted cannabis products in dispensaries are on offer at THC levels above 90%.

With legality has come not only potency but big money, with an estimated market of $47 billion in sales in 2026. Has the big money in cannabis found Big Tobacco’s playbook? Have they studied the page about encouraging the addictive effects of their products yet not acknowledging them? The gray market producers of high-level THC products made from low-THC hemp, a $24 billion industry, have taken advantage of the lack of age restrictions for hemp products and are blatantly marketing to minors, packaging THC-infused candy and treats in child-friendly packages. Getting them while young was an important chapter in the Big Tobacco playbook.

In the 1980s Big Tobacco acquired the ultraprocessed food companies General Mills, Kraft, and Nabisco and brought their playbook with them. The main premise of ultraprocessed food is hyperpalatability, the sense that a food is so good it is hard to stop eating. Addictive qualities and the targeting of children have been key to making ultraprocessed food a $2 trillion dollar industry.

The federal government joined with the states in the public health effort to control tobacco and together they have had great success reducing smoking rates. There remains much more to be done, and we can’t tolerate any more U.S. Surgeon General nominees like Casey Means, who owned stock in Big Tobacco.

But a framework in which ultraprocessed food could be limited has begun to be constructed, although controlling a $2 trillion dollar industry will demand a prioritization of public health that administrations so far have not been able to make.

The federal government’s position with Big Cannabis is actually better than it was with tobacco or ultraprocessed food. Cannabis is still illegal at the federal level. Loosening the cannabis law to a level of tight regulation will be easier than creating restrictions on largely unregulated markets, as was the case with tobacco and will hopefully be the case with ultraprocessed food.

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Here are seven recommendations for federal cannabis policy.

Acknowledging that recreational cannabis use can be safe and is widely popular and that medical cannabis is regarded as uniquely beneficial by patients who use it, a public health first approach would call for, minimally:

1. Copious support for research into all aspects of cannabis use, including medical use for physical and mental health conditions.

2. Legalization and full regulation at the federal level, including strict product testing for contaminants and chemical components and full labeling of those components. Regulation would cover both recreational and medical products.

3. A minimum federal age requirement and safety labeling that would align with the development of scientific evidence about brain development concerns as it becomes available.

4. Federal marketing regulation that would require front of package safety labeling, forbid packaging that targets youth, and forbid health claims that are not fully supported by scientific evidence.

5. Creation of a window for transition of medical cannabis from state licensed dispensaries to pharmacies, with federal approval of the efficacy of a product allowing insurance coverage and lowered prices for patients.

6. Adherence to the November 2026 federal deadline to ban manufacturing and sale of hemp-based products with more than a non-intoxicating level of THC.

7. Critically, the setting of maximum strength levels across all types of cannabis products. These potency caps would need to be set at a conservative level until research could prove equivalent safety in higher dose products – or at least provide reliable estimates of increased risk with increased doses upon which to decide ultimate cap levels.

On this last point, researchers have proposed the need for potency caps, and others, including recently the New York Times Editorial Board, have proposed cannabis taxation based on product strength. In the same way as whiskey is taxed more than beer, products with higher concentrations of THC would be taxed more than lower THC products.

Tiered taxation might be warranted but only if done in combination with caps. It would be irresponsible to allow continued sales of THC concentrations that exceed amounts required for enjoyment by most people. Putting a government stamp of approval on high-doses is not in the public interest. Just as alcohol consumers can drink themselves into inebriation, so can cannabis users continue to consume cannabis until reaching a state of mind (or lack of it) equal to that reached more quickly with high-potency cannabis. They would still have the freedom to take that risk.

The result of implementing these measures would be a cannabis landscape somewhat similar to that for alcohol sales. Standards would be set at the federal level and licensing and most enforcement would remain at the local level. Taxation would occur at both the federal and state level, as with alcohol.

THE BLACK MARKET

The continued activity everywhere of the black or illicit market for cannabis is an important consideration in setting regulatory standards in a legalized environment.

Canada had good success in reducing illegal sales, which by 2023 had dropped from 88% to 24% of total sales in the five years following recreational legalization in 2018. (It’s noteworthy that along with recreational legalization, medical sales in Canada decreased from 12% to 4% of total sales.)

In 2014 Uruguay became the first country to legalize cannabis, taking an approach that allowed cannabis clubs that could grow their own, home growing, and pharmacy sales of state-controlled and -priced product.

Initially the illicit, organized crime-controlled market in Uruguay remained dominant because of overly strict regulations for legal cannabis that included limiting THC levels to just 3%. To increase uptake of the government produced cannabis sold in pharmacies, maximum allowed THC levels were increased to 9%, then 15%, and currently 20%. The organized crime-controlled market is now only 7% of the total, although a gray market of distribution from home growers is estimated at 30% of the market.

Uruguay seems to demonstrate a model where potency caps can be put in place while keeping the least safe black market purchases, those from criminal enterprises, small in volume.

In the U.S., the volume of black market sales in legalized states varies, influenced by state taxes and regulations and local conditions. California is repeatedly mentioned as a state with significant black market and unlicensed retailer sales.

THE CREATION OF BIG CANNABIS

The political and countercultural revolution of the 1960s was the turning point for wide acceptance of cannabis in America. The advocacy group NORML was formed in 1970, and the call for legalization began and continued unabated with the work of activists and the funding of various pro-cannabis organizations and efforts by benevolent donors.

With the beginning of recreational legalization in 2012, corporate money took over the funding of activists and has also paid for political lobbyists. Large donations to legislators began to correspond closely to “yes” votes for legalization. Congressional efforts to legalize cannabis in 2021 attracted $4 million in lobbying by the cannabis industry and large expenditures by Big Tobacco and beer manufacturers.

The cannabis industry might exceed hundreds of billions of dollars in sales in the next decade. Just as with the explosion of ultraprocessed food beginning in the 1970s, the prospect of large cannabis profits has unleashed intense lobbying, in the case of cannabis for legalization and relaxed regulation.

The regulatory position of the cannabis industry is strengthened by the happiness of recreational use states which are enjoying the large cannabis tax revenues they are collecting: $4.4 billion in 2024, for example. In 2021, in 11 states with legal cannabis sales, cannabis taxes brought in more revenue than alcohol taxes by 20%.

As legalization pushes forward and the need for greatly increased regulation becomes more apparent, the flow of billions of dollars in sales and tax revenues will tend to make further increasing revenue a priority for states and a continued number one priority for the cannabis industry. Public health concerns will need active voices and strong defending.

That’s the conclusion of our series “Ultraprocessed Cannabis: Potency, Policy, and Public Health in America.” You can find the first three articles in the series at EatingInAmerica.co.

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Usually Eating in America is about what we eat and what people like RFK, Jr. are doing or not doing to make it healthy. But EiA is near the end of four-part series on cannabis, something Kennedy and Trump could help make less of a threat to health, and today we touch on another big failure of Kennedy and the current administration, this time with regard to a smokable substance with strongly negative health effects: tobacco.

Look for the final part of my cannabis series in two days, on April 21. We get into black market cannabis, the effect of big money in cannabis, and policy ideas to move forward balancing public health and public opinion.

First, the smoking gun.

A lot has been going on with Trump, RFK, Jr., and public health in America since the new administration began last year, so it went somewhat unnoticed that in April’s decimation of the CDC, all 120 Office on Smoking and Health staff were fired. The federal government has effectively ended its effort to prevent initiation to tobacco and reduce use.

Meanwhile, nearly a half-million Americans continue to die annually from tobacco use.

The obliterated Office had been formed in 1978 and has led effective national anti-smoking campaigns, written the Surgeons General’s many reports on tobacco, and run and analyzed the annual National Youth Tobacco Survey, a key tool to monitor smoking among adolescents and older youths. The Surgeons General’s reports had to be restored to public access by court order but are now deep-sixed in an archive, including the last one, 2024’s “Eliminating Tobacco-Related Disease and Death: Addressing Disparities.”

Fortunately, the National Youth Tobacco Survey data from 2025 has been released by the FDA, although without comment or analysis that was usually provided by the Office of Smoking and Health.

Statnews reported that former Office of Smoking and Health Director Tim McAfee called the closing of the office “the greatest gift to the tobacco industry in the last half century.”

Foundayo

Good news in the world of GLP-1s, the new daily orforglipron pill from Eli Lilly got very fast fast-track approval on April 1 from the FDA. Eli Lilly, confident that their application would be approved, had started manufacturing the drug months ago, and it is already available for purchase.

The pill, brand name Foundayo, can be taken without regard for time of day and with or without food. The other new GLP-1 pill, Novo Nordisk’s Wegovy, must be taken first thing in the morning a half-hour before consuming anything. For those of us who cannot cope with waiting 30 minutes for their first cup of coffee, that might be a deal breaker.

The Wegovy pill became available in January. Trials showed average weight loss of 16.6% with Wegovy, about 3% more than the average loss achieved with Foundayo. Side effects are typical of GLP-1s with both pills, but the effect profiles may be better with the Wegovy. Their head-to-head costs are competitive and somewhat less expensive than the injectable version of Wegovy or Eli Lilly’s Zepbound.

Both manufacturers are optimistic about uptake on their pills. There is speculation that the pills might work out as a weight maintenance option for many people who create their weight loss with an injectable Wegovy or Zepbound regimen for some months or years but would prefer to take pills for lifelong maintenance of the weight loss.

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The Gorske dilemma

When I was a young man and beginning to collect random ideas about healthy eating, NPR played a story in which a farmer declared he was a vigorous 98 years old and had eaten bacon every day of his life. I was happy to realize eating fried, fatty, salted pork would not automatically result in my death warrant going out to the grim reaper.

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Eating in America is typically about what’s on our plate: what we’re eating. However, in this series we’re examining something that is not on everybody’s plate but was consumed by 44 million Americans in the last month. Cannabis is very much “in the air” these days, so to speak, especially if you live in a state where it is decriminalized and the smell of cannabis is easily found on the streets.

Cannabis use is not unrelated to our consumption of food and to the food environment. The pleasure people find in cannabis taps into the dopamine pathways in our brain that help us choose what to eat. And the parallels to alcohol use are often pointed out.

On Eating in America, we talk a lot about how ultraprocessed food has taken over our food environment. Has ultraprocessed cannabis taken over its world?

THC levels in cannabis have exploded in the last 25 years, going from around 5% in illegal cannabis in the 1970s to over 90% for some legal products in today’s recreational dispensaries. Cannabis use disorder is growing along with the potency of products, and research is clarifying that some claims of benefits don’t hold up. Instead, a number of risks are being confirmed.

The status of alcohol has often been used as a reference point when discussing cannabis legalization and regulation. While there are natural parallels between alcohol and cannabis distribution and consumption in our culture, there are important differences. On the one hand, alcohol and cannabis are the two recreational substances that are consumed in significant amounts by large percentages of our population. They are both, for the most part, widely available for purchase at prices that most people can afford.

However, their effects on the body and mind are very different. Because of its long status as a legal substance, the risks associated with alcohol have been much more researched than the risks associated with cannabis. For example, we now know a heightened risk of cancer begins with the consumption of any alcohol. The World Health Organization and the 2020 U.S. Dietary Guidelines Scientific Advisory Committee are among the groups who have found that the only safe level of alcohol consumption is zero.

While far too little research has been done on cannabis with regard to biological safety, research has begun to make clear that there is not much benefit for the mental health conditions for which cannabis is often recommended and good evidence of mental health risks.

A new review published in The Lancet analyzed existing randomized controlled trials, the gold standard of cause-and-effect research, and found no difference in outcome with cannabis treatment for anxiety, anorexia, psychotic disorders, PTSD, and opioid use disorder. Cannabinoids in cannabis actually increased cravings in those with cocaine use disorder.

The Lancet review did find some evidence that cannabis “can reduce symptoms of … insomnia, tic or Tourette’s, and autism spectrum disorder.” There was insufficient or no data to make conclusions about other mental health conditions like ADHD, bipolar disorder, and depression.

While evidence of the mental health benefits of cannabis is limited to a few conditions, the evidence has been mounting about mental health risks. A new Journal of the American Medical Association Internal Medicine review finds cannabis linked to psychosis, cannabis use disorder, and self-harm in adolescents with mood disorders. However, the JAMA review did find some evidence that the main non-psychoactive chemical in cannabis, CBD, by itself, without THC, the part of cannabis that is psychoactive, might help relieve anxiety, although more research is needed.

THE ALCOHOL COMPARISON

Alcohol is highly regulated at a national level and cannabis is not well-regulated. The amounts of alcohol in a product are clear and well-understood by consumers. While alcohol percentages are not regulated, for fermented products like beer and wine, they are controlled by the biology of yeast, and for distilled products like hard liquor and brandy, they are controlled by manufacturers adhering to convention and optimizing taste.

On the fully natural to ultraprocessed spectrum, the process of distilling fermented grains or grapes puts hard liquors and brandy in the processed category of consumables. Beer and wine, the precursors of whiskey and brandy, are lightly processed.

There are always trends in alcoholic beverages, but, as a consumable substance, the field as a whole is mature.

ULTRA-POTENT AND ULTRAPROCESSED

In contrast, cannabis products now sold on the black market, in medical dispensaries, and particularly in recreational dispensaries, are very far removed from the relatively low-powered cannabis used by the Chinese in 2,700 BC and in the hippie world of Haight-Ashbury in the 1960s. But in the 70s, a steep upward curve of potency began as a Mexican drug gang in Sinaloa, soon to be a cartel, discovered that isolating the unpollinated female cannabis plant, called sinsemilla, tripled cannabis THC levels, from 2% to 6%.

