Candy and snacks made with THC, the psychoactive ingredient in cannabis, are for sale to both adults and kids in America: not in cannabis dispensaries but places like convenience stores. These treats are not regulated. Seventh graders on their way to school can stop and pick up packages of THC edibles made to look like familiar name brand candies. Except these candies can get them high, dangerously high.

As I reported in my April series “Ultraprocessed Cannabis: Potency, Policy, and Public Health in America,” in 2018 Trump and Congress deregulated hemp, meaning cannabis without an intoxicating amount of THC. While the intent was to allow the unregulated sale of wellness products and supplements containing CBD, or cannabidiol, a non-psychoactive chemical in the Cannabis Sativa plant, there was a loophole. While hemp products couldn’t contain more than a tiny amount of Delta-9 THC, which causes the high in cannabis, nothing forbid using ultraprocessing techniques to make products with potent amounts of the Delta-8 THC that is found in hemp.

For years, large quantities of Delta-8 THC have been added to canned drinks, gummies, and other snacks that have been sold without restriction, including purchasing age.

Some states have taken action, but more than half have not

Thirteen states ranging from Idaho to New York have banned hemp products with Delta-8 THC. Another seven allow intoxicating products but impose limitations or regulation. It is alarming from a public health viewpoint that intoxicating hemp products are legal and unregulated in about 25 states.

Federal action at last

Last year, as part of a continuing funding bill, Congress, with Trump’s signature, set this coming November 12th as the date when all hemp-based products with intoxicating levels of THC would be banned federally. Some legislators pushed for an additional one-year delay in the ban, but that effort failed.

Trump changes mind, now favors a delay in action. Did the White House Chief of Staff’s daughter marrying a hemp products CEO have anything to do with Trump’s reversal?

In June, Trump reversed himself and began asking Congress either to enact a regulatory framework allowing hemp-based products or to delay the ban. MS-NOW has pointed out this is the same month that White House Chief of Staff Susie Wiles’ daughter got married to the CEO of MC Nutraceuticals, a large wholesaler of hemp-based products, including Delta-8 THC. Could Trump’s reversal on the ban be a wedding gift? Forgive me for suggesting this possibility, but Trump’s past behavior is consistent with an inability to see himself in a conflict of interest in anything he fancies to do.

What was the political game with the delay?

At the beginning of August the quest for a delay turned into a proposed 4-week postponement of the ban ostensibly to allow legislators time to work out a hemp regulatory proposal. This ask for a small one-month delay baffled me at the time. It came an entire three months before the ban was meant to go into effect. I could understand if November 12th was drawing close after three months of hard lobbying and work constructing a compromise proposal and then a delay to the ban was asked for, but to ask so far ahead for a small one-month delay?

Clearly, some political gamesmanship and heavy hemp industry lobbying was at play. Maybe the hemp lobby thought waiting until after the mid-terms would free up some favorable votes, or maybe they thought just being able to get one positive outcome in favor of hemp, even if just a short delay, would swing momentum in hemp’s favor. Or maybe the fact that Congress was not going to be in session at the start of the ban was a factor.

One month delay slid into a funding bill and passed.

In any case, the hemp ban delay was added to a must-pass federal short-term funding extension and the hemp industry got their 4-week reprieve. As it stands the ban will now end on December 11.

Three types of hemp-based products: not gross, gross, and the big money maker to be.

So let’s try to make sense of what is at stake. There are three types of hemp-based products.

In the first, the hemp form of the Cannabis Sativa plant is used to make CBD products, such as tinctures, gummies, edibles, teas, and topical creams. The same plant is used for making rope and fabric.

Within this first, non-intoxicating CBD category, there are three sub-categories. The first subcategory of hemp products use full spectrum CBD, meaning small amounts of different types of THC are retained. Some users regard full spectrum as providing the most beneficial effect. However, full spectrum consumable products can have enough total THC to cross the federal threshold of 0.4 mg, in which case they would be banned beginning December 11^th.

In the second sub-category, broad spectrum CBD has Delta-9 THC, the main kind of THC in cannabis, but the total quantity of is not enough to have any psychoactive effect.

Thirdly, CBD isolate is, as the name implies, just the cannabidiol with other compounds, including any kind of THC, removed.

The worst harm with this whole category of CBD products - it is not a huge harm but it is a harm - is that people are usually spending money on the basis of health claims which are not proven and are not regulated. The actual amount of active ingredient can vary from what is claimed on the package, which is never a good thing. There is, however, strong evidence for the usefulness of CBD in treating epilepsy, although using an unregulated product for this important purpose carries risks.

The second type of hemp-based product is of greatest concern and most in need of regulation. Those are the consumables like gummies and edibles that can have very high levels of Delta-8 or other synthetic THC components. Some makers have gone so far as to put these dangerous psychoactive products into forms and packages which look like well-known, colorful, innocent candies.

No alcohol but still a buzz in the can

THC beverages represent the third type of hemp-based product. I suspect the enormous financial potential of THC drinks sold outside of cannabis dispensaries is the biggest motivator for the hemp lobby to try to kill the hemp ban. Currently these drinks are being put on shelves in stores that sell alcohol.

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Can hemp leapfrog cannabis to get federal approval and regulation?

As alcohol sales decline and cannabis consumption increases, major voices on the retail side of the alcohol industry are in favor of regulating THC drinks made from hemp so that liquor stores and restaurants can sell them. Some major brewers like Constellation (Corona, Modelo), Heineken (Lagunitas), and Coors Molson, along with some craft brewers, are already investing in hemp-based beverages. Restaurant associations are also part of the lobby to legalize intoxicating hemp drinks. This whole beverage segment would love to leapfrog the possibility of federal legalization of cannabis and reap big gains in this quickly developing market.

The big dog in the fight: THC in a can or martini glass

So, to review, in the realm of hemp first we have the fairly innocent CBD products, then the THC gummies and edibles, a segment that has been grossly tarnished by the those who make hemp products targeting a market that doesn’t have an adult understanding of psychoactive drugs and their hazards, including kids who end up hallucinating at school. Third is the big dog in the fight, the hemp-based THC beverage market.

The wild, wild west of cannabis at 90% potency vs. a regulated hemp industry? Hmmm…

The current state of legal cannabis access is a hodge-podge wild west, not regulated at all by about half of the states, with many products having excessive levels of THC. High potency THC in hemp or cannabis products is associated with increased risk of cannabis use disorder and mental illness.

A strong federal structure of cannabis regulation is needed. However, the medical and adult-use cannabis dispensary lobby is influential, bringing in substantial revenues for states where cannabis has been legalized. The cannabis industry is likely to push for a light federal regulatory hand when, and if, it is legalized on the national level. This could mean continued high THC content products in dispensaries.