Due to breeding, cloning, and cultivation innovations, THC contents of black market cannabis rose further to 17% on average, by 2017.

New products, some found in dispensaries and some, avoiding regulation and law, found on the gray market in gas stations and convenience stores, have further increased potency using THC extraction and concentration methods employing solvents. THC levels for dispensary products can be 90% or more. Some solvents used for extraction are toxic, and incomplete residue removal in substandard manufacturing processes might pose a risk to consumers.

With extraction methods creating new ultra-high potency levels, cannabis has entered the era of the ultraprocessed.

Ultraprocessed gray market gummies and other products with intoxicating levels of THC are a particular concern. In 2018 Congress deregulated hemp, or cannabis without an intoxicating amount of THC. The intent was to allow hemp-based products containing CBD to be sold without regulation. However, the law did not forbid the conversion of the CBD in hemp into THC through chemical processing.

Soon colorful bags of candies and treats with high levels of THC were showing up in gas stations, convenience stores, and smoke shops. Some of these products were packaged to closely mimic popular brands like Frito-Lays and Cheetos or children’s gummies. With no age restrictions, or restrictions of any kind, reports began to come in of children hallucinating at school.

Colorful cans of beverages containing THC-derived from hemp have become popular outside of dispensaries, often being used as a substitute for alcoholic drinks. The THC in beverage products has a quick effect compared to edible products like gummies, although not as quick as smoked cannabis.

A handful of states banned all hemp products containing THC and last November Congress inserted a provision into the legislation that reopened the government. The law will limit the THC content in hemp products and ban the conversion of CBD into THC. The law gave the $28 billion hemp products industry a year before the restrictions go active this coming November, but lawmakers are proposing a one year extension. Meanwhile, the regulated cannabis industry has been lobbying for the restrictions to protect their businesses. Meanwhile, THC candies and snacks remain on shelves in many jurisdictions in states like Massachusetts without any restrictions or enforcement against purchase by minors.

Both cultivation practices and chemical extraction have greatly increased the potency of cannabis. And there is now good evidence that higher potency cannabis is associated with increased risk of psychosis and cannabis use disorder.

Ironically, with the reality of psychosis risk with today’s high potency cannabis, a dose of truth has been bestowed on 1937’s laughable propaganda film “Reefer Madness,” although it seems to me unlikely that there were a large number of cases of psychosis with the low potency cannabis of almost a hundred years ago when “Reefer Madness” was being made.

There is cannabis madness today in that there is far too little cannabis science and far too little regulation. As a result, we have a chaotic landscape of cannabis sales, quality, and use. This shouldn’t be the case. Alcohol has been an important point of comparison when the loosening of laws and regulations has been argued for cannabis. However, the marketing, sale, and quality of alcohol is very well-defined, and its use is not confused by dual systems of lightly regulated recreational and medicinal alcohol.

On the other hand, the cannabis sanity is in the wide recognition that the fun, stupefying, euphoric, or calming effects of cannabis aren’t a threat to our communities and that, as with the risks associated with alcohol, the risks of cannabis consumption can be reasonably weighed by adults for themselves. But, going forward, the science and regulation deficits have to be fixed.

Thank you for reading. In Part Four of “Ultraprocessed Cannabis: Potency, Policy, And Public Health In America,” we check on the continued black market in cannabis, look at how big money in cannabis has become a powerful influence, and propose seven policy and regulation recommendations to bring the public’s comfort with cannabis together with public health moving forward.

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In Part One of this series, we have a look at the surprising history of cannabis in America. Did you know the Puritans brought it here, and by law they had to raise it because it was so valuable for hemp fiber to make rope and sails? We also discuss medical cannabis, cannabis use disorder, and the increased appearance in emergency rooms of people with uncontrollable vomiting and screaming stomach pain from too much cannabis, in Part Two.

You can find all that at EatingInAmerica.co.

What are your thoughts and experiences with cannabis, unregulated hemp-based THC products, and the way forward? Please share your comments! Your support for this post and podcast are appreciated. Peace.

Cannabis was legal in America well into the 20^th century and medical cannabis products were manufactured by pharmaceutical companies and widely prescribed and used. Of course, it’s important to keep in mind that this was before modern medicine: before aspirin even.

Thirty years after medical cannabis was first re-legalized in California in 1996, what is the role of medical cannabis today?

The flip side of cannabis as a medical or mental health treatment is when cannabis use is disruptive, harmful, and risky. What is cannabis use disorder, and is today’s increase in cannabis use disorder related to the potency of cannabis now? Related to this, which is greater: the number of people who drink alcohol almost daily or the number of people who use cannabis almost daily?

Cannabis became common in American medicine beginning in 1840 when knowledge of medical uses was brought from India, but medical beliefs and practice around cannabis began to turn in the 20^th century. In 1915 California became the first state to make cannabis illegal. Of course, always the eager trendsetter, California was also first to reverse course and re-legalize cannabis for medical purposes in 1996.

Medical re-legalization pulled some people away from black market cannabis, allowed professional medical supervision of cannabis treatment, and added to the number of products tailored or specified for treatment of conditions including cancer, chronic pain, multiple sclerosis, nausea, vomiting, epilepsy, PTSD, and arthritis.

Now, patients seeking cannabis help in the 40 states with comprehensive medical cannabis programs, along with the District of Columbia and Puerto Rico, can have their need certified by a doctor and then usually pay a fee for a state medical card. Today, around 3 million patients are certified for medical cannabis purchases or home-cultivation.

Medical cannabis programs have requirements for lab testing, which increases safety and standardization of doses for patients and lets patients avoid the unknowns of black market cannabis. However, widely varying methodology between labs and cherry-picking of samples submitted to labs have sometimes made test results unreliable and variable according to the lab, putting patients at risk of misdosing. State regulatory oversight has increased over time, but it remains uncertain whether medical cannabis is well-tested for impurities and the cannabinoid content well-quantified at all times in every jurisdiction.

Nonetheless, medical dispensaries provide relative safety assurance compared to the black market, where pesticide, heavy metal, and fungal contamination is untested and deliberate adulteration of cannabis with dangerous substances such as fentanyl sometimes occurs.

Yet cannabis in a medical dispensary is lightly regulated compared to federally regulated pharmaceuticals. For example, all non-prescription over-the-counter drugs, such as pain relievers and cold medicine, must conform to strict standards published by the FDA. We are far from that with medical cannabis.

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THE ECONOMICS OF MEDICAL CANNABIS

Most medical cannabis is not taxed, while recreational cannabis is heavily taxed in some states. However, most patients seeking cannabis face fees for a doctor’s certification and for the state medical card.

Medical cannabis patients are more frequently low-income and tend to be older and in worse health compared to recreational users. Perhaps this has to do partly with the more limited access these groups have to traditional medical care.

Medical dispensaries risk losing customers to recreational dispensaries in states with both, while paying higher operating costs. While some states with recreational cannabis continue to see increases in the number of medical patients, it may be that more dual-licensing states have a decreasing number of medical patients. However, patients typically don’t find specialized cannabis formulations to treat their chronic conditions in recreational dispensaries, which tend to focus on products with high levels of the psychoactive ingredient, THC, the part that makes users high. Products for medical purposes usually have lower THC doses and, often, high ratios of CBD, a non-psychoactive ingredient, to THC.

CANNABIS USE DISORDER

This substance use disorder is defined with 11 criteria that include craving, unsuccessful effort to cut down, and interference with work or relationships. Meeting two or three of these 11 criteria constitutes a mild case of cannabis use disorder and having six or more is a severe case. In 2024, 7% of Americans 12 and up, that is 21 million people, had cannabis use disorder of some severity. Within those numbers, 5% of adolescents and 16% of young adults had cannabis use disorder. That’s 1.2 million kids age 12 to 17 and 5.5 million adults age 18 to 25.

Related to cannabis use disorder, the number of people who use cannabis on a daily or near daily basis has been climbing rapidly over the last 20 years, and in 2022 the number of frequent users of cannabis surpassed the number of frequent users of alcohol in America. In the same way that near daily use of alcohol has a statistical association with alcohol use disorder, so does near daily use of cannabis have a statistical association with cannabis use disorder. I find the rapid increase in near daily use of cannabis worrying.

The reason that there are now more people who use cannabis near daily compared to those who drink near daily is unknown. I have seen that the 2024 study that reported the increased near daily use did not take into account that medical use of cannabis is frequently on a daily or near daily basis (42% in one study), which would tend to increase the reported overall number of daily or near daily cannabis consumers.

Decriminalization of cannabis is, of course, likely the biggest contributor to the increase of near daily use, but it’s concerning that frequent use has been found to be associated with the use of stronger cannabis at the individual level.

Both frequent use and stronger cannabis are related to Cannabis Hyperemesis Syndrome, or CHS. Emergency room visits for CHS have risen in the last 10 years. CHS presents in the emergency department as severe nausea, cyclic vomiting, and very bad stomach pain, conditions that can continue up to a week.

Some people might have heard a frequently cited estimate of how common CHS is. That estimate is a large number, but, to me, the methodology for making the estimate is very suspect, so I won’t quote it. But, even if on further research the risk turns out to be relatively small, for those who get it, CHS is very, very not fun.

Despite cannabis still being listed as a Federal Schedule 1 drug with no accepted medical use, like heroin and LSD, the FDA has approved four THC- or CBD-based drugs. These are for the treatment of nausea from chemotherapy, anorexia, and seizures from two rare forms of epilepsy. The FDA seems to have an encouraging posture towards applications for additional cannabis-based medicines.

Alcohol and cannabis are both used by many people to self-medicate. That is unlikely to ever stop. While there is often a difference between what makes people feel better and what science says is the most effective treatment to make them better, there is a validity to both perspectives. After all, even placebos without any biologically active ingredient can be effective. If a benefit is perceived, a benefit is received.

Why, what, and how we eat is all about our neurological reward circuits, the dopamine pathways that control so much of what we do. These are the channels tapped, to our detriment, by the designers of ultraprocessed food. They are also the paths that lead to pleasure when we drink, smoke a cigarette, or eat a weed gummy.

In this four-part series I’m going to expand the scope of Eating In America a little bit and look at one of the non-food items consumed by 44 million Americans in the last month: cannabis.

We begin with a surprising history of ye olde cannabis.

It was the Puritans and ye other olde colonists from England that brought cannabis, otherwise known as hemp, to America. It was so valuable for making rope, sails, and clothing, hemp was used as currency. Jamestown was growing it from the start in 1607, and in a while the Virginia, Massachusetts, and Connecticut colonies passed laws that farmers had to grow it. Yes, it was illegal not to grow cannabis, although the cannabis strains in question were industrial hemp, bred for fiber without enough THC content for intoxication.

Medicinal use of cannabis began in the 1840s and became very common and widespread. Cannabis was in many medicines, including tonics, tinctures, and extracts. Parke-Davis, one of the world’s largest pharmaceutical companies, was among the drug manufacturers producing cannabis products.

The weight of medical opinion began to turn against cannabis in the late 1800s. In 1915, California, always ahead of the times, was the first state to make recreational cannabis illegal. Ironically, later in the century California was the first state to make cannabis legal again.

By 1937, 23 states had made possessing cannabis illegal, which is, with almost perfect symmetry, nearly the number of states that have re-legalized recreational cannabis today.

In 1937 Congress made cannabis illegal for the first time across America by passing the “Marihuana Tax Act.” Motivated by its own racism, Congress called the drug marijuana, its Mexican name, to promote anxiety and fear about the large number of Mexicans who had come to the U.S.

1937’s “Reefer Madness” is an outrageous anti-cannabis propaganda movie intended to stoke the building fear about cannabis. Of course, in the 1970s “Reefer Madness” was resurrected and became a cult classic: a terrible film but amusing for many when sufficiently stoned.

I’m using the term “cannabis” throughout this series instead of “marijuana” or a slang term. “Cannabis” is the scientific name for the plant and what the drug was called before the 1930s.

In Part 3 we will look at how the hemp form of cannabis has recently been exploited to make high THC content products that have been marketed to youths by unscrupulous producers outside the regulated cannabis industry.

So on to our investigation of today’s cannabis environment. Cannabis madness or long-awaited sanity? There are many questions that need addressing.

What are the dramatic changes that have occurred in cannabis itself in the last 25 years? What does the evolving legal landscape for cannabis look like in America? How chaotic is the regulatory landscape? What is the role of medical cannabis? How can and, indeed, should medical cannabis dispensaries remain a part of the landscape?

Why do more people today use cannabis on a daily or near daily basis than drink alcohol? Yes, since 2022 more people are frequent cannabis users than frequent alcohol consumers!

What are the new and increasingly dominant economics of cannabis? And what are some policy changes that would help address safety and public health issues while aligning cannabis use and regulation with both science and public attitudes?

Let’s get to sorting out the madness.

Tetrahydrocannabinols, or THC, are the psychoactive chemicals in cannabis that are the reason it is so popular as a consumable. THC content in cannabis stayed fairly level at around 5% from the 1970s into the early 2000’s. Since then average levels have climbed steeply to around 20%, a four-fold increase.

Cannabis bought on the black market today is often not as strong as that bought in a dispensary, but it can be. And there are concentrated products in dispensaries that can go over 90% THC content.

High content extracts are made using solvents. The chemicals used in producing extracts, both regulated and black or gray market, are not well identified, but solvents commonly used in making black or gray market extracts include alcohols, acetone like in nail polish remover, and toxic petroleum-based chemicals.

Safely produced or not, these extracted products are ultraprocessed, and so cannabis has joined the food we eat in the era of the ultraprocessed.

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A visit to a recreational dispensary makes evident that connoisseurs are a part of today’s cannabis culture, not dissimilar to the way connoisseurs are a part of wine culture. There is a lot to know about the psychoactive effects of various cannabis cultivars, blends, and forms of administration. While the Indica plant species label denotes a sedative effect and the Sativa species an energizing or cerebral effect, those are somewhat outdated terms, in that there are many compounds in cannabis called terpenes, each of which has a different psychoactive effect.

And then there are the 120 plus cannabinoids, the most well-known two being the psychoactive Delta-9 THC and the not-psychoactive cannabidiol, or CBD. The THC and CBD quantities are stated in products displayed in recreational dispensaries.

However, CBD will create differing effects of the THC, depending on the overall blend of compounds, the form of administration, quantities, and the consumer’s biology. For example, sometimes the high is enhanced or muted, or unwanted effects of THC, like anxiety, are reduced. To the uninitiated, trying to figure out the offerings in a dispensary and what a product will be like when consumed can be more guess work than shopping the Burgundy section at a high-end wine shop.

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So where can cannabis be bought legally today?

Cannabis is fully legal in 24 states and Washington D.C. with recreational and medical dispensaries in all of them except for Virginia, where sales will likely be allowed this year. Fifteen more states and Puerto Rico allow only medical cannabis sales, and six more states allow sales of CBD oil with a low level of THC. You will not find any kind of cannabis for legal sale or consumption in Idaho, Wyoming, Nebraska, North or South Carolina.

Most states with recreational dispensaries allow a limited amount of home growing, typically 3 to 6 plants per person. Only a few states that allow sales of cannabis solely for medical purposes also permit home cultivation.

Cannabis’s illegal status at the federal level has resulted in highly variable regulation and enforcement, ranging from inadequate to, at times, grossly inadequate, as states have legalized cannabis one by one. The patchwork quilt of regulation has two layers since essentially every state that has recreational cannabis started with medical legalization, requiring dual-levels of regulation per state for the co-existing channels of dispensing.

Estimates date the growing of Cannabis sativa to 10,000 BC, likely as a grain food and for its useful fiber. The first known medical uses are attributed to the Chinese emperor Shen Nung, around 2,700 BC. Since then, medicinal cannabis has been used and researched around the globe and widely used here in America in the 19^th century.

However, as we have seen, quoting science writer Stephanie Pain, “In the twentieth century, prescription gave way to proscription.” What was once recommended, became forbidden.

Despite cannabis’s illegal status over the last 100 years or so, Americans suffering physical or mental ailments have long sought the return of medicalized cannabis as an adjunct or alternative to federally-approved medicine or treatment.

Thank you for reading. In Part Two of “Ultraprocessed Cannabis: Potency, Policy, And Public Health In America,” we take the pulse of medical cannabis and consider the rise of cannabis use disorder.

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You’ve got a healthy weight, or you are not interested in weight loss, or at least in weight loss using available medical paths like GLP-1s or bariatric surgery – why should you care about GLP-1s?

GLP-1s are a factor in the continued fast rise in health care costs in America. If you don’t need them or take them but you have medical insurance or just pay federal taxes, you are likely still affected by the cost and popularity of GLP-1s. (I might point out that most people don’t ever have cancer, but their insurance payments help save the lives of those who do. Maybe it can be seen as a sort of actuarial scientist’s form of karma.) No matter our personal stance, GLP-1s are having an impact on the health and economic well-being of America.

I was writing today’s update on GLP-1s when I noticed a Boston Globe Editorial that mused about how the City of Boston wants to control the cost of GLP-1 medications for its employees, how that dilemma was common now across employers and insurers throughout government and industry, and what could be done to control GLP-1 pricing. The end of this podcast is what I posted in the Globe as comment both on its Editorial and the other comments of Globe readers.

Also, today, many GLP-1 questions are popping up. GLP-1s and muscle mass – worry or no worry? Stretching out the GLP-1 dose schedule when a patient’s target weight level is reached would be a great way to save money…but does it work without weight re-gain?

Also, what is happening with GLP-1 pricing, new products, and Ozempic patent expirations? And could GLP-1s really be made for only $3 a dose? There’s a lot going on.

To our questions.

If you are using or contemplating using a GLP-1 you have likely been made to worry about the fact that dieting causes loss of the soft tissue we like, such as muscles, along with loss of fatty tissue, which we don’t like. A lot of the anxiety about GLP-1 muscle loss is generated by social influencers and nutrition and conditioning hawkers. Not to worry…but do step up with the strength conditioning.

The bigger you are the more muscle you need to support and control your weight. Strength and conditioning is always important, but especially so during weight loss. And, unlike dieting, where will-power is a very poor tool for permanent results, I do recommend putting will-power into play as much as possible if strength exercises are not your thing. Improvements can be seen from workout to workout, whether in the gym or your living room. The important thing is to start and continue on a regular basis, finding as many ways to enjoy yourself and take pride in your gains as possible.

A small study has found that once some patients reach their target weight on a GLP-1 they can reduce the frequency of their doses without regaining weight. This finding is hopeful for GLP-1 patients having difficulty with the long-term cost of the medication, but much more research is needed to understand the risks and conditions required for success in any reduced dosing approach. We do know that a complete stopping of GLP-1 treatment is strongly linked to weight regain. Proceed with caution if thinking about a reduced dosage and be sure to consult your health care provider.

The Trump administration’s work to reduce GLP-1 costs is welcome but, so far, not a huge game changer. Continued pressure on pricing may come from the introduction of competing medications, but manufacturers other than Novo Nordisk and Eli Lilly have not yet made application to the FDA for any product approvals.

But there is room for improvement. A new study released in preprint found that semaglutide, the ingredient in Wegovy and Ozempic, could be sold for $12 a month in generic liquid form for injection and $36 a month in generic pill form, a dramatic savings over the cost of the Novo Nordisk brands.

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With Novo Nordisk semaglutide patents expiring this year in China, India, Brazil, Canada, Turkey and five other countries, and no patent protection in 150 other countries, theoretically by the end of this year 85% of the world’s population with the disease of obesity could be living in a country with a generic semaglutide medication available.

Meanwhile, Novo Nordisk just received fast-track approval for a high-dose form of Wegovy in a pen. The dose in Wegovy HD is three times greater than the highest dose in regular Wegovy and average weight reduction is 21%, compared to 15% with regular Wegovy.

Novo Nordisk has also just put its Wegovy pill on the market. Eli Lilly has applied on the fast track for approval for its new GLP-1 pill, Orforglipron. Unlike the Wegovy pill which must be taken on an empty stomach at least 30 minutes before eating anything, Orforglipron can be taken with or without food.

That’s a rundown of the some of the biggest news in GLP-1s.

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The following is based on my response to the Boston Globe Editorial on GLP-1 coverage for City of Boston employees. The Editorial advocated compromises that could result in some people who were already on a GLP-1 being removed from coverage for their medication. The comments featured a lot of folks who were of the mind that will-power and exercise were all that is required for weight loss.

Quote: I’m a nutritional epidemiologist and publish EatingInAmerica.co. I have studied the obesity epidemic in America, what has caused it, and the GLP-1 drugs. These highly effective medications are saving lives and reducing chronic disease, including obesity, diabetes, cardiovascular disease, kidney disease, osteoarthritis, and sleep apnea, and generally making life better for millions of Americans.

Because of the arbitrarily high prices of GLP-1 medications in America, the point at which health care savings from GLP-1s exceed their costs is somewhere in the future, requiring the decision to cover them at this moment to be based in large part on difficult estimates of the value of these medications to the quality of life of a patient.

There is still stigma on these medications because of some remaining popular belief, evidenced in many of the comments to the Boston Globe Editorial, that GLP-1s are the easy way out of unhealthy weight and that all that is required to restore a healthy weight is will-power and exercise. My personal opinion is that because of this remaining attitude it is easier for insurers and employers to restrict coverage to GLP-1s and save money.

But why are we thinking about the use of medications to control weight at all? Best would be if we could roll back the clock 50 years to the beginning of the obesity epidemic, or 60 years to when ultraprocessed food was allowed to start taking over our food environment and put strong protections in place against the making and marketing of unhealthy food.

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This post and podcast are about what’s in our food and who’s in charge of making it healthy. While RFK, Jr. and his Department of Health and Human Services are getting a lot of attention when it comes to federal action or inaction on making our food healthy, in many ways it’s the USDA, the Department of Agriculture, that’s more in charge of the healthiness of our food.

For example, the USDA is responsible for the safety and inspection of our food. The Department is a full partner with Health and Human Services in writing the Dietary Guidelines that this year famously featured the upside-down food pyramid.

But, more importantly, the 2026 USDA budget is $458 billion – nearly half of a trillion dollars. Most of that money flows to agriculture through consumers who receive food assistance like SNAP in order to put food on their tables. Folks being able to afford to eat and not go hungry is certainly a big factor in health. But also, how SNAP and the other programs allow that money to be spent in the store influences the healthiness of the food that is produced. As Jerold Mande in our interview today points out, a lot of states are now beginning to put restrictions on SNAP dollars being used to buy unhealthy products like Coca-Cola.

However, a lot of money flows through the USDA to directly support agriculture in this country, and whether that money goes to the production of fruits and vegetables that are in short supply in American diets, which it mostly doesn’t, or whether that money goes to help produce corn for ethanol, feed for cattle and pigs, or ingredients for ultraprocessed food, which are the places most of the money goes, makes a tremendous amount of difference to what our American food environment looks like.

Perhaps no one knows more about these issues and how the USDA handles them then our guest on Eating in America today, Jerold Mande.

Interview - Introduction

Jerold R. Mande is a nationally recognized expert in public health, nutrition, policy. He’s an adjunct professor of nutrition at the Harvard Chan School of Public Health and CEO of Nourish Science, an NGO dedicated to greatly increasing nutrition research, putting bite and muscle (my words) into the FDA’s regulation of food ingredients and additives, including the regulation of ultra-processed food and modernizing SNAP food assistance.

This is all towards the overarching Nourish Science mission to change the federal nutrition goal to “ensuring every child reaches age 18 at a healthy weight and in good metabolic health.”

Mande has served three presidents in senior policymaking positions at USDA, FDA, and OSHA. He has shaped nutrition, food safety, and tobacco control programs. He led the Nutrition Fact Label Design Team at FDA for George H.W. Bush.

And first but not least, Mande started his career with Al Gore in Congress, helping Gore write America’s organ donation laws.

Transcript (lightly edited for clarity)

RB: “Jerry Mande, it is such a pleasure and honor to have you on Eating in America.”

JM: “Ric, thanks for having me.”

RB: “So I get sent frequent press releases from the USDA, as I’m sure you do. And I want to save a few minutes in this discussion to get your interpretation about what’s going on with all the program and policy initiatives and media events from the USDA these days.

“But first, one of the press releases that I passed over very quickly said the USDA is closing a couple of buildings in Washington DC and Alexandria, Virginia. But that closure had a lot of meaning for you. Will you explain please Jerry, what has happened with those buildings?”

JM: “So these closures are core facilities of USDA and represent a demolishing of the culture that makes USDA such a remarkable agency, fulfilling the goal of President Lincoln, who created the agency’s mission to make it “the people’s department.”

“First, the Braddock Building in Alexandria is the home of the Food and Nutrition Service. That’s the agency within the USDA that manages 80% of the USDA budget, feeds one in four Americans each year, and houses programs such as SNAP, the Food Stamp Program, the School Meals Program, and the Women Infants and Children, or WIC, program.

“The South Building in D.C. proper is attached to the USDA main headquarters building, the Witten Building. It’s the only federal department that is actually on the mall. It’s a short walk from the White House and right next to the Washington Monument. Actually the South Building should be the headquarters building because it’s many times larger. But the headquarters is the Witten Building. It’s a beautiful building.

“The South Building when it was built in 1936 was the largest office building in America. It held that distinction until the Pentagon was built. And still today, it’s the second largest.

“So the announcement you mentioned, it doesn’t scream out that there’s a problem in getting rid of those buildings. And what they’re doing in getting rid of those buildings is moving those programs somewhere else.”

RB: “Well, it occurs to me that USDA Deputy Secretary Vaden, when he announced the closures, said Trump’s idea is to control this sprawling federal bureaucracy. But to control it, they’re actually sending it away to many far, far away places. And that seems the opposite of actually controlling sprawl!”

JM: “Just a little bit of background to help explain the impact of these closures. Earlier in my career, I worked at the Department of Health and Human Services, particularly the FDA. These were great agencies, I thought.

“And indeed, I thought that the Department of Agriculture was sort of the bad guys because of the industry influence on the issues I worked on, like food labeling, where we had to fight the USDA at every step to get the Nutrition Facts Label that we have in place today. But when I worked at HHS, something just didn’t stand out to me at all.

“The HHS, because it was cobbled together over many administrations and literally decades and decades, was scattered all across the country in different buildings and agencies. There is a big building a block off the mall. The secretary works there, but none of our agency heads work there because their agencies are scattered all across the country. I thought it was always a bit dysfunctional, and there were a lot of challenges. But I figured, this is just life in the federal government and that’s as good as it gets, I guess.

“But then in the Obama administration, I was invited to join the Department of Agriculture. And it was just this remarkable eye-opening experience that, wow, this agency operates so much better than anything I’ve ever experienced before. And it was because of the culture created by the proximity of all of the staff.”