Could hemp products provide a model for federal approval and regulation of cannabis?

If hemp-based THC beverages are legalized at the federal level, it would likely be with enough regulation and moderation to serve as a model for when the eventual federal legalization of cannabis occurs, assuming it does. So I am rooting for the hemp-based THC beverage industry to succeed in getting sensible regulations in place and soon. I just wish they didn’t have to play mysterious political games to get there in such a volatile and corrupt political environment.

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References

Senator Ted Budd, Republican, North Carolina on Hemp Ban Delay legislation, (August 5, 2026) (Senate).

Bayly R. Ultraprocessed Cannabis: Potency, Policy, and Public Health in America. April 14, 2026. Eating In America. https://www.eatinginamerica.co/p/ultraprocessed-cannabis-potency-policy-aeb

Marijuana Policy Project. What are state regulators doing about delta-8? Accessed September 18, 2026. https://www.mpp.org/policy/federal/delta-8/what-are-state-regulators-doing/

Fitzpatrick J. ‘Reefer Madness’: White House’s hemp reversal divides GOP — and sparks conflict of interest concerns. MS NOW. August 6, 2026. https://www.ms.now/news/white-house-hemp-reversal-susie-wiles

Sholler DJ, Schoene L, Spindle TR. Therapeutic Efficacy of Cannabidiol (CBD): A Review of the Evidence from Clinical Trials and Human Laboratory Studies. Curr Addict Rep. Sep 2020;7(3):405–412. https://doi.org/10.1007/s40429-020-00326-8

Surgeon General nominee Dr. Nicole Saphier will testify at her Senate confirmation hearing tomorrow. If she is approved as Surgeon General it will represent another major corruption of America’s public health authority.

Eating In America previously reported that Saphier owns a supplement company. Her pricey tinctures have unquantified, ultraprocessed ingredients, and the health claims she makes for them are unsupported by science. One of them contains kava root, a supplement that is banned in the U.S. military because of its association with liver damage.

Her involvement in supplements should have immediately dismissed her from consideration as Surgeon General. Newly disclosed is that she has profited by $270,000 from these products.

Equally disqualifying are new revelations in the financial disclosure and ethics agreement she submitted last week that she owns stock in the three major tobacco companies, Altria Group, British American Tobacco, and Philip Morris.

Equally disqualifying are the new revelations Saphier owns shares of Nestlé, a giant ultraprocessed food company, who’s ethics include vigorously marketing infant formula to women who could have breast fed but were convinced by Nestlé to use formula, even though they did not have clean water to mix the formula, resulting in the deaths of hundreds of thousands of babies and children.

Equally disqualifying are the new revelations that she is an owner of Coca-Cola, PepsiCo, Mondelēz, Taco Bell, McDonald’s, KFC, makers of food linked to obesity, diabetes, heart disease, and many other ailments.

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Saphier owns stock in 239 major corporations apart from these nine who peddle toxic products. She did not have to sacrifice profit to make choices that were less abhorrent for a health leader.

With these new revelations of tobacco and sugar-based food investments, Saphier draws even closer to matching the profiles and disqualifications of the two Surgeons General nominees who were “voted off” before her.

As I point out in my May podcast/post “Survivor, Surgeon General,” Saphier shares with the first nominee, Dr. Janette Nesheiwat, graduation from a medical school in the Caribbean and broadcasting at Fox News. With failed nominee #2 Casey Means, Saphier shares profiting from the supplement industry and stated ambiguity about vaccines. Newly disclosed and also thoroughly damning are the tobacco investments Saphier has made, like Means, in Altria Group and Philip Morris.

Trump’s need to insist repeatedly that his choices are right until they are accepted, despite the consequences Americans are suffering, is again reflected in his third Surgeon General nominee, stamped in the very same mold as the first two.

Unfortunately, back in her hearing in February, the Senate paid little attention to Casey Means’ involvement with tobacco, so that black stain on Saphier’s public health resume may not be a factor in her hearing tomorrow.

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References

Saphier, Nicole. Surgeon General nomination, financial disclosure details. September 7, 2026. Provided by U.S. Office of Government Ethics, September 15, 2026.

Saphier, Nicole. Letter of financial disclosure and ethics agreement. September 7, 2026. https://extapps2.oge.gov/201/Presiden.nsf/PAS+Index/54788BB045EFAE6E85258E6E002DFF11/$FILE/Saphier

Bayly R. Survivor, Surgeon General, podcast/post on Eating In America. May 26, 2026. https://www.eatinginamerica.co/p/survivor-surgeon-general-who-will

Are you one of the 300 million Americans who together spend $23 billion to eat breakfast cereal each year? Is there nostalgia in that bowl or just a pleasant-enough dose of food to push you out the door in the morning?

Marion Nestle and Lisa Sutherland’s new book, Sugar Coated, Unboxing the Hidden Forces Shaping America’s Favorite Breakfast Food, is a not-sugar-coated history of the invention and evolution of cereal in America, inspired by and told through an extraordinary collection of Kellogg cereal box reproductions dating back to 1919 and given to Nestle by Kellogg in 2010. Nestle and Sutherland, who was Vice President for Nutrition at Kellogg at the time, understood immediately that these artifacts embodied - and displayed in bright colors - a macro case study of the way processed food has been marketed in the United States in the last hundred years.

Granula, the sanctified but inedible beginning

As Nestle and Sutherland recount the history, the first granola was created in 1863 in a sanatorium in western New York. “Granula,” as it was called, was inedible unless it was soaked overnight.

Nonetheless, the idea for the whole grain breakfast food was quickly appropriated by two brothers, the Kelloggs, who added a moralistic wrapper as they served it along with the beliefs of the health and nutrition conscious Seventh-Day Adventist Church. C.W. Post, of the soon to be Postum Cereals, helped in the kitchen of the Kelloggs’ sanatorium in Battle Creek, Michigan where Post also, let’s not sugar coat it again, appropriated stole the idea of a healthy whole grain cereal.

Snake oil and whole grains

By the turn of the century, the shift from pulpit to profit was complete in the cereal market and soon 100 cereal makers populated Battle Creek. In 1906, health-promising snake oil sales were at their peak in America, but purchases of genuinely healthy cereal were taking off, albeit with the help of snake-oil-like health claims such as Postum Grape-Nuts’ “rebuilds the soft gray matter in your brain.”

Cereal had already been industrialized with extrusion and crushing processes that break the whole grains down into a more digestible form. Some cereal makers in Battle Creek were adding barley malt to sweeten their products, but the elder Kellogg, Dr. John Harvey, was adamantly opposed to sugar in the diet. The younger W.K. Kellogg saw great wealth in the future, however, and in 1906 added cane sugar to the new Kellogg’s Corn Flakes. The road to the prominence of breakfast cereal as a highly- and ultra-processed food in our culture was paved.