“Secretary Vilsack, the secretary then, and all of his undersecretaries, which are the equivalent of these HHS agency heads, were literally on the same hallway in the Witten building, and all of their staff were right behind them in the big South building. As a result, we met all together, face-to-face, in-person every week. This, what I’ll call the subcabinet, and the physical proximity of all the agencies and the secretary, created just a much more effective culture.

“So the [Trump] administration is going to the HHS model: wanting to destroy the culture of the USDA and move its agencies all over.

“They began that in their first term. They ran an experiment. They took two of the smaller but important agencies at USDA, the Economic Research Service and the National Institute of Food and Agriculture, both research agencies, and decided they were going to move them to Kansas City. They did and it had the desired effect.

“People quit. People didn’t pick up and move to Kansas City. So the elite quality of those agencies was destroyed. The Biden administration tried to build them back, but they still haven’t been as strong and as effective as they had been in the past.

“The Trump administration took that lesson to heart. If you try to just get rid of an agency altogether, well, that’s up to Congress to do and people go to court and the administration loses. But they said, gee, it’s within our authority to just tell an agency they have to relocate somewhere else. If we can do it within our budget, it seems to be legal, and it’s going to have the net effect of destroying that agency, essentially.”

RB: “I think almost two thirds of the Economic Research Service just declined to move to Kansas City, as nice as Kansas City might be.”

JM: “No, they have their families, their careers, their lives in Washington. And so four years wiser and learning from their first time, the Trump administration came back and said, just move the agencies someplace different. They’ll explain it that the agencies need to be closer to the people, but you have to say “if it’s not broke, why do you?”

“So you have this extraordinary agency with a really remarkable culture that Abraham Lincoln literally put in place and that’s operated at an elite level for 150 plus years. But they came armed with a blueprint of how to demolish that, and that’s what they’ve embarked on. And that’s what these closures represent.”

RB: “Thank you for that insight and perspective. The contrast you have drawn between HHS and USDA couldn’t make things clearer.

“The other thing I wanted to look at a little bit is what’s going on with the programs. I’m a recent subscriber to the press releases from the USDA. I see a lot of program initiatives. Big ones, like $38 billion in conservation money, $12 billion in Farmer Bridge Assistance, $16 billion in Supplemental Disaster Assistance, and smaller ones, too. And then lots of media events.

“What’s going on? Am I incorrect in getting the sense that the USDA is making a push to shore up farm and ranch support in this somewhat chaotic environment for the country and agriculture and ranching?”

JM: “Well, they are trying to support our farmers, our ranchers, and should, right? We rely on only 2 % of the population to feed us all. So it’s a very important thing to do.

“But they’re actually good on the food and nutrition issues, particularly the diet quality issues that I’ve devoted my career to.

“Food and nutrition, I will divide broadly into three buckets, all equally important. Food justice has to do with making sure Americans who are poor have the support and food that they need, but also that the workers in the system are taken care of.

Then there’s diet quality, which is my issue, making sure that the food we eat helps us thrive and certainly doesn’t make us sick or cause a chronic disease. And then, climate and sustainability, agriculture plays a big role in that.

My whole career is devoted to the diet quality piece. All three buckets are large areas and equally important. I strongly support work in all of them. I just chose to work in diet and health. It’s the one that most inspires and animates me.

“This administration has been remarkable on the diet and health part of food and nutrition. They’re actually doing a great job on MAHA, Make America Healthy Again, particularly SNAP, which is something that I oversaw.

“When I was with the USDA for six years, we were trying to make changes, or at least test some changes in pilots about how SNAP could be used as a lever with big food to improve diet quality. We couldn’t get a single state pilot started. They now have 22, which is just remarkable. Twenty-two states no longer sell soda to SNAP recipients [using SNAP dollars], which I think is a great idea.

“But on the food justice side and on sustainability and climate, they’re really breaking those things. That’s not their priority, and they’re doing a poor job.

“For me, it’s challenging. There are some areas where they’re doing a really great job. The dietary guidelines they put out are a sort of a microcosm of both [the good and the bad]. They’ve said some things that just don’t follow the science. They seem to be heading down the path about eating more red meat. That really is fine. People can eat red meat, but we don’t need to eat more of it. In fact, people should eat less of it. But then at the same time, they’ve said people shouldn’t be eating ultraprocessed foods, which is great - and something a second Biden administration probably would not have said.

“So it’s a very unpredictable time and something we’re all trying to still figure out.”

RB: “Thank you so much Jerry Mande for your perspective on the direction of the USDA these days: both the favorable things that are happening and things that are still, perhaps, lacking in their direction.

“I wish we could talk forever because there’s a wealth of knowledge there and some great ideas. What’s the website for folks who want to learn more about your efforts?”

JM: “It’s NourishScience.org. And Ric, thank you for having me. I enjoyed this and if you invite me back, I promise to come.”

RB: “All right! I will do that! Thanks so much!”

RFK, Jr. has gone full publicity blitzkrieg about his success enlisting U.S. medical schools to teach more about nutrition. The Health and Human Services Department is selling it as a great victory for Kennedy’s Make America Healthy Again Movement. However, the omission of a very important item from Kennedy’s proposed nutrition curriculum topics for doctors has hit a very sensitive nerve with me today.

First, the background.

As Eating in America reported last fall, the Trump administration and the USDA have killed the annual U.S. Food Security Report. After thirty years of continual monitoring of American household food security, the final report was quietly issued, two months late, on December 30.

Over the decades, the Food Security Report has been crucial to guide food assistance programs like SNAP and to measure our progress, or lack of it, in reducing hunger in America. Most of us have never had to worry about hunger or food security, but in 2024 one in seven households, 41 million Americans, experienced food insecurity. That was measured at 13.7% of households, a little more than in 2023, but not statistically different.

In 2024, 5.4% of households had very low food security compared to 5.1% in 2023, but still not statistically different. Very low food security means sometimes being hungry, skipping a meal, or not eating for a whole day because of lack of money for food.

Children experienced food insecurity in 3.3 million households and very low food security in 318,000 households.

Why does Trump want to let the fact that hunger is still found in America be hidden? Does he not want to address it? Is he aware that his policies and actions are likely to increase food insecurity and hunger, and he would rather not see statistics proving the rise of food insecurity and hunger in adults and children?

Trump’s lack of support for SNAP benefits during last fall’s federal shutdown and his tightening of eligibility requirements make it highly likely that food security, if it were still being measured, would show a downturn and hunger an upturn in the first year of his administration.

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This masking of hunger in America reminds me how rich coffee plantation owners in Central America, where the use of enslaved people was forbidden, essentially created a system of slavery by maintaining a state of food deprivation on their plantations in order to force the indigenous people to work (Coffeeland, Sedgewick, 2020). Families were tied to the plantation. There were no other source of work and no other source of food. The indigenous laborers were nominally free – there was nothing to rebel against - but because they and their families were hungry, they were subdued, controlled, and subservient.

When I see the prevalence of hunger in Americans and the fact that hunger will be officially hidden by our government going forward, I cannot help but see hunger as a device of repression against poor Americans in the hands of Trump and his minions. And in recent months outside of America, Trump has weaponized the hunger of civilians in Gaza and Cuba.

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So what has this to do with the addition of nutrition to a medical education?

I’m getting there.

There are two kinds of malnutrition in America, and increasingly around the world: undernutrition and overnutrition.

I have only heard RFK, Jr. talk about overnutrition. Overnutrition as expressed in unhealthy weight is all around all of us. Kennedy, Trump, and MAHA advocates and siblings Calley and Casey Means, the latter Trump’s nominee for Surgeon General, all grew up in privilege, moving in elite circles and with exposure mainly to people like themselves, many of whom had issues of overnutrition. Maybe I am wrong, but meaningful exposure to the real lives of Americans with food insecurity and, worse, undernutrition, might never have been part of Kennedy, Trump, and the Means’ real-world education.

However, real doctors and health experts, not unqualified people like Casey Means or Kennedy, should be, need to be, attentive to the fact that some of their patients and constituents may be experiencing food insecurity.

Doctors in training need to learn that there are quick food security screeners that can be administered in the doctor’s office. The best known is the simple Hunger Vital Sign tool: a two-question validated screener developed by Children’s Health Watch in Boston. It is based on the Trump-killed U.S. Food Security Survey. The doctor or professional simply asks for an “often” or “sometimes true” versus “never true” response to two statements: First, “Within the past 12 months we worried whether our food would run out before we got money to buy more.” Second, “Within the past 12 months the food we bought just didn’t last and we didn’t have money to get more.” A response other than “never true” flags the need for a doctor to assist in assuring that the patient’s food security is addressed.

So why would teaching the use of a food security screening tool like the Hunger Vital Sign not be at the very top of the list of things about nutrition that a doctor should be taught? It boggles my mind, but food security screening is not explicitly on the list of 71 nutrition competencies Kennedy recommends be addressed in medical education.

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Kennedy’s list is billed as being based on an expert list of 36 competencies published in the Journal of the American Medical Association in 2024, but it bears little resemblance. The JAMA list puts food security screening as the #2 item, behind #1 “Provides evidence-based, culturally sensitive nutrition and food recommendations to patients for the prevention and treatment of disease.” In general, the JAMA list is written to make doctors-to-be aware and sensitive to nutritional issues and competent to address nutrition in partnership with dedicated nutrition professionals. I like the JAMA list a lot.

The Kennedy list is, on the other hand, more like a curriculum for doctors who want to become social media influencers and snake oil peddlers, like our unlicensed-doctor-waiting-to-be-Surgeon-General, Casey Means. For example, recommended core competency #58 is learning how to recommend a wide range of “nutraceuticals” or food and herb-derived supplements like Means sells. And then there are bizarre recommendations for the training of a doctor, like competency #67: “Regenerative agriculture immersion: participate in on-site learning at farms including soil sampling, composting, crop rotation.”

The single competency on Kennedy’s list that pops out as a genuinely valuable addition to JAMA’s list of two years ago is #55: “GLP-1 agonists counseling with diet and lifestyle guidance.” In other words, doctors should be familiar with the growing arsenal of GLP-1 and related medicines, how they work, their powerful intended and side effects, real world food needs stemming from taking GLP-1s, effects - real or feared - on muscle mass, and that there should be no stigma attached to taking GLP-1s. Well, of course, yes.

There has long been a push for more nutrition training in medical school. As doctors watched the obesity epidemic explode and attendant chronic diseases increase in America, the nutrition training gap in medical school became undeniable. More awareness and understanding in the medical profession were required, even if effective treatment tools to curb the symptoms of the disease of obesity were not yet widely available.

I didn’t understand until I read JAMA’s 2024 recommended nutritional competencies that the need was not for doctors to learn more facts about fats and carbohydrates but to learn how to treat people with respect, understanding, and thoughtful guidance when those people are just coping with the effects of living in a terrible food environment that is allowed to prey on their biology.

Fifty-three out of the approximately160 medical schools in the U.S. have capitulated to Kennedy’s somewhat extortionate push to incorporate more nutrition training. The use of any of Kennedy’s 71 competencies is, fortunately, not required by the medical school agreements with Kennedy, and it might be embarrassing to see any medical school work from a list grounded in Kennedy’s personal bias and not in science. However, the list is described by Kennedy as “recommended”, not merely “suggested.”

So despite my long-held belief and advocacy for more nutrition training for doctors, I stand with those who are upset by Kennedy forcing the issue on medical schools. Our federal government does not place science and the health of its people above all else. Opening any door to future federal dictates for medical training is scary, given the current administration.

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Red meat consumption is down, and chicken consumption is up.

While the consumption of beef, the most popular red meat, continued to grow in the prosperous years after World War II, it peaked in the 1970s and has rapidly declined since. On the other hand, chicken consumption has been growing steadily since World War II. During the Great Recession of 2007 to 2009, chicken overtook beef as the most consumed animal protein.

Shunned by some and loved by others, pork is classified by the USDA as a red meat but was famously and successfully marketed from 1987 to 2011 as “the other white meat.” Observers remarked that the white meat ad campaign contradicting the USDA was paid for by a tax on pig sales organized by the USDA.

In fact, pork can be quite lean like poultry, but the fat content of both beef and pork depends on the cut and can vary greatly in both cases. As a nutritionist, I agree with the USDA, and even RFK, Jr., that pork is red meat.

Pork’s fortunes have taken small ups and downs, particularly in the Great Depression of the 1930s and during the beef boom of the mid-1970s, when it took a big dip, but consumption has generally grown slowly over time.

Altogether, Americans eat a lot of protein, before we even get to plant protein and dairy. According to USDA data there were about 200 pounds of trimmed, boneless meat of various types available for each American in 2021.

Those 200 pounds consist of chicken in the number one position at 68 pounds; beef at 56; pork, 48; turkey, 12; and about 20 pounds of fish. That’s over a half-pound of meat, poultry, and fish per American per day.

The reason that many Americans have been reducing their red meat consumption is that they’ve received the message about red meat being bad for your health. The true science is very clear on three points: red meat is linked to cancer, red meat in general has a lot of saturated fat which is linked to heart disease, and most Americans get more than the recommended level of protein.

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Groups concerned with the environment have long publicized the heavy climate burden of cattle. Livestock, mostly cattle, are responsible for 15% of human-created greenhouse gas from their burps and production of manure. Additional sources of emissions are due to the loss of forest for pasture, the production of feed, and manure storage. However, survey data indicate that environmental concerns are not, for most people, a big motivator in their reduction of red meat consumption.

Apart from health, the other key factor in reduced red meat consumption, is cost.

Since the pandemic beef has led all food products in cost increases: roasts have gone up 74%, steaks 57%, and ground beef 53%. But while alarm bells have been ringing with the price of round roast hitting $9 a pound at the end of 2025, round was at $11 a pound – adjusted for inflation – in 1980, a few years after the peak of beef consumption in the mid-70s.

In short, beef got very popular and then very expensive and as the demand fell, prices fell, but now they’re back up despite only a very slow growth in demand over the last decade. It may be a difficult task for RFK, Jr. and the USDA to boost consumption much at this point.

And, despite the scientific consensus around the increased health risks associated with red meat, Kennedy wants us to eat more for our health. He believes we need more protein, while most nutritionists agree that generally we eat much more than we need.

Kennedy’s beliefs coincide with the mission of the USDA to support the cattle industry. Kennedy embrace of this symbiotic relationship was demonstrated in his February address to the National Cattlemen’s Beef Association, “begging” them to vastly expand the size of their herds to accommodate increased consumer demand and drive prices lower.

RFK, Jr.’s comment on herd expansion alarmed environmentalists. According to reporting in The Guardian, The World Resources Institute has calculated that to expand the American herd by 25 million head of beef cattle, 100 million acres of arable land would be required in the U.S. There are currently 86 million head of cattle in beef production, a 75 year low. The conversion of 100 million acres, about the size of California, would come at great cost in methane gas emissions and loss of land that would otherwise be a carbon sink or produce lower-burden plant protein.

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Will Kennedy succeed?

Not only will RFK, Jr. and the USDA be fighting the widening understanding of the health risks linked to red meat and the price of beef at the supermarket, but they will also be fighting demographics. A 2023 study analyzed CDC National Survey data from 2015 to 2018 and found that 12% of American adults eat half of the beef we consumed.

That highest consuming population tends to be in the 50- to 65-year-old range. They were kids at the peak of beef consumption in the 1970s.

Foods we are exposed to at an early age make a biological imprint on us as part of the creation of our culinary compass. A large component of this early setting of food preferences is our family’s food culture. In short, children and teens fed a lot of meat, as many were in the 1970s, were tending to learn a lifelong meat habit. In coming years, as those heavy meat eaters age out of the population, the beef marketers are going to have to work even harder to bolster sales.

Plant protein and grain

When we hear the advice to eat more plant protein, we may think first about whether we could eat more beans like soy or many others. We may also tend to increase consumption of plant-based meat alternatives, like Impossible Burgers. We may not be conscious that on average 31% of the protein Americans eat already comes from plants, mostly from grains. Our diet is in contrast to the average diet in lower-income countries where 70% of protein comes from plants.

What about plant-based meat alternatives?

A 2025 study found plant-based, what I call “pretend,” meat had just 1.4% of the retail meat market share in the U.S.

It may be difficult to evaluate any health benefits of plant-based meat alternatives compared to actual meat or to plant protein sources in grains or beans, as plant-based meat alternatives are ultraprocessed foods with a wide variety of mixes of ingredients. These highly-promoted, lab-designed and manufactured products are convenient and likely more healthy than red meat products they replace, although pretend chicken or turkey replacements for organic poultry are a hard health sell for me.

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If you believe in the greater certainty of the health benefits of real food, for additional concentrated plant protein, minimally processed ingredients like beans or moderately processed foods like tofu or tempeh might make sense.

Moving forward

So no, for pressures of cost, health, and the increasing difficulty of political and agricultural policy leaders in denying the climate crisis, I don’t think we are going back to the beef consumption America saw in yester year.

The cowboy and beef, and the heightened, comfortable machismo state they have evoked in our culture, are becoming saddle sore, encroached, and endangered in America.

In fact, let me be the first, or perhaps among the first, to propose a rational but radical idea. States and localities have authority to regulate and tax unhealthy substances, think tobacco, alcohol, marijuana (for those states where it is legal), and has been attempted in a few places, sugar-sweetened beverages. Tax revenues from these sources can be and sometimes have been used to pay for health expenses incurred by the state because of these substances. What brave state will be the first to tax red meat? Or ultraprocessed food, for that matter?

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My dream is that nutrition will be an apex science some day: treated as one of the foremost disciplines in maximizing the health of humans. Then, having written the codex spelling out how our bodies metabolize food and how to eat healthy, nutrition can take a seat next to Newtonian physics: always fundamental, exerting its rule every moment of our lives, but just part of life. No need to think about it. In my dream gastronomy will become very simple like basic physics: apples fall from trees, and we eat them… and other real foods.

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Excess unhealthy weight is a risk factor for serious chronic diseases, including heart disease, stroke, diabetes, osteoarthritis, and cancer. A new study reveals trends in obesity among people who are Black, White, and Hispanic. The projected trend for the next ten years, through 2035, does not look good for any of these groups.

In 1990, a little less than 20% of American adults had a BMI of 30 or more, which is the standard, although imperfect, measure of obesity. By 2022, that percentage had risen to 45%. Obesity in the U.S. had more than doubled in 22 years.

While all the groups analyzed fared poorly, the levels of obesity among groups ranged from 40% in males who were either White or Black to 60% in females who were Black. Hispanics of both sexes had the biggest jumps in obesity from 1990: 25% increases in both males and females, with 2022 levels of almost 50% in females and 43% in males.

Obesity is highest in people who are

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GLP-1 coverage shrinks as demand grows

As costs rapidly rose in the last few years due to expanded coverage of GLP-1s like Ozempic, Wegovy, and Zepbound, insurers began to respond with medication management programs and restrictions on coverage. Many GLP-1 patients prescribed for obesity or excess unhealthy weight have struggled to maintain coverage, pay increased costs for coverage, or find the money to buy their medicine without insurance help.

GLP-1 medications are highly effective for not only treatment of excess unhealthy weight but for treatment of diabetes. Patients with diabetes have experienced cutbacks in coverage, too, but not to the same extent as those being treated for obesity.

Of course, Zepbound and the others are very expensive. A study by authors at Yale, Harvard, King’s College Hospital London, and Doctors Without Borders, estimated that the full price of Ozempic is more than 200 times the cost of manufacturing. But the two major GLP-1 makers, Novo Nordisk and Eli Lilly, operate in an unregulated near-monopoly market in the U.S., where one of eight adults are prescribed a GLP-1.

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CVS Caremark, an Aetna company, dropped GLP-1 coverage for obesity in July, but is facing a class-action lawsuit to restore it. Many other commercial insurers and large, self-insured employers have dropped GLP-1 coverage for obesity or imposed restrictions or larger shared costs.

Three states recently dropped Medicaid coverage for patients to receive a GLP-1 for obesity. Now only thirteen states provide coverage, which is sad given that Medicaid patients are among the most impoverished and a population heavily afflicted by the disease of obesity.

It is disturbing to see patients pulled away from access to a highly effective medication which is likely providing substantial health improvement and for which there is no equivalent substitute.

Worst are the manipulative processes used by GLP-1 management programs such as EnCircleRx, a cost control program started in 2024 by EverNorth, a prescription insurance company under the Cigna umbrella. In the face of GLP-1 coverage cost increases of as much as 40% a year hitting some plan sponsors in the insurance market, EverNorth offered employers EnCircleRx, with a guaranteed 15% cap on cost increases, year-to-year. EnCircleRx manages costs by creating barriers erected at the prior authorization stage and then finds additional savings with its lifestyle support program.

In the first year, eleven million patients were enrolled in EnCircleRx to get their GLP-1. As part of the process most are required to engage at least once a week with a program called Omada Health. Omada provides required nutrition, exercise, and behavioral health education and weigh-ins which are instantly uploaded from a connected digital scale provided by Omada. As beneficial as healthy eating and exercise are, these are likely things these patients have already tried unsuccessfully on their own for losing weight: interventions that science has proven do not work for most people in the long run. However, if a patient stops engagement with Omada, their EnCircleRX GLP-1 coverage can be taken away, and they will have to pay the market cost or drop the medication.

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The value of a program like Omada for increasing weight loss while on a GLP-1 is questionable. There has come to be considerable medical consensus that these sorts of GLP-1 add-on programs are important for weight loss, and it seems, sort of, like it makes sense, but a good randomized controlled trial proving that assumption is hard to find.

Actual nutrition modifications and exercise are not required as part of Omada and similar programs, just receiving the message that they are important. If there was good fact-based evidence that eating changes and physical activity were essential, it seems to be these lifestyle plans would require them.

In addition to burdening patients with this sort of “use-or-lose” nutrition and exercise counseling regimen, there are reports of programs like EnCircleRx rejecting patients for coverage out-of-hand, at least until the patient puts in an appeal, even though they meet the requirements for high BMI or elevated BMI in combination with other chronic conditions which can benefit from weight loss like high-blood pressure, high cholesterol, cardiovascular conditions, sleep apnea, or diabetes.

Weaker or stronger bones with GLP-1s?

Patients who take a GLP-1 to lose unhealthy weight or treat diabetes should be warned that weight loss, especially the sometimes-dramatic losses that can come with GLP-1 use, warrants regular exercise to stem the potential loss of muscle mass. A lot of muscle can be consumed as the body seeks to replace the calories it’s not getting from food by instead burning skeletal muscle along with the targeted fat. Strengthening through resistance work is very important, but vigorous aerobic exercise should be added to the regimen as well.

Tangible reductions in strength can be felt with muscle mass loss. What is not tangible, is unseen, and is seldom discussed are changes in bone mass density that may occur with weight loss and GLP-1 use. Weight loss without GLP-1 use is linked to decreasing bone mass density, meaning weaker bones and more susceptibility to fractures. However, studies have reported conflicting results about weight loss caused by GLP-1 use. GLP-1s might provide limited help in increasing bone mass density while losing weight – or they might not. A 2024 randomized controlled study found that the GLP-1, liraglutide, sold as Saxenda for weight loss, reduced bone mass density along with body fat and weight. Exercise combined with liraglutide roughly cut in half the loss of bone mass density.

So, for those of us prescribed a GLP-1, in addition to the effect of heavy resistance exercise in stemming the loss of muscle, we have yet another reason to be at the gym.

New GLP-1 medications coming

Three new GLP-1s may reach the market this year, according to the Journal of the American Medical Association. Eli Lilly, maker of Zepbound and Mounjaro, expects fast track FDA approval of a new semaglutide pill, Orforglipron, targeted at those reluctant to self-inject. Trials of the pill, to be taken daily, delivered an average weight loss of 11% in patients with obesity but not diabetes after about a year and a half.

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Novo Nordisk has a high-dose version of Wegovy that is also on FDA fast track. The new injectable will have three times more semaglutide in it than Wegovy. Trials in patients with obesity but not diabetes indicate an average 19% weight loss, only about 3% more than Wegovy delivers.

Novo Nordisk has also applied for approval of a new injectable, this time combining semaglutide with cagrilintide. The new drug, CagriSema, is on a par for efficacy with the high-dose Wegovy, with trials providing 20% weight loss in patients with obesity but not diabetes. However, CagriSema also registered slightly more side effect reports than Wegovy.

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Other more powerful GLP-1s and related drugs are in the works. One of the objectives of coming products will be more weight loss but we also might find medications coming which are intended to cause less side effects, which are an important limitation for some folks trying to stay on a GLP-1.

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Everyone on Earth has one food in common, milk. We all drank it as our first meal, even if it was just the milk contained in formula.

Breast milk is the most perfect food: the ultimate personalized nutrition. I envy all moms and dads who have experienced breast feeding and its joy and love. Of course, breastfeeding is great if it can happen, but, in the interest of inclusivity, I wasn’t breastfed and I turned out fine.

Milk has been in the news a lot lately with full fat milk being promoted in the new Dietary Guidelines and the Whole Milk for Healthy Kids Act signed this month, so I am going to share the answers, many of which I think you will find interesting or useful, to the questions I have had about milk.

First, guess the answer, which is better for hydration, water or milk?

Full fat milk is 87% water and skim is 90%. A 2016 study found that both full fat and skim milk were better than water for hydration of adults. In fact, milk was more effective than any tested fluid. Oral hydration solution, like Pedialyte or the equivalent homemade solution mixed with the correct balance of sugar and salt, was also effective, as was orange juice. Plain water was on a par with, surprisingly, Coca-Cola, tea, coffee, beer, and Powerade. That’s right, water is just as good as a sports drink for hydration…but not as good as milk.

In a small sample of participants, a 2014 study found that milk was better than Powerade for re-hydration after vigorous exercise. The dairy industry has made much out of some small studies that show milk outperforms water for rehydration after heavy sweating. This evidence is weak, but milk does have the electrolytes calcium, potassium, and sodium, which water has little of. More research is needed, but, since milk does deliver protein and good hydration, you might find it a good option after a workout, as I do.

Okay, let’s deal with what is in RFK Jr.’s head, and I mean his thoughts about milk, raw and whole.

RFK, Jr. says raw milk is good for you. He drinks it.

Raw milk can carry Salmonella, E. coli, and Listeria. The USDA, CDC, and FDA all strongly warn against drinking it.

Testing has refuted the argument that raw milk is better than pasteurized nutritionally. There is a minor reduction in some vitamins from pasteurization, but not nearly enough to risk a serious illness. The CDC found that from 1998 through 2018, 2,645 people became ill from raw milk, with 228 hospitalizations.

However, hard cheese made from raw milk is safer than fluid raw milk. One study found that raw milk hard cheese can meet European Union standards for bacterial safety, but that a rigorous production process is needed, so safety is not guaranteed. Softer cheeses are not as effective in reducing pathogen loads as hard cheese, so beware. Also, FDA research in 2024 and 2025 found that Avian Flu virus, H5N1, can survive the raw milk hard cheese aging process. However, the FDA has found that milk pasteurization does kill the H5N1 virus.