The cereal industry’s manipulation of … everybody

In Sugar Coated, Nestle and Sutherland carefully lead us through formulation of cereals over time with the addition of artificial colors, vitamins, minerals, fiber, protein, artificial sweeteners, and, of course, sugar, and lots of it. The book thoroughly and frighteningly tracks the industry’s manipulation of the Food and Drug Administration for food and labeling standards, the Federal Trade Commission for commercial advertising, academia and the nutrition research community for production of the supporting science, along with the USDA and Congress for laws and policies, all to help avoid or reduce regulation and gain license to market in ways that would best promote cereal sales.

Health claims, laughable and cringeworthy

The authors by turn amused and enraged me in sorting out the confusing and contentious history of health claims on cereal boxes, from the reasonable “avoids constipation” of the Kellogg 1919 All-Bran to the icky-sticky endorsement of the America Diabetes Association on boxes of Post’s sugary cereals.

Sugar Coated is bound to be frequently cited for detailing the way the industry has doggedly pursued its marketing goals, through managing to get government regulations changed, creating self-imposed regulation to deflect government efforts to regulate, or just ignoring the rules, often paying the penalty in court while reaping the bigger benefit in sales. Other writers will undoubtedly extend the lessons of Sugar Coated to help examine and link the tactics of highly- and ultra-processed food segments and other industries which market addictive or regulated substances. (I include sugar as an addictive substance, a conclusion W.K. Kellogg himself might have intuited.)

Sugar as the essence of cereal’s rise to be a keystone of the diet of many Americans

As the name Sugar Coated implies and Nestle and Sutherland convincingly detail, sugar has long been the essential ingredient for the success of breakfast cereal, as well as one of the key battlegrounds in regulatory and court struggles. The unhealthiness of added sugar is also the reason that the behavior of the Big Four cereal makers in targeting children is unethical. Of the four giants, General Mills, Kellogg, Post, and Quaker Oats, it is no coincidence that Kellogg, now split into W.C. Kellogg for North America and Kellanova for the rest of the world, is owned by Ferraro, the Italian candy maker, and Mars, the American candy maker. Quaker Oats is also owned by a sugar-centric food maker, PepsiCo.

Candy for the breakfast of kids as a new norm

With marshmallows, chocolate, and candy-names in and on our cereal, we live in a food environment where candy is promoted for breakfast and breakfast is marketed as a sugary snack for eating throughout the day. The authors’ incense at the TV ads, cartoon characters, in-box prizes, colored cereals in unusual shapes, and other marketing tricks that drive the buying of sugar-laden cereal for children is restrained but palpable.

The idea of stop signals to warn us

Change is coming in other parts of the world and Nestle and Sutherland provide examples. The most important and potentially achievable change the authors describe would be the addition of an instantly understandable and nutritionally-sound front-of-box indication of the healthiness of the cereal or other processed food product being examined. This consumer-friendly heads up has been enacted in the form of octagonal stop-sign shaped warnings in the majority of countries in South America and has greatly reduced sugary cereal sales there. Our Secretary of Health and Human Services and the Make America Healthy Again leader, Robert F. Kennedy, Jr., has advocated for perhaps the strongest choice for such a warning system, red-yellow-green light icons. Of course, after reading Sugar Coated, we shouldn’t be left with any delusions about the forces the Big Four and the rest of the highly- and ultra-processed food industry are bringing to bear to fight back against RFK, Jr.’s idea.

Happy birthday, Marion Nestle!

Look at the photo and guess how old Marion Nestle is. This week she celebrated a birthday that ends with a zero.

You probably guessed 70^th and would be in disbelief that it was her 80^th, but it was actually Nestle’s 90^th. Where does the impressive nutrition advocacy, book-producing, interview-giving, lecture-delivering, FoodPolitics.com post-writing energy come from? Good luck, but also good nutrition, Nestle says.

Happy birthday and thank you and Lisa Sutherland, for this perfect insight into the way Big Food markets, lobbies, and formulates its way onto our tables with the only consideration of healthiness being the ultimate effect on the bottom line.

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In two weeks, we’ll set Nestle and Sutherland’s Sugar Coated cereal story in the context of the other choices made in the morning by Americans. It will be Breakfast in America on Eating in America. Please join me then and every week at EatingInAmerica.co.

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Height equals genetics plus nutrition plus health. George Washington was about 6’-2” tall. Trump claims to be 6’-3”, but his draft card and driver’s license said he was 6’-2”.

Average Americans were a little shorter in Washington’s time than they are now, making Washington’s height more impressive. However, average American men were a whopping 5’8”, three inches taller than the average European! Colonial Americans were largely farmers, growing and eating their own food. Apparently, they got more food and better food on the New World farm, and they got taller.

Remembering Wendell Berry

Let me pause here to remember the great American agrarian writer Wendell Berry, who died this week. He wrote a lot about society that is divorced from the farm, that is, most of us today: “The industrial eater is, in fact, one who does not know that eating is an agricultural act, who no longer knows or imagines the connections between eating and the land, and who is therefore necessarily passive and uncritical—in short, a victim.” That’s from the book Bringing it to the Table. Thank you, Wendell Berry.

The equation for good teeth

Back to teeth. Good teeth equals genetics plus nutrition plus health plus good dental care.

The dental situation is where Washington came up short

There was no or little added sugar in Washington’s growing up years, but also no added fluoride, no toothbrushes, and nothing similar to the professional dental care we have today.

Washington lost his last tooth while he was President. None of his various dentures ever fit well, causing him problems like being reluctant to speak in public.

I wrote recently about how Washington’s mandatory smallpox inoculation measures were possibly critical in the eventual success of the Continental Army. An incident involving the General’s teeth helped deceive the British about Washington’s ultimately successful attack on Yorktown, Virginia.

A stolen letter and a lost battle

Washington had written to his dentist in Philadelphia asking him to send tooth cleaning tools, saying that he, Washington, wouldn’t be in Philadelphia soon. The letter was intercepted by the British and unintentionally helped convince them that Washington’s plan was to stay north and attack New York City. Because of this Cornwallis received no reinforcements at Yorktown and lost the battle to Washington, leading to the end of the Revolutionary War.

The very unpleasant, unethical makeup of Washington’s dentures

Those dentures the General was trying to take care of? Not wood, but the ivory bases were so brown-stained that an observer might think so. The teeth in various of Washington’s dentures consisted of a few of his own teeth that had been removed, along with “purchased” teeth extracted from people enslaved by Washington at Mount Vernon. Cow, donkey, and horse teeth were also used, along with ivory from a hippopotamus, a walrus, and maybe an elephant. The mandibles were spring loaded to open, and the teeth were embedded in lead, tin, copper, and silver alloys.