Should I buy ultra-pasteurized milk?

First Louis Pasteur discovered that the beer fermenting process was caused by yeast, and then he invented pasteurization to kill off the unwanted microbes that could cause beer to go bad. Having revolutioned the beer industry, Pasteur figured out how to pasteurize milk – 161 years ago in 1864.

I have a hard time heating milk on the stove for hot chocolate without making a skin on the surface. Have you ever wondered how milk is pasteurized without being ruined? The High Temperature/Short Time method is the common way. Milk is heated to 161°F for just 15 seconds. Milk pasteurized this way is coded for removal from grocery shelves 16 to 21 days after bottling or boxing.

Ultra-pasteurized milk, on the other hand, is flash-heated with injected steam to 280°F and then rapidly vacuum chilled. A box of ultra-processed milk can last for months, often without refrigeration. Very convenient, but there is a slightly sweeter, “cooked” taste, and some folks might prefer regular pasteurized milk for some uses. After it is opened the shelf life of ultra-processed milk is similar to that of regular pasteurized milk.

The Whole Milk for Healthy Kids Act and the case for whole milk

Trump signed the Whole Milk for Healthy Kids Act this month, allowing schools in the National School Lunch Program to serve full and 2% fat milk. This policy is heartily approved by Trump and RFK, Jr.’s MAHA followers.

But as Yasmin Tayag points out in the Atlantic, whole milk also connects Trump’s MAGA constituency back to a bucolic, pure, but imaginary American past that appeals to the right and far right. Social media posts by Trump and Kennedy of them with milk mustaches are reminiscent of the dairy industry’s “Got Milk” campaign of the 20^th century.

And Trump’s post of himself as a milkman further reinforces this connection to a white American past. The milkman image goes way back to Trump’s childhood and reminds us that milkmen delivered milk bottles to doorsteps in the early through the mid-20^th century. At one time almost a third of all the milk we drank in America was home delivered. Milkmen were the original Uber Eats, but without the app.

Framing Trump as a restorer of an old version of America is strong messaging built on a weak basis.

The effort to promote whole milk is meant to benefit farmers who hope to sell more, as milk sales continue a 50-year decline. Whole milk is more expensive than reduced fat milks (by which I mean 2%, 1%, and skim milk) because of its fat content, which can be used in other products like butter and cream. So if some people switch from lower fat to full fat milk, that’s good for the dairy industry.

What types of milk sell the most?

My analysis of USDA 2025 data through November shows that full fat milk is 47% of sales, skim is just 6%. In between are 2% fat, which has 34% of sales, and 1%, which has a modest 13% of sales.

In fact, there was a little shift in 2025 with all the buzz about whole milk. Regular full fat milk was up about one percent over 2024, but milk sales as a whole were down about two percent. So despite the promotion of whole milk, for the moment the industry continues to slip in volume.

Flavored milk is 11% of all non-organic milk sales. About 2/3 of flavored milk consumed is chocolate, both at school and at home. A survey of 51 flavored milks sold in schools found they all contained added sugar, ranging from 6 to 16 grams worth.

Organic milk, by the way, is 7% of all milk sales.

Is organic better?

How much healthier is organic milk for you than conventional? Pesticides are in conventional cow milk, mainly from cows eating contaminated feed and forage. Most conventionally farmed cows are treated with growth hormones and antibiotics that also show up in their milk.

Organic is a little better nutritionally because forage results in somewhat better milk than than the feed mixtures provided to intensively-raised indoor cows. While many conventionally producing cows are allowed to graze, factory farming counts for about 70% of milk production, and the number of small dairy farms dropped by almost half in the last ten years.

It would be an easy choice between organic and conventional milk if price weren’t a factor, but this week in the U.S. the average advertised cost of a gallon of organic, $8.16, is exactly three times that of a gallon of conventional milk.

Other motivators for organic dairy purchases are the public health benefits of not introducing pesticides and antibiotics into the environment, and the presumption that cows are happier being out grazing in a pasture at least three months a year, as required by the USDA for organic milk cows, as opposed to those many cows that spend their life inside where welfare issues are a concern.

Another hopefully interesting statistic: cow milk is almost 100% of American animal milk production, but, worldwide, cow milk is about 80%, followed by buffalos at 15%. Goats, sheep, camels, yaks, horses, reindeers, and donkeys together are responsible for 5% of milk production.

Will school kids actually drink more milk if full fat milk is available?

Blind taste test studies indicate kids will maybe, maybe not drink more full fat milk than lower fat milk on the basis of taste. One study found consumers can’t tell the difference between milk types by taste alone, while a recent one found a taste preference for full fat milk.

Saturated fat?

There is new debate among nutrition scientists about whether saturated fat in milk has the same risk-increasing effect on heart health that saturated fat in, say meat, does. More research is needed.

It seems very likely to me that if a kid is a milk drinker of whatever fat content, that alone is a win for health, as long as the milk is unflavored and not raw. Milk’s health benefit is further increased if the milk is consumed in place of less healthy juice or sugar-sweetened beverages.

Doesn’t removing fat from milk remove vitamins?

Calcium absorption in the intestines can’t effectively happen without vitamin D. The vitamins dissolved in the milk fat, A and D, are removed along with the fat in lower fat milk, but they are, by regulation, replaced with 2,000 IU of vitamin A in all lower fat milk.

Further, since about 1933, vitamin D has been added to milk. Vitamin D fortification is the primary reason that rickets, the crippling bone disease, is rare in America, 100 years after it was epidemic in northern industrial cities and the poor South. Almost eliminating rickets in America was a big public health and nutrition win.

However, rickets has begun to reappear, with a disease rate in the early 2000’s ten times what it was twenty years previously: still very low but unacceptable. Those affected have been primarily poor, dark-skinned children in the South who did not receive vitamin D supplements when breast feeding past six months.

Your skin is a vitamin D factory when you get sun exposure. If you are dark-skinned or above the 37^th parallel, which runs roughly from San Francisco to Tulsa to southern Virginia, you are likely getting less vitamin D production from the sun than might be optimal.

What about the extra calories in full fat milk?

A large study, part of the Framingham Heart Study, found no relationship between drinking lower fat versus full fat milk on weight gain. So probably no worries there.

Calcium, the wondrous white metal we all need a lot of

Calcium quantities are the same in full and lower fat milk, so this is not part of the whole milk debate. Since calcium is a metal, when you think of it, our bones are made of metal, although a soft one! Calcium is critical to our bone health but also lets our blood clot, muscles contract, and heart beat. We lose calcium all the time through our nails, hair, urine, and feces. If it is not replaced in our food, our body takes calcium from our bones. There are a lot of factors that affect loss of bone mass and microstructure, but studies have shown dairy consumption is a protective factor: it decreases the risk of bone fractures.

Milk, yogurt, and cheese are not the only things that can benefit bone health. Physical stress delivered to your bones through exercise helps them strengthen and reduces the risk of osteoporosis. That goes for everyone. There might not be an upper age limit on the benefit of exercise to bone health.

For dairy-free consumers, in addition to exercise, to reduce the risk of osteoporosis calcium can be obtained by eating nuts and seeds, kale, broccoli, some lettuces, collard, Brussel sprouts, and cabbage.

Many people have good reason to avoid dairy. There is an interesting history to that.

It used to be that during childhood everyone in the world gradually lost the ability to digest milk - until about 8,000 years ago when dairy animals were domesticated in Turkey. My theory is that the body’s development of lactose intolerance was nature’s way of forcing the weaning of older children so that young ones could have their turn at the breast.

However, along came cow farming, and a genetic mutation that kept lactase production going in the human body through adulthood gradually spread. Then 3,000 years ago dairy herders in Northern Europe experienced selection for the lactase gene during famines – when dairy was the most reliable food source. Those who had the mutation were more likely to live through crop failures.

Everyone quotes a 2017 study that found 36% of Americans have lactose intolerance. The rate worldwide according to the study is 68%, but the study’s methods were off, and it was retracted last year. So perhaps we don’t have a reliable figure, but we know a lot of Americans have trouble with milk. Yogurt, by the way, tends to be less troublesome for lactose intolerant folks, since the fermentation process reduces the lactose content in yogurt.

The plant milk solution

While about 10% of the animal and plant milk market combined is lactase-treated milk for the lactose intolerant, about 15% is comprised of plant-based milks, mainly almond. In 2022 almond milk had about 60% of the market. Oat milk had 20% of sales, with coconut and soy milk each taking about 10%. Almond and oat milk lead sales because of their taste, which is preferred by many.

Plant-based milks have good nutrition, and although sugar is added to some, it can be less sugar than the lactose in milk. However, lactose in cow milk is a slow-digesting sugar compared to fast-digesting sucrose in plant-based milk, so expect less glycemic control with plant-based milks.

Oxalic acid is in a lot of foods. Be aware that the high oxalic acid content in almond milk significantly reduces the uptake of calcium from the milk. So when an almond milk claims it has more calcium than cow milk, the reason is that it needs to start with more calcium to try to match the ultimate calcium delivery of cow milk.

Milk allergy

Milk allergy is one of the most common allergies for children. Reactions vary from mild to severe. Happily, most kids outgrow it.

Trump’s disgust and dismissal of breastfeeding

First, in 2011 Trump called a lawyer in a deposition hearing who requested a break to pump milk “disgusting.”

Second, for decades the misleading marketing of infant formula in developing countries has caused untold infant deaths due to the use of contaminated water mixed with the powder. Formula use in these places is also associated with nutritional issues and economic stress for impoverished women who are misled into buying formula. America, the World Health Organization, and nutrition and public health experts everywhere had agreed for 40 years that breast feeding was the best source of nutrition to keep infants healthy.

However, in 2018, on the order of Trump, who was acting in the interest of formula manufacturers like Nestlé, the U.S. delegation to the World Health Assembly tried to block a resolution to promote breastfeeding and clamp down on inaccurate formula marketing. The U.S. forced Ecuador to withdraw the resolution by using trade threats and threats of withdrawing military assistance for the armed conflict on Ecuador’s border with Columbia. Many other intimidated nations refused to sponsor the resolution until Russia finally did, at which time it overwhelmingly passed.

That year, I was in Malawi to gather formula samples to test for contamination. I saw Nestlé formula marketing everywhere. I stood in line at a market behind a clearly low-income woman with a baby. She had one item: formula. She was not buying clean water…

I wonder how the U.S.’s own, already subpar, infant mortality rate will fare under Trump?

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Got Milk?

In the face of 50 years of declining sales, the dairy industry has heavily marketed milk as an essential part of the diet to the American public. There are a lot of pluses to milk consumption, full fat or lower fat: great calcium and hydration, a substitute for unhealthy beverages, and it’s got low-cost protein. This may be a too-rare instance of a food industry interest roughly aligning with a public health interest. So, “Got milk?” Heck, yeah!

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Oh, and a…

Conflict of interest disclosure. I had an early career in milk nutrition. In 3^rd grade I was in charge of bringing the crate of little milk cartons to the classroom where we ate lunch. I was very proud. I think the milk cost 3 cents.

The long reach of USAID across the globe, saving lives, making friends for America, and elevating this country’s place in the world, ended in 2025. This morning I came across a photo of a food pyramid poster I took at the health headquarters in Nampula Province in Mozambique while I was doing USAID-funded research in 2018 on childhood stunting caused by aflatoxin in mold on staples like maize and cassava.

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The poster was in Portuguese and focused on a healthy diet for people with diabetes. Nutrition science has corrected its simplistic “fats are bad, carbs are good” stance since the original 1992 American pyramid from which this Mozambican one was derived, but I love the local adaptation with its beautiful cassava, maize, pineapples and papaya.

However, I am still not a fan of the pyramid shape to depict a healthy diet. All parts of the diet should be healthy and work together. No food type should be at the pinnacle.

It is both surprising and dismaying how the 1992 pyramid has not only re-emerged in America with the new, RFK, Jr. upside-down food pyramid, but that it spread so far around the globe it never really went away.

My prediction, and I feel pretty confident here: the new U.S. food pyramid will not achieve the universality of the original. First, I have to think that our global credibility in the realm of health and nutrition has been damaged enough in the last year that many other nations will no longer be ready to accept on face value the science and messaging that has poured out of our country for the last 75 years since the end of World War Two.

Second and third, the new pyramid does not make sense graphically or provide the best advice nutritionally.

Ok. Enough food pyramid talk for a while, but, in a completely different realm of pyramids, ones you can’t eat, a quick tip that if you happen to be in Austin, Denver, Chicago, DC, Edmonton, Quebec, Montreal, Lisbon, Sydney, or Utrecht, go at once to the Horizons of Khofu. This totally unique, virtual reality experience of the Giza Pyramid in Egypt is at once both realistic and surreal! I went in New York while it was there. Very, very different and very cool.

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The 2025 Dietary Guidelines are finally here. Revealing them took a lot longer than Bobby Kennedy expected.

It turns out that, working in secret, Brooke Rollins’ USDA and RFK Jr.’s Department of Health and Human Services went to the trouble of writing a whole new science report to replace the one that didn’t say what they, and their friends in the cattle, pork, and dairy industries, wanted it to say.

To create the report, Secretaries Rollins and Kennedy secretly appointed a whole new committee with blatant, strong ties to the industries whose products they were primarily writing about. Creating science takes time, even when it is preordained science, but the secret committee did write a tremendous amount in a very short period.

We’ll get back to the report in Part 2 of this podcast.

Part 1: Biggest takeaways

• One of the most important recommendations in the new Guidelines is to consume no added sugar. This recommendation is for everyone but is also repeated explicitly for children under the age of eleven. The Guideline’s position is clear, direct, and could be – maybe not under Trump but down the road – the basis for policy and program changes that would eventually make a difference in American health and fitness. Excellent progress.

• The other big recommendation is to reduce consumption of unhealthy categories of ultraprocessed food, called here “highly processed food.” Highly processed foods are condemned and warned against and that is a pleasant surprise and a political win for Kennedy, who had been shut down on ultraprocessed food in the Make America Healthy Again Strategy Report of September. Regardless of the politics this was excellent progress.

• The promoting of red meat is the biggest negative in the new recommendations. The link between red meat and cancer is removed in this version. Big win here for the cattle and pork industries and a step back for healthy food.

• The saturated-fat-friendly language relative to meat and dairy is a very bad message for the public, but, for the dieticians and program planners, the retention of the 10% limit on fat calories from previous Guidelines makes adding more red meat and whole fat dairy to the meals they plan a challenge. But, in essence, a big win here for cattle, pork, and dairy.

• The alcohol language is watered down. Drink limit recommendations are left out, as is the warning about how any amount of alcohol consumption is linked to cancer. The alcohol lobby is popping their most expensive champaign to toast their win on this.

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These Guidelines shift from the previous approach of focusing on a precise standard addressed to dieticians and policy and program designers. The old Guidelines needed subsequent interpretation for the public, while the new Guidelines directly address the public. They are readable, concise, and largely clear. They’ll have to be interpreted back in the other direction – for use by dieticians, policy makers, and program designers. However, the more the public understands what is required, the more they can advocate for the massive change in policies that will allow Americans to achieve healthy diets.

The bottom line: the newly issued Dietary Guidelines for Americans, 2025, will do real harm around red meat, alcohol, and saturated fat, but, given that the Guidelines push hard on two important points about sugar and ultraprocessed food that have needed hard pushes, these Guidelines might, on balance, do some real good in the long run. This will depend, however, on if and when valid, true science returns to being an imperative when federal nutrition messaging and health policy are made.

Regardless, with the new language in the Guidelines about sugar and highly processed foods, there is no going back. A barrier has been cleared that might allow going forward from a policy standpoint.

Part 2: Pseudo-science, propaganda, pyramids, and how it all breaks down

Pseudo-science and propaganda

We knew the new Guidelines would ultimately be controlled by ideology and big money influence and not by science. Unfortunately, Kennedy and Rollins went to the trouble of having a group of industry-entwined scientists do their bidding and find science to match Kennedy and Rollins’ personal ideas of truth - and provide talking points for their propaganda lies about the old and new Guidelines. If you look in their new Dietary Guidelines upside-down-science report (the conclusions were clearly dictated ahead of time and the science was filled in to support them) you can find a disclosure of Conflicts of Interest that makes Kennedy and Rollins’ complaining about previous industry influence in the Guidelines utter, outrageous hypocrisy. Seven out of nine of the Kennedy/Rollins scientists have strong ties to cattle, pork, dairy, supplement and meal substitute peddlers, Big Food, grain farmers, or GLP-1 business interests.

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That wacky food pyramid – again?

While the official use of the USDA food pyramid is 15 years in the past – it was replaced by the MyPlate graphic in 2011 – its simplicity in depicting the supposedly best way to eat has kept it present in nutrition discussions to the present day. Now RFK, Jr. and USDA Secretary Rollins have officially resurrected it.

However, like the prior two food pyramids from 1990 and 2005, this reincarnation is awkward and unrealistic, and, since the pyramid is now standing on its tip, to me it is disconcertingly unbalanced. Grains are now at the bottom (the narrow upside-down tip), essentially making the pyramid represent a low carb diet, which very few Americans are going to agree to adopt any time soon.

But wait, the food items are drawn such that the ones lower in the pyramid very slightly hide the items above. Seen this way, the pyramid is like a rack of billiard balls on a pool table, the balls at the tip slightly hiding the balls behind.

In this perspective it’s ambiguous as to what is the top and what is the bottom: all of the food items can be seen as on the same nutritional level and contributors to a healthy diet. I like that perspective, intended or not. And it is a clean, attractive graphic, especially compared to the weird 2005 version.

The images of frozen peas and canned green beans are quite legible in the new pyramid. I like their inclusion because it acknowledges that frozen and canned vegetables, which are more affordable, can be just as nutritious, and sometimes more so, than fresh ones. And for Americans to incorporate a lot more produce into their diets, it is going to have to be more affordable. And you can see a big slab of healthy salmon up near the top (below a fat-rippled slab of steak, of course!)

Oh, and I like the motto that comes with these Guidelines: “Eat Real Food.” This is adapted from Michael Pollan’s mantra: “Eat food. Not too much. Mostly plants.” Kennedy was sure to leave out the “mostly plants” part, but “Eat real food” is still an good motto to promote.

The new versus the old recommendations – what went right and what went wrong

Protein

The 2025 Guidelines push protein, saying eating twice as much as previously recommended. These Guidelines are friendly to red meat where the 2020 Guidelines encouraged fish and vegetable proteins and discouraged meat that was processed.

Americans generally get enough protein. Doubling intake is not necessary under normal conditions.

However, increasing protein is, by itself, fine – more protein is, in moderation, nutritionally harmless and, if done as a substitute for refined carbohydrates, provides calories that are metabolized much more slowly, a good thing. The caution would be in adding red meat as part of that increased protein because of red meat’s links to heart disease and cancer.

Also, some fish have such high levels of mercury that they should be avoided or eaten sparingly. RFK, Jr. himself had mercury poisoning from frequent eating of tuna. I can’t let it go unsaid that unfortunately, while Kennedy railed against mercury in the environment prior to becoming Secretary of Health, he has had tight lips as Trump has begun rolling back mercury-emission regulations.

Dairy

The 2025 Guidelines want us to include full fat dairy, but exclude dairy that has added sugar. The 2020 guidelines specified drinking no-fat or reduced-fat milk and omitted any mention of added sugar.

The 2020 Guidelines pointed out that 90% of Americans do not consume enough dairy.

In that light, the consumption of saturated fat in whole milk and other dairy products could be weighed by the individual against consumption of other sources of saturated fat, like red meat, the goal being to increase milk consumption with its nutrients like calcium and added Vitamin D.

Recommending exclusion of added sugar from milk is good. Other ways must be found to increase milk consumption in kids apart from adding sugar in flavored milk.

Gut health

Gut health appears in the new Guidelines for the first time.

They point out that highly processed foods are disruptive for the trillions of bacteria in our colons and that this microbiome of organisms plays a key role in our health. Vegetables, fruits, and fermented and high fiber foods are recommended for gut health.

Vegetables and fruit

The essential message in the new Guidelines remains the same: Eat lots of vegetables and fruits, and canned (without sugar) and frozen vegetables and fruits are just fine. The more detailed 2020 Guidelines took care to point out that 90% of Americans don’t eat enough vegetables and 80% not enough fruit.

The new Guidelines recommend 3 servings of vegetables and 2 of fruit. This is more or less the same as the 2020 recommendations, but those were expressed in cups. Cups are nice and precise for dieticians planning meals for schools or the military, but don’t communicate well with the public who would rather just know they can grab an apple or put a pile of carrots on their plate to begin to meet their health needs.

Any uptick in fruit and vegetable consumption on the part of the public would be a win but still leave consumers far from meeting the fruit and vegetable recommendations. And these Guidelines are all about the public. The dieticians and program planners are going to have to interpret them for their own specific purposes.

Healthy fats

The 2025 Guidelines claim, against the evidence, that saturated fats in meat and dairy are healthy and advocate for their use. However, the 2025 Guidelines still stick to the recommended 10% limit on saturated fat consumption from previous Guidelines and call for more research into healthy fats.

Seeds are still identified as good sources of healthy fats in 2025, but, per RFK, Jr.’s personal beliefs, healthy seed oils like canola, soybean, and corn, don’t get a mention.

Whole grains and refined carbohydrates

The new Guidelines say to prioritize whole grains and reduce highly refined grains in a way that is stronger than the previous Guidelines.

More than two-thirds of our bread, a major source of grain in the American diet, is white, and 23% is a mix of white and whole grain. I like the simple dictum of the 2025 Guidelines: switch from highly refined grains to whole grains. This is a stronger approach for the public than the previous Guidelines’ advice to limit refined grains to 50% of grain consumption, which is an almost impossible calculation to make or goal to achieve for the average American consumer whose highly refined grain consumption is way more than 50%.

There are a few additional considerations in the whole grains crusade that always go unmentioned. We often have the wrong idea how much whole grain versus refined flour is in our bread, pasta, frozen waffles, or breakfast cereal labeled as multigrain or as made with whole grains. These products can be mostly refined flour. Where is the acknowledgement of that?

And where is the acknowledgement that most of the time to make whole wheat flour, the wheat berry is milled to separate the endosperm (the source of the white flour), from the germ and bran, which are then all separately ground down fine and recombined to qualify for the term “whole wheat” on the label or in the name? This type of whole wheat bread has a palatable, smooth consistency. It just doesn’t have all the nutrients, phytochemicals, and structurally intact fiber that were in the original wheat berries and that are retained in whole wheat flour made by grinding down the wheat berries without separating their three parts. Phytochemicals have very important antioxidant, anti-inflammatory, and antimicrobial effects in our system.

Grain products with added fiber similarly are missing vitamins, nutrients, and phytochemicals.

Real food in the form of grain is not highly refined. Policy is needed at the federal level to reduce the use of nutrient- and fiber-deficient refined grains in favor of whole grains, and the Guidelines have yet to provide real impetus for that change.

Ultraprocessed food

The new Guidelines call for “a dramatic reduction in highly processed foods laden with refined carbohydrates, added sugars, excess sodium, unhealthy fats, and chemical additives…”

No argument from me.

Sugar

On average according to the USDA, Americans eat and drink 34 teaspoons of sugar a day. That’s 544 calories worth.

The 2025 Guidelines say, “While no amount of added sugars or non-nutritive sweeteners is recommended or considered part of a healthy or nutritious diet, one meal should contain no more than 10 grams of added sugars.” I won’t bore you with the math, but this is way less sugar than the old 10% of calories recommendation.

The sugar language is perhaps the most important improvement in the Guidelines. Basically, it says don’t eat added sugar, and if you have to, cut down a lot from the average. The sugar recommendation is even stronger for children. Previously the recommendation was that children under 2 should not have added sugar. The new Guidelines say no added sugar before age 11.

My hope is that this new sugar language can be a bit of a turning point and momentum can build from here toward political action and regulation aimed to eventually returning control of our sugar-contaminated food environment to the people.

Salt

The 2025 Guidelines are basically the same as before but specifically recommend avoiding highly processed foods high in sodium.

Alcohol

In a big reversal, the 2025 Guidelines say, weakly, “Consume less alcohol.” The 2020 Guidelines said limit alcohol to two drinks for men, one for women and that alcohol in any amount is associated with cancer.

The alcohol industry is the 4^th largest lobby in America, after ultraprocessed food, tobacco, and gambling. Alcohol’s big money lobby, and the Trump administration’s level of susceptibility to big money influence, likely explain why alcohol had a huge win in diluting the alcohol recommendations in the new Guidelines.

The basis for the watered-down language was provided by a new National Academies of Sciences report on the health effects of alcohol. According to the National Academies’ report, if you are drinking moderately, as within the limits previously stipulated by the Dietary Guidelines, you’re not increasing your risk of death and may be decreasing it. However, there’s no evidence supporting doing away with a moderate drinking limit in the Guidelines and the evidence linking alcohol to the risk of cancer and heart and liver disease continues to strengthen.

I guess a reluctant tip of the glass to the alcohol lobby is in order.

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A proposal for 2030

In 2030 when the next Guidelines are due, I would like to propose the name of the document be changed to “Dietary Guidelines for America,” not “Americans.” The guidelines are meant to inform policy formation, but their title implies it is the sole responsibility of Americans as individuals if they want to eat healthy food in line with the Guidelines. However, obesity and malnutrition are diseases, and malnutrition in America is caused not only by inability to get sufficient calories but also by being overfed but still badly nourished. Curing these diseases depends on our government taking responsibility for cleaning up the food environment to make it healthy.

Kennedy and Rollins’ introduction to the new Guidelines lays part of the blame for the ongoing devastation of diet-related chronic disease on past federal policies. This is more than true. The worst food environment in American history can only move toward healing and rehabilitation if policy changes are made and new policies formulated.

The USDA, Kennedy’s Health and Human Services Department, the larger administration, and Congress should all be working in favor of the people when the people’s interests collide with those of Big Food and Big Agriculture.

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We toss over 10% of our national food supply out of our homes each year, based on new statistics and methods from the 2025 Food Waste Report by ReFED, a leading non-profit using hard evidence to push for a reduction in food waste. That thrown-away food not only has a significant environmental impact but costs us consumers $262 billion. That is a lot of grocery money: $62 a week on average for a family of four. “Cash in the trash”, the EPA says.

The product’s date label is often the only thing we check in deciding whether to chuck food we suspect is too old.

In my household we have a range of approaches to dates on a food container. Some of us will not touch a product with a date that has passed, no matter if the label says “Best by,” “Sell by,” or “Use by.” Those products are mostly thrown away around here. Some of us will open a product with a date that has passed, take a look, give it a smell, have a little taste, and, if no alarms are raised, eat it.