American oral health has improved a lot since Washington’s day

The huge increase in dental health began in the 1940s as the era of the ultra-processed was getting started with the technical innovations devised for military food. Two changes in dental care happened just in time to save our teeth, somewhat, from the flood of carbonated, sugared sodas and ultra-processed foods with refined starches and added sugars which was just about to come.

Give me 100 pushups and brush for two minutes

It was the military that changed American dental habits. Badly hampered in readiness by dental issues like Trench Mouth in World War One, the military made it a firm policy that troops in World War Two would brush daily. They were provided with toothbrushes and powder or paste, supplies that many, perhaps most, could not afford before joining up. Brushing was a habit brought back home in the 1940s by many millions of troops.

The other big change was fluoridated water. Fluoridation of the water supply was first tested in Grand Rapids, Michigan in 1945. In ten years, tooth decay in the city’s 30,000 school children had dropped 60%. Today over 209 million Americans receive caries protection from 17,400 fluoridated community water systems. Community water supplied populations which receive fluoridation range from an extreme low of 8.5% in Hawaii, mostly on military bases, to a low of 16% in New Jersey, to around 90% to 100% in many southern and rural states. Globally, 25 countries have fluoridated systems.

Tooth decay remains a public health issue

Despite these changes and big improvements, tooth decay, or caries, remains a public health issue because of all the pain, infections, time lost from work and school, loss of teeth, and costs. It’s the most common chronic disease in children, with half of nine-year olds having already developed caries. And for people over 65, one-quarter have severe tooth loss, meaning they have only eight or less teeth remaining. All the teeth are gone in fifteen percent of older Americans. Socioeconomic disparities and inequities continue to exist in oral health, particularly impacting poor children, but those disparities have tended to lessen as dental health has gotten better in America.

Tooth decay down 26% with fluoride in the water

Fluoridated water can reduce caries 26% in permanent teeth. This varies depending on factors like the use of fluoride toothpaste in a population or whether the water supply contains natural fluoride. Fluoride is the 13^th most common element in nature and some community water systems and many private wells contain higher levels of natural fluoride than the low level added to fluoridated systems.

Fluorosis

Too much fluoride can cause fluorosis. In its mildest form, fluorosis can cause almost invisible white flecks on the teeth. Acute fluorosis comes with gastrointestinal problems. In a combination of data from 40 other studies, researchers found fluorosis to the degree of showing as spots or streaks on teeth, an esthetic concern, in 12% of people. Another study found that fluorosis is mainly diagnosed in children age five and under who might have swallowed too much fluoridated toothpaste.

Fluoride applied directly to the teeth through toothpaste or treatment at a dentist’s visit is by far the most effective method of delivering protection.

$120 billion on tooth care per year

In 2015, Americans spent $120 billion on their teeth and gums. That spending reduced productivity losses, which were still $46 billion. But fluoridation is the hero for dental return on investment. Every dollar spent on fluoridation decreased dental costs and productivity losses by $20.

From a public health standpoint, fluoridation is especially beneficial to those who can’t or don’t access regular dental preventive health services or don’t use fluoride toothpaste.

Despite the unquestionable and highly important benefits of fluoridation, community fluoridation is still an issue for many. The concern is not just fluorosis but also the potential risk to IQ.

IQ and fluoride

A recent analysis combining the results of other studies found a relationship between loss of IQ and increased level of fluoride from all sources. A big caveat of this analysis is that it did not include any direct data of the effect on IQ at the low level of fluoride added to community water systems. More research is needed around the possible effects of low levels of fluoride before the public health benefits of fluoridation are sacrificed.

In addition to fluoride in drinking water, toothpaste, or dental treatments to prevent cavities, dental sealants should be applied to the back teeth of children and young adults. Sealants can prevent 80% of cavities, and 9 out of 10 cavities are in the back teeth.

You are putting what in my mouth?

Throughout history the dental profession has promoted the use of various substances in our mouths which have been great for dental results but can be cringey when other health concerns are considered. Just drawing from the past 100 years, I am thinking of mercury amalgam fillings; BPA or Bisphenol A and a host of other toxic chemicals used in composite fillings, retainers, and sealant; Teflon for brace wires; arsenic to kill tooth roots; formaldehyde to remove the pulp in an infected baby tooth; and chloroform to dissolve the roots of teeth in a root canal operation. About the mercury and BPA-containing fillings: better than the molten lead fillings French dentists would pour as hot liquid into their patients mouths in the 1700s, right?!

And then there are the liberal x-rays, the radiation dose of which has been cut dramatically in the digital age.

Today, these toxic substances have been eliminated or greatly reduced in dental treatments. Of course, there are other materials and chemicals used in dental care outside the office. Almost all toothbrushes have nylon bristles that can shed microplastics. Dental floss is made of nylon or, much worse, Teflon, as in Glide floss. Even natural products maker Tom’s of Maine uses nylon in its floss.

Mouthwash and the possible negative effect on heart health

And then there’s mouthwash. The concern most worth considering is that anti-bacterial mouthwash wipes out beneficial bacteria in the oral microbiome. A 2023 set of papers reviewed the evidence and could not conclude if the effect of anti-bacterial mouthwashes, which can improve dental health, are harmful to overall health, mainly through killing bacteria in the saliva which help convert good nitrates from vegetables into nitric oxide in your blood. Nitric oxide is a vasodilator that relaxes your blood vessels, lowers your blood pressure, and is protective against heart disease. More research on mouthwashes is required.

Doctors and dentists: is having such separation good?

By the way, did your primary care doctor ever ask if you were seeing a dentist regularly or take a peek at your dental records? None of my doctors ever did. For dentists and dental insurers, it’s the opinion of the American Dental Association about the benefits of a treatment that most matters. The dental results come first, and the overall health perspective is not represented in our dental health choice making. The separation of dental care from other medical care in our society is probably not to our benefit. The division seems sort of strange.

The tunnel vision and the benefits of dental innovations

I don’t mean to be too harsh on the dental profession. Humans tend to look to new technologies for solutions without fully understanding the long term consequences. That tunnel vision has happened repeatedly in dentistry. Our FDA has long accepted this approach to the industrialization of our food supply, allowing all sorts of chemicals to corrupt our food without much scrutiny.

However, in contrast to what has happened with the gratuitous de-naturalization of the food environment, these dental technologies have given us much better teeth and gums, with less pain and cost and more comfort, beauty, and durability. But, yes, I asked about the amount of BPA exposure before I allowed the dentist to put sealant on my kids teeth.

Can I get a dental chair for my living room?

One dental technology cannot be quibbled with: the modern dental chair, which first appeared in 1958. For me, a dental procedure, even a cleaning, can be exhausting because of the potential for pain. Nonetheless, this year, in the middle of a long and very complicated root canal procedure, I fell asleep in the chair…while being worked on.

The “caines”

Thank goodness for the “caines.” Cocaine was a good local anesthetic for dentistry before the 20^th century. I know how good it can be to numb pain locally. I once had an operation on my nose septum where the doctor used only cocaine, but plenty of it. I looked out from under the eye covering to see him pounding on my nose with a steel chisel and hammer. He asked how I was doing.

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In this post:

• New evidence on the worrisome, lifelong health effects of sugar in the first 1,000 days

• American infant formula promotes obesity and many other diseases

• American formula is primarily added sugar: corn syrup is prominent and even most of the lactose is refined

• Do formula makers like corn syrup because it gets infants to drink more?

• RFK, Jr. needs to make Big Formula back down to fulfill his goal of reforming formula in any meaningful way

• The added sugar Mom eats is “secondhand sugar” for the fetus

• 2025 Dietary Guidelines: no added sugar up to age 10. Radical?

Take a folic acid supplement if you are trying to get pregnant; don’t drink, smoke, or take drugs during pregnancy; hold and love your baby and use breast milk if available. Talk to your infant a lot. These we know.

New evidence about the health effects of sugar in the first 1,000 days

With the appearance of a new study, the evidence is now very strong for another recommendation that should be on the list already but is not always expressed by an obstetrician, pediatrician, or other relied on sources of pre- or neonatal information. It should be a must-add: don’t feed your fetus, baby, infant, or toddler added sugar.

Withholding added sugar from a fetus or child still seems like a bit of a radical idea today, even as we have established the role of refined sugar as a cause of obesity, but there was a time it wasn’t a choice.

George Washington did okay without sugar

Three hundred years ago sugar was an expensive luxury for the tea cups of the rich. Few kids or adults had much opportunity to enjoy it. The neural pathways of fetuses and babies were not re-shaped by exposure to sugar, because there were very few houses with a sugar bowl on the table and none with highly-processed food in the pantry.

That changed during the course of George Washington’s lifetime. Born in 1732, our first President likely ate little sugar as a child. That deprivation didn’t stop him from growing exceptionally tall, very athletic, and into a great leader. But by the 1800s and its industrial innovations in processing, sugar had transformed into a commodity, produced cheaply in massive quantities by enslaved labor on plantations in Haiti, Cuba, Mississippi, Louisiana, Brazil, and Java. Sugar had become part of most people’s diets. Today the pleasure, acceptance, and assumption of refined sugar in the diet is engrained in parents, great-grandparents, obstetricians, pediatricians, politicians, and, unfortunately, nutritionists and public health scientists, including me, around the globe. What’s a baby to do?

The evidence brought forward by several papers in the last few years provides compelling reasons for us grownups to do more.

Here’s the clever way this evidence has come together.

War time rationing in the UK: babies who had sugar and babies who didn’t

From the wartime rationing of 1942 all the way until 1953 each person in the United Kingdom, rich or poor, received about 1 cup of sugar a week and 3 ounces of sweets. Children two and under received no ration. Sugar rationing ended throughout the UK on one day in September 1953, and families could suddenly buy as much sugar as they wanted, and they immediately bought a lot.

The UK Biobank has medical and biological data for a half-million people. A large number of these spent their first 1,000 days of development just before, just after, or right through the abrupt end of sugar rationing. Those 1,000 days from conception through the second birthday are a critical period for child development. What happens in those first 1,000 days has been tied to obesity, cardiovascular disease, asthma, mental health, diabetes, and cancer.

A “natural experiment”

The way the Biobank data overlapped with the end of sugar rationing allowed our sugar researchers what is called a natural experiment, a comparison of two groups, one of which was exposed to a real life condition, in this case sugar rationing, and other not exposed.

Using the Biobank in this way was such a good idea that several groups did it, each analyzing a group of 60,000 to 65,000 people, the ones that bracketed the end of sugar rationing.

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Evidence of disease from the data of people born as sugar rationing ended

First, Gracner and team found that those who spent their first 1,000 days with restricted sugar had better outcomes later in life for type 2 diabetes and high blood pressure.

Two more teams followed with a look at the data for cardiovascular outcomes, finding that heart failure, cardiovascular disease, myocardial infarction, atrial fibrillation, and stroke were all a greater risk for those whose sugar consumption had not been restricted in their first 1,000 days.

Cancer and sugar in the first 1,000 days

Next, researchers Chen Zhu and Weilong Zhang went back to the same Biobank data and asked if restricting sugar in the first 1,000 days could reduce the risk of cancer? They found that, yes indeed, restricting sugar from womb to 2 years old is very protective. The adults who started life before sugar rationing ended had a reduced chance of cancer for each cancer they looked at: 69% for liver, 40% for rectum, 41% for lung, 52% for prostate, and 36% less chance of breast cancer.

What can explain these good results? The authors found that five decades after birth, sugar-restricted people ate less sugar and less food, and their diets were healthier and more diverse. They also had reduced levels of chronic inflammation. They also found that the telomeres of these folks had aged 2.2 years less than the telomeres of the people who came on board life after sugar rationing stopped.

Longer chromosome “shoelaces” with less sugar

What are telomeres you might ask?

Telomeres are the bits at the ends of chromosomes that protect the genetic data when a cell divides. They’re like the plastic tips of a shoelace. The telomeres get shorter every time a cell divides. Eventually the telomere gets too short and the cell dies. Getting an extra 2.2 years of telomere life is a good thing, sort of like when you buy a tire that’s rated for an extra 10,000 miles. Except that tires can be replaced, and some cells, like brain cells, once they’re gone, they’re gone.

So, to recap, Zhu and Zhang found that restricting sugar during pregnancy up to the second birthday caused, and they use the word “cause”, a reduction in cancer, chronic inflammation, and cellular aging as those children turn into adults.

This, combined with reductions in diabetes, high blood pressure, heart disease and stroke, makes a convincing case for adding a recommendation to restrict, if not eliminate, sugar exposure in the first 1,000 days.

Lots of recommendations not to feed added sugar before age two

But wait, the American Heart Association recommended no added sugar for children under two in 2016, ten years ago! And the American Academy of Pediatrics followed suit in 2019! And the Dietary Guidelines for Americans said this in 2020!

Whew! I guess new moms and dads already know what to do when it comes to sugar.

Unfortunately, the FDA does not regulate the carbohydrate content of baby formula or require amounts or types of added sugars to be stated on the label. This is not the case in other parts of civilization or for adult food in America. If knowing added sugar content is helpful for adult nutritional health, surely it’s helpful to make sure infants are getting the best nutrition?

Why the FDA needs to act

The FDA’s lack of ingredient control and labeling matters a great deal. According to a study published last year, of the 73 infant formula products available in the U.S. across three major brands (Similac, Enfamil, and Gerber/Nestlé), one smaller brand, and some store brands, only a few have naturally occurring lactose as their primary carbohydrate. Lactose is a sugar designed by evolution for mammals at an early stage of life. Almost all of the carbohydrate in human milk is lactose. Natural lactose is bound to fats and proteins in the mother’s milk and is digested somewhat slowly.

Added refined lactose is an added sugar and acts like it

A little more than half the formula products in the U.S. use added lactose which is refined. Refined lactose is like other refined sugars and isn’t bound to the fat and protein in the formula. It absorbs into the baby’s blood fast, spiking blood sugar and then insulin in response. And lots of formula products use other refined sugars apart from lactose, like glucose, maltose, or sucrose, all with refined lactose’s fast absorption and insulin response.

American formula is primarily added sugar

With no FDA requirements to use primarily natural lactose and to provide details of the carbohydrate ingredients, American parents and caregivers have no way to know that they are usually giving their babies primarily refined sugar and not natural lactose. I could not tell the proportion of natural to refined lactose from reading any of the formula containers I checked.

The Wirecutter doesn’t get it

Parents are not getting the info. In June, the Wirecutter section in the New York Times rated the six best infant formulas on the market in the U.S., in their opinion. They claim to have read 20 scientific articles in their research, but five of the six papers they cited were published nine or more years ago. Their seven expert interviews were mostly from 2022 or before, and more than half were with formula makers, none of whose formula sales websites said anything about natural lactose versus refined.

In essence, The Wirecutter reported that the FDA had baby needs covered, and all U.S. sold formulas were good. Wirecutter completely missed both that there is an important difference between natural lactose and refined and that FDA-approved formulas contribute to later obesity, and are not adequate for normal growth as The Wirecutter claims, unless obesogenic is the new normal.

U.S. baby formula is obesogenic: it promotes obesity

A whole lot of education needs to happen, even for New York Times writers.

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It’s good to remember that parents might use formula early in their baby’s life for reasons including low breast milk production, medical issues, lack of paid family leave, a need to get back to earning, or their baby is adopted.

Natural lactose is more costly than refined lactose, but if the potential health differences between natural and refined lactose were publicized, I would expect there would be a larger market for natural. If the FDA were to up-regulate the natural lactose content of formula, some consideration would be needed so that access for families with less income would not be limited.

Corn syrup is a prominent ingredient in formula

Natural lactose is the most costly carbohydrate to meet the requirements of formula. Corn syrup, corn syrup solids, and other refined sugars are widely used, replacing some or all of the lactose. These sugars are not only cheaper than both refined and natural lactose, they are sweeter. Babies on formula tend to drink more than babies who are breastfeeding. The reward of sweetness increases consumption of a food in adults and might be true in babies. Formula makers are ultraprocessed food makers, and ultraprocessed food makers generally are happy to sell more product by increasing consumption.

Does corn syrup sell more formula?

I am perhaps jaded by the global formula behemoth Nestlé’s completely unethical, infanticidal marketing that contributed to hundreds of thousands of child deaths over decades for children who were receiving formula when they should have been breastfed. To me, the level of evil of Nestlé in this marketing of formula was considerably worse than that of Perdue Pharmaceuticals in marketing deadly opioids. It was, after all, babies dying from drinking formula made with unclean water when breast milk was available.

So forgive me for wondering if adding cheap, very sweet sugars instead of lactose is seen as both a cost-saving and a revenue-increasing recipe by the American formula makers, one of whom is Nestlé, owner of the Gerber label.

Operation Stork Speed: putting on the brakes?

Soon after RFK, Jr. was confirmed as Secretary of Health and Human Services, the FDA announced Operation Stork Speed, an effort to review infant formula nutrients for the first time since 1998, and to increase testing for contaminated formula. The Request For Information period closed a year ago, but there has been no announcement yet of any conclusions or actions to improve the nutrition of formula.

There is a clear pattern of delays in major action in Trump’s HHS as the ultraprocessed food industry pulls strings to protect its interests. This delay in updating formula regulation cannot be for a lack of clear evidence of ways to improve formula. Forbidding corn syrup and similar sugars, like the Europeans do, would be a first step, along with labeling that details the amount and types of added sugars. These are low hanging fruit.

Is Big Formula involved in a delay of the first phase of re-regulation of U.S. formula?

A recent FDA press release says there will be a phased approach to nutrient review based on available evidence, but perhaps it neglected to say that enacting a plan might depend on the degree of resistance from the Big Formula lobby. In fact, while the release failed to announce progress on the review of nutrient content and labeling, it played up a focus on potential formula contaminants, an area in which the formula industry is cooperative.

European formula imported for quality

There was a shortage of formula in America in 2022 as bacterial infections caused factory closings for Similac and other Abbott brands making up 40% of the U.S. supply. To help ease the crisis, individuals were allowed to import European formula for personal use. Today, some people who can afford it, import European formula because it is organic or because it forbids corn syrup as an ingredient.

Lots of sources for added sugar in the first 1,000 days

But it is not just formula that can be a source of added sugar in the first 1,000 days. Snacks, baked goods, fruit-concentrates, flavored yogurt, fruit-flavored beverages, sweetened milk, and breakfast cereals are all sources of added sugars.

Mom’s added sugar is “secondhand sugar” for the fetus

During gestation, sugars the mother consumes are available to the fetus through the placenta and have a “secondhand sugar effect.” The 1,000 day sugar-rationing studies found that sugar levels delivered in utero had a role similar to post-natal sugar consumption.

It has been 10 years since the American Heart Association told us no added sugar should be given in the first two years after birth, and six years since the Dietary Guidelines followed suit.

2025 Dietary Guidelines: no added sugar up to age 10. Radical?

And the new 2025 Dietary Guidelines for Americans recommend, rather radically, no added sugar up to age 10. Now it is time for the government to cut their teeth and start biting down on those recommendations.

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References

Zhu C, Zhang W. Early-life sugar restriction causally reduces adult cancer incidence and slows biological aging. Proc Natl Acad Sci U S A. 2026;123(32):e2610287123. doi:https://www.pnas.org/doi/abs/10.1073/pnas.2610287123

Xu A, Guerlich K, Koletzko B, Grote V. Nutrition interventions in the first 1000 days and long-term health outcomes: a systematic review.

Gracner T, Boone C, Gertler PJ. Exposure to sugar rationing in the first 1000 days of life protected against chronic disease. Science. 2024;386(6725):1043–1048. doi:https://www.science.org/doi/10.1126/science.adn5421

Zheng J, Zhou Z, Huang J, et al. Exposure to sugar rationing in first 1000 days after conception and long term cardiovascular outcomes: natural experiment study. bmj. 2025;391doi:http://dx.doi.org/10.1136/bmj-2024‑083890

Tang H, Zhang X, Huang J, et al. Sugar rationing during the first 1000 days of life and lifelong risk of heart failure. Nature Communications. 2026/01/21 2026;17(1):1894. doi:https://doi.org/10.1038/s41467-026-68713-9

Chadwick L. Telomeres. National Human Genome Research Institute, NIH. Updated August 29, 2026. https://www.genome.gov/genetics-glossary/Telomere

Vos MB, Kaar JL, Welsh JA, et al. Added Sugars and Cardiovascular Disease Risk in Children: A Scientific Statement From the American

Rips-Goodwin AR, Jun D, Griebel-Thompson A, Kong KL, Fazzino TL. US infant formulas contain primarily added sugars: An analysis of infant formulas on the US market. Journal of Food Composition and Analysis. 2025/05/01/ 2025;141:107369. doi:https://doi.org/10.1016/j.jfca.2025.107369

Szalinski C. The Wirecutter: The Best Baby Formula. New York Times. June 12, 2026. https://www.nytimes.com/wirecutter/reviews/best-baby-formula/

Uwaezuoke SN, Eneh CI, Ndu IK. Relationship Between Exclusive Breastfeeding and Lower Risk of Childhood Obesity: A Narrative Review of Published Evidence. Clinical Medicine Insights: Pediatrics. 2017;11:1179556517690196. doi:https://journals.sagepub.com/doi/abs/10.1177/1179556517690196

Kong KL, Burgess B, Morris KS, et al. Association Between Added Sugars from Infant Formulas and Rapid Weight Gain in US Infants and Toddlers. The Journal of Nutrition. 2021/06/01/ 2021;151(6):1572–1580. doi:https://doi.org/10.1093/jn/nxab044

Anttila-Hughes J. Mortality From Nestlé’s Marketing Of Infant Formula In Low And Middle-Income Countries. 2018. 24452. https://www.nber.org/system/files/working_papers/w24452/w24452.pdf

HHS, FDA Announce Operation Stork Speed to Expand Options for Safe, Reliable, and Nutritious Infant Formula for American Families. U.S. Health and Human Services Department; March 18, 2025, 2025. https://www.fda.gov/news-events/press-announcements/hhs-fda-announce-operation-stork-speed-expand-options-safe-reliable-and-nutritious-infant-formula

Food and Drug Administration. Operation Stork Speed. U.S. Health and Human Services Department. Updated July 13, 2026. https://www.fda.gov/food/infant-formula-homepage/operation-stork-speed

Goran MI, Plows JF, Ventura EE. Effects of consuming sugars and alternative sweeteners during pregnancy on maternal and child health: evidence for a secondhand sugar effect. Proc Nutr Soc. Aug 2019;78(3):262–271. doi:https://doi.org/10.1017/s002966511800263x

The RFK, Jr. press conference two weeks ago was billed as a “celebration…of landmark actions…The event will highlight…Trump…accomplishments…and announce two major new food policy actions.”

This press event billed as announcing major food policy wins contained nothing impressive. One announcement was for a very partial measure to address the Generally Recognized As Safe loophole, and the other item was a non-announcement saying, in effect, that the much anticipated definition of ultra-processed food is still being kept a secret.

Big Food has a big foot in the door of the White House

As I have reported, Big Food has been working hard in Washington to minimize the damage that could come from the regulation of highly- and ultra-processed food, or HUPF. HUPF started out as a top issue of RFK, Jr.’s Make America Health Again agenda, with the initial MAHA Assessment report in May of 2025 mentioning ultra-processed more than 40 times. However, the MAHA Strategy Report, released the following September, mentioned ultra-processed only once, saying it needed to be defined in order to be researched. The squashing of discussion of HUPF was a result of pressure from the HUPF manufacturers. Now, almost a year after the MAHA Strategy Report, CEOs and industry associations have been lobbying the administration to delay the release of the definition that has been presented to the White House.

The disappearing HUPF definition

In fact, it seems as if RFK, Jr. was planning to release the definition two weeks ago, but, presumably, last minute pressure from the food industry caused him to announce only that the proposed definition was still being reviewed.

The proposed Generally Recognized As Safe loophole rule: Please don’t call this a win.

It looks like another loss for consumers, in favor of industry. However, compared to the non-news with the HUPF definition, slightly more progress was announced by Kennedy on the Generally Recognized As Safe loophole that has allowed an estimated one thousand substances to be introduced into the food supply without notice to the FDA. One thousand is the non-profit NRDC’s rough estimate, but the real number may be much higher. No one knows.

Further, the manufacturers are self-certifying these substances as safe for consumption, and the FDA and the public do not know how reliable that self-certification is.

If a new FDA rule is activated, manufacturers will still be able to self-certify safety and introduce the substances into the food supply. They will have to notify the FDA of both new and previously introduced substances.

It’s not clear when or whether the food or additive will need to be pulled from the market if the FDA takes objection to the manufacturer-funded safety certification. It is clear from decades of FDA underfunding and inaction and Trump’s recent deep cuts in FDA personnel, that, when inundated with hundreds, perhaps thousands of notifications of new and previously added substances, the FDA will have a very difficult, perhaps almost impossible, time working through the backlog of substances to pick the most worrisome to review. No new funding has been promised in conjunction with Kennedy’s announcement.

A database of food substances/chemicals/additives will be public

At least the newly revealed food substances will be added to a public database where scrutiny from outside scientists could potentially shed light on the riskiest additives that the public is consuming or the most questionable safety self-certifications.

The gaping GRAS loophole

So, in reality, the GRAS loophole is not closing. As Melanie Banesh of EWG, the Environmental Working Group, has put it, mandatory notification is a “first step” in GRAS reform, which also needs the creation of scientific standards and review by the FDA before chemicals are introduced to our food, along with review of the substances that have already been introduced under GRAS. As Benesh puts it: “Americans deserve a system where food safety decisions are made by independent experts at the FDA – not by the companies that profit from selling these chemicals.”

Will Big Food or consumers benefit from the delayed HUPF definition?

And as for the further delayed HUPF definition, when it is released, I would not be surprised if it is designed to be more helpful to the HUPF manufacturers than to those who would regulate or study HUPF.

Every food substance created in the last two hundred years is HUPF

In reality, every food, food-like substance, or additive created since the mid-1800s – the beginning of the Second Industrial Revolution – is highly-or ultra-processed, or HUPF. It is only with the technology of the last two hundred years that we have been able to create new foods, and they are, by virtue of that technology, at least highly- if not ultra-processed. If it didn’t need technology and it was good to eat, it had already been introduced as a food hundreds of years ago.

This HUPF definition even applies to ingredients like refined sugar and flour, which have been around since before the Industrial Revolution but only became a problem when industrial technology made them cheap, plentiful, and consumed in unhealthy quantities!

A broad definition of HUPF is not sufficient for policy making. HUPF is too complex.

The way HUPF has been defined in the last twenty years, initially by Carlos Monteiro or in my own definition, is too broad as a category to make policy and conduct new, helpful research. HUPF comes in many subcategories based on its ingredients, and these subcategories may be related to very different health outcomes such as cancer, heart disease, diabetes, gut biome disruption, respiratory disease, and decreased mental health, for examples.

All types of HUPF are not created equal, and I predict the coming industry-influenced definition from the American government will play upon this complexity to delay research and regulation. It may be up to the states, national governments elsewhere, and the academic community to provide meaningful progress on regulation of different types of HUPF.

For my own, time- and technology-based definition of HUPF, see Refining a Highly-Refined Food Definition.

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There’s a big food story from the Trump administration this week. It goes right back to the Eating on Board story from a few weeks ago here on Eating In America. I did a podcast and post in conjunction with the Tall Ships that sailed the East Coast in honor of America’s 250^th birthday. We talked then about the role of food in keeping up the morale of sailors, and that very topic has exploded with the retreat of the USS Lincoln from the Iran War theater due to the political cost of further deployment while the ship is struggling to feed its troops.

Today, the exposure of our sailors and Marines at sea in the Middle East to inadequate food and deteriorating morale is risky for them and the forces they support in an ill-conceived, unauthorized, unpopular war that is bleeding our resources and endangering our troops, nation, the world, and innocent civilians in many countries without a clear, believable goal.

Trump’s war in the Middle East is a disaster. There are tens of thousands of sailors and Marines at sea who are, or could be, in harm’s way. Several sailors on the Lincoln have attempted suicide. The Navy knows how to feed them in the best possible manner for deployment at sea, but the system is failing these troops.

Weight-loss is not meant as an enticement to enlist

Diet profiteers are everywhere in our society, but weight-loss is not meant to be a benefit of enlistment. It’s a cruel joke, but I wouldn’t put it past Trump to say it in public, given his complete public dismissal of the problems brought to light on the USS Abraham Lincoln and the USS Tripoli. There are multiple reports of severe weight loss and consequent reduction of physical and mental fitness among sailors and Marines aboard vessels deployed to the Middle East. These troops are not being served enough food, and the food they are being served is often not appetizing, but they are expected to do their jobs and be ready for attack in an ongoing war.

Seven tons of food a day

I visited the USS Intrepid, a huge floating museum, in New York City two weeks ago. The aircraft carrier, which saw action in World War II and the Vietnam War, was crewed by up to 3,400 troops. The men on the Intrepid required seven tons of food each day. That’s 14,000 pounds of food.

Navies have known for millennia the importance of food for morale and to keep up health, both physical and mental. Food planning has always been fundamental. Even on voyages of Greek mythology, food shortages were deadly, as we’re reminded in several scenes of the new movie re-telling of the Odyssey.

Napoleon Bonaparte invented the processing of canning fruits and vegetables for his sailors. Similarly, his nephew, Napoleon III invented margarine to replace butter, which could only last one week at sea.

The armed services know exactly what they are doing with food

The U.S. military devotes significant resources to optimizing the food and nutrition provided to its troops. The Food Utilization and Energy Laboratory (FUEL) provides the Navy with hard science on warfighter nutrition for high-stress environments, energy utilization, and performance optimization. During World War II the Natick Soldier Systems Center outside Boston developed many ultra-processed foods with the goal of keeping troops fed in heat, cold, and stressful conditions.

I visited the Natick Soldier Systems Center a few years back to investigate research being done there to optimize the gut microbiome for combat performance. It is a little ironic that the very lab that invented foods that could disrupt the gut microbiome was now inventing foods to optimize that biome. But it was all being done with the goal of helping our fighting forces survive combat

.So the Navy knows exactly what and how much food stuffs to put on board every vessel from an aircraft carrier to a submarine and how that food can best be prepared for purposes of morale, physical health, strength, and energy. They know how much fresh food they can leave port with and how much must be canned, frozen, dehydrated, or dry. What a military food scientist cannot know is the exact nature of the bad conditions that will occur in a war, and conditions have gotten bad in the war on Iran.

Persian Gulf Navy supply hub was a predictable Iranian target

The Iranians destroyed the functionality of the U.S. supply hub on the island of Bahrain in the Persian Gulf, directly across from Iran. Trump should have taken into account, and maybe he did, that this was a vulnerable and likely target for Iran’s missiles. After the depot’s destruction early in the war, the logistics and supply hub had to be moved 2,200 miles away to Diego Garcia in the Pacific. Replenishment of food, weapons, and other supplies became a massive problem, which likely played a large part in the morale crises on board the Lincoln and the Tripoli.

Morale on board reflective of events and attitudes at home?

Also, I suspect – there is little hard data, although some investigators like NPR have made a good case – that decisions in the White House and Pentagon, an upheaval of culture in the military with a downgrading of minorities and women in promotions, political firings, dissatisfaction of the American public, uncertainty about the Iranian war goals, and constant shifting in strategy have been factors in the downward direction of morale. Remember, the Commander in Chief of our armed forces has called troops who gave their lives fighting for America in World War II “suckers” and “losers.”

What is certain is that the chef in charge on a navy vessel is likely to be highly experienced, extremely well-organized, very creative, and absolutely dedicated to his or her role in boosting the morale of the troops eating his or her food.

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A sailor testifies to the importance of food on board ship

Here is a former enlisted seaman, who said his name is “Joe,” describing the role of a sailor’s meals at sea. I recorded him as he was about to board the USS Intrepid aircraft carrier:

Your morale is directly tied to food. I was on a small ship, a destroyer, DDG-64 [the USS Carney], so we had usually a bit of a better quality of life for food ‘cause our cooks weren’t making meals for 5,000 people. They had to do 300. So our food was a little bit better quality. We knew our cooks. We talked to them every day, gave them hell when they messed something up. When the food was good, it was great. It made us a lot happier. It was also a great way of telling what day of the week it was. Tuesday is tacos, burger Wednesdays, pizza Fridays, Sunday was brunch. And if you forget everything else out there, as soon as you get burgers for lunch, you know, okay it’s Wednesday. That’s what’s going on now.

Last week Retired Chief Petty