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The confusion and widely differing ideas about date labels stem from the fact that there are fifty states, Puerto Rico, D.C., and other entities and no standard for food date labeling across them. By one estimate there are fifty different terms like “Freshest before,” “Expires on,” and “Sell by” used on products in the U.S.

I wondered if Americans all over the country grapple, like me, with the question of what the heck the date on a food product actually means? Are the terms we see on products about safety or quality? And who decides what date to use?

Because I have been told the people in Odessa Texas are very nice, and I know the people in food banks and pantries are really nice, I decided to call Libby Stephens, the CEO of the West Texas Food Bank, serving the urban areas of Midland and Odessa Texas plus 19 very rural counties which together are the size of the state of Maine.

I asked Stephens if she understood food date labels.

“Well, I mean, I think so, just because I’ve been in the food banking world for 15 years. So, there are expiration or “best by” dates, but also from the USDA we do get some different dates that let us know when we can or cannot continue to pass out donated food or salvage and reclamation food that we pick up from grocery stores.”

Ok. So the USDA provides some safety guidance – the federal government has no rules or requirements for food dates – and a food bank or pantry can use that guidance in determining when it is still okay to offer food to customers. Stephens again:

“We have charts hanging up in all of our processing rooms at the Midland and the Odessa campuses that tell us whether milk is after expiration or not after expiration. Bottled water is up to a year. We really don’t like to take sodas, but those are 9 months. If you get to juices, it’s 6 months past the date. So it just depends on what the commodity is.”

Sounds complicated to have to depend on dates, even for the professionals, who in the case of the West Texas Food Bank are taking a date on the product and adding on a recommended margin, which might be quite large but is still regarded as safe. The Food Bank of course wants to be very sure its customers are safe but also wants to make sure they aren’t hungry. Any food bank or pantry is going to want to maximize the amount of safe food it can pass through from donors to those in need.

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Lots of folks, 43% of us according to a 2025 survey, toss out food close to or past the date on the container.

And states are confused as well as consumers. About 20 states ban sales or donations of past-date products. That is good, healthy food that cannot go to a food bank.

Economists, nutritionists, environmental scientists, and politicians have been worried for years about the costs to consumers, the environment, and those in need that occur when good food is thrown away because of confusion around food date labels.

California again gets honors for stepping up, as California so often does, with an answer. It’s a law that is quite tidy and very easy to understand. As of July 2026 all food products sold in California that have a date must also have the words “Best if used by” or “Use by” in front of the date. Only those terms. No other terms are allowed. If a retailer or distributor wants to have a “sell by” date so they know when to pull a product off the shelves, that date will have to be coded so a consumer can’t read it. And, as in the past, the use of food date labels is not required by the California law.

For the consumer this means that if there is a “use by” date, it can be understood to be the last day on which the food packer guarantees the product will not have spoiled. If there is a “Best if used by” date, that marks the end of the estimated period of peak freshness. And remember, freshness is something that deteriorates tiny bit by tiny bit from the minute the product is packed, canned, or bottled to days, weeks, months, and often years past the date on the food container. I trust my senses, including my common sense, along with some basic food safety rules when it comes to things like meat and seafood, to tell me what to do as a product passes its printed date.

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The USDA backs me up in this:

“If the food date label passes during home storage, the food product (except for infant formula) should still be safe and wholesome if handled properly until the time spoilage is evident. Spoiled foods will develop an off-odor, flavor, or texture due to naturally occurring spoilage bacteria. If a food has developed such spoilage characteristics, it should not be eaten.”

Neither terminology allowed in the California law, “Best if used by” nor “Use by”, provides a date a product needs to be thrown out. The USDA is clear:

“Food date labels are not indicators of food safety.”

By the way, it is the manufacturers and packers who decide the dates, often running shelf-life tests to help choose a date for the label. The dates you find on labels might or might not be a sort of science-y choice.

The food dating issue is very big for us a society when you add in the various costs involved in the production and transportation of the food to the consumer: the land, fuel, crop treatments, and a lot of water used for irrigation. And the story doesn’t end with the consumer’s cash in the trash. When the food waste leaves the home, 96% goes to landfills, incinerators, or into the sewer system. The landfill waste decomposes, releasing methane gas, which contributes to the buildup of heat trapped in our atmosphere. All these are reasons why bipartisan legislation, along the lines of what has been enacted in California, has been introduced in Congress to bring federal standards to food date labeling.

Meanwhile, when you go to the supermarket, ignore “Sell by”: that is just for the retailer. And remember “Best if used by” is an indicator of freshness and “Use by” is just an indicator of a spoilage timeframe.

Thank you for reading. Please support Eating in America and help it grow with your subscription, comments, and likes, and share this with others, please! I’m curious to know what you have been thinking about food label dates. The comments are open to all readers.

I wish you lots of love, kindness, good eating, and good health for 2026.

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The fascinating and despicable colonial history of our most beloved drug’s most beloved delivery agent, I’m talking about caffeine and the way we most like to take it, that is in coffee, is told in Coffeeland by Augustine Sedgewick.

You could argue that sugar is actually our most beloved drug. David Kessler explains how sugar triggers our reward circuits and is addictive in Diet, Drugs, and Dopamine. I wonder what we can learn about the addictive qualities of ultraprocessed food and why we are not to blame for the eating behaviors brought on by our food environment, and so David Kessler’s book is essential reading. The GLP-1s like Zepbound and Ozempic hold a lot of promise as a fix, although not a cure, for obesity, and they offer benefits for other chronic diseases and disorders. Kessler, a GLP-1 user like me and a doctor, discusses the drugs from a clinical perspective.

On the topic of the biological workings of healthy and unhealthy food, Julia Belluz and Kevin Hall provide a valuable and digestible look at the science in the new book Food Intelligence. I like that I’m in harmony with them in singing the hymn that it is not our lack of willpower that is causing endemic unhealthy eating, it is the food system working as Big Food designed it.

I am fascinated how three addictive substances on the milder side have so taken over the behaviors of so many people over centuries and have parallel histories involving human slavery or near-slavery: tobacco, sugar, and coffee. We might be a little familiar with tobacco and sugar slavery. They were a part of U.S. history. The Central American coffee plantations of the late 19^th century bound indigenous people to the work of the plantation by keeping them in hunger. Only if they worked on the plantation could they get fed. Sundays in that Catholic society were not just a day of rest, they were a day of hunger.

I talk in Eating in America about how and why we consume tobacco, sugar, and coffee today, but I feel compelled to understand how the global addiction to them was made possible by the millions of people brutally enslaved or bound to plantations to produce them. Sugar slavery is an immense part of Cuba’s history, so I’m reading Ada Ferrer’s An American History of Cuba.

And also my brother teaches in Cuba (and throughout South America) every year. His new book Working with Actors is in my stack because Stephen Bayly is my wonderful brother and the book is great.

Chef José Andrés’ Change the Recipe, seems to be about how cooking and serving food are acts of love and generosity but more importantly metaphors for how to live a life of love and generosity and efficacy.

John Green’s The Anthropocene Reviewed is interesting…

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Significant changes may be coming!

The Dietary Guidelines have, in the past, been largely guided by science. This year Secretary of Health and Human Services Kennedy would like them to reflect his own particular ideas about healthy food. Given the makeup of his Advisory Committee on Immunization Practices, we know Kennedy feels unrestrained by the evidence of science when it comes to public health. We’ll soon see if this is reflected in the new Dietary Guidelines.

But no matter if Kennedy is able to override science to assert his own beliefs in the new Guidelines, going forward, the 2030 Guidelines, and the Report of the 2030 Guidelines Scientific Advisory Committee, which is meant to inform the Guidelines, need to be updated to address the rapid downward slide of American nutritional health that has occurred over the last 75 years. The pace of change of the Guidelines must be accelerated to address the pace of change of our food environment.

The last Guidelines were 160 pages long to provide detailed guidance for a host of Federal and state nutritional programs, and for policymakers and health professionals. Kennedy has promised a 4-to-6-page document this time. A six-pager, with necessarily general guidance, if issued, would present a great challenge of interpretation to the nutrition programs that depend on the Guidelines. Brevity would provide a strong focus on any changes to the Guidance, but the most important possible beneficial change, the condemnation of unhealthy ultraprocessed food in our diets, has so far been squashed by the ultraprocessed food industry and their insiders in the administration.

The 2025 Guidelines’ Scientific Advisors were appointed, in the usual secretive process reflecting corporate influence, by Biden’s USDA and Department of Health and Human Services. However, all of the 2025 Advisors had true scientific bonafides.

The next Dietary Guidelines Scientific Advisory Committee is due to be appointed by the Trump USDA and Department of Health and Human Services, the politicized nature of which poses the potential that it will be a sham, in the same way that the current Advisory Committee on Immunization Practices appointed by Kennedy is an embarrassment for public health and a lethal danger to Americans.

With the current administration tilting toward heavy corporate influence in governance and dismissal of science as a key to American well-being, combined with a diet-based health crisis of obesity, now is the moment to strongly advocate for change in the formulation of the next Dietary Guidelines.

This month I attended a panel discussion with 2025 Dietary Guidelines Scientific Advisory Committee Chair Dr. Sara Booth. When asked about public compliance with the Guidelines, Dr. Booth noted that, sadly, there is not much compliance: we have a failing grade at healthy eating in our society. Most interestingly, Dr. Booth advocated that the next Scientific Committee revisit the question of eating behaviors to address lack of public compliance to the Guidelines. This year’s Scientific Report cited the need for research of eating environment changes that can support behavioral change, giving the home as an example.

That is a baby step.

Eating behaviors in today’s food environment are in large measure created by the marketing and sale of lab-designed, hyperpalatable, high-profit-margin, ultraprocessed food. These products prey on our biological and psychological responses to their combinations of salt, sugar, carbohydrates, and fat – and to the manufactured sensory appeal of the food apart from the taste. Like lab rats, we feel rewarded when we see, taste, and ingest these products, and we soon want more.

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The 2025 Scientific Advisory Committee punted on the issue of ultraprocessed food. According to Dr. Booth, some Advisors argued that the Committee was already accounting for the effects of ultraprocessed food as they evaluated its components. This approach in isolation overlooks the fact that these foods are designed to work in combination. The successful formulation of ultraprocessed food depends on the whole being greater than the sum of the parts. That is the guiding principle of ultraprocessed food.

I am never excited about eating a minimally processed baked potato with salt and butter, but I can devour a bag of McDonald’s french fries with its list of 10 to 20 ingredients, working together to trigger the reward circuit in my brain. The ultraprocessed difference for me and other consumers ends up in the quantity and quality of nutrients and the number of calories consumed.

The 2030 Dietary Guidelines Scientific Advisory Report needs to account for the ultraprocessed food effects on diet that simple minimally processed food ingredients don’t elicit.

The Dietary Guidelines themselves are intended to make recommendations with the end goal of our healthy eating. As Dr. Booth pointed out, decade after decade, five-year iteration to five-year iteration, the Guidelines evolve a little each time but are always healthy. And the public always gets a failing grade at eating to the Guidelines standards. However, the failure is really that of our federal and state governments who have neglected to ensure the safety and healthiness of our food environment and to protect the public.

In the last half of the twentieth century our food environment underwent a technology-driven, historically unprecedented transformation, the scale of which has never been seen. Ultraprocessed food grew from a small portion of our diet to 55% of our calories, 62% when just youths ages one to 18 are considered. Now, on any given day, almost 10% of us get more than half of our calories from fast food. On any given day, one-third of us patronize a fast-food seller.

When the first formal dietary guidelines were produced in 1980, the explosion of fast and other ultraprocessed food and the obesity epidemic were both just getting started. Ultraprocessed food was not even named until 2009, and the fact the U.S. and the world were in a growing obesity epidemic was not identified until the 1990s.

In effectiveness, what penicillin was to infection, GLP-1s are to obesity. But unlike an antibiotic, Zepbound, Ozempic, and that class of drugs are a fix to the symptom, not to the problem. Even with a possible leveling off of the number of adults with obesity (about 40%), the obesity epidemic is not about to end – even though drugs may help hide it. And severe obesity (about 9% of adults) is continuing to increase.

As Dr. Chris van Tulleken said last month in introducing the public health action paper in the new Lancet trilogy of papers on ultraprocessed food, the obesity epidemic is commercially driven. And the money is huge. The ultraprocessed food lobby is the biggest lobby in Washington by a wide margin.

The Dietary Guidelines have slowly evolved while the U.S. has found itself in a food environment crisis in a new era in food history. In response to these changes, it is time for the Dietary Guidelines to reboot and grapple with ultraprocessed food. The Scientific Committee needs to investigate eating behavior, as Dr. Booth proposes, and so, of necessity, investigate the drivers of unhealthy eating behavior in our food environment.

The Scientific Committee is concerned with the nutrient effects of food components and so in this cycle deferred making recommendations about ultraprocessed food, saying it required a standardized definition of ultraprocessed food that could be researched with results that could be compared across studies. A federal ultraprocessed food standard definition, while promised by RFK, Jr. and the recent Make America Healthy Again Strategy Report, may or may not come within the current administration’s term. A body of research adhering to a standardized definition is years in the future at best.

A new approach for the next Scientific Committee is required, an approach focused on the biological effects of hyperpalatable foods, how those effects drive how we eat, and how the 2030 Dietary Guidelines should take those hyperpalatable foods into account. The crushing burden of chronic disease due to our unhealthy eating has been made abundantly clear, in the research and in the personal lives of Americans. Assertive action by the 2030 Dietary Guidelines Scientific Advisory Committee and by the USDA and HHS is required, with the goal of helping Americans live longer and healthier.

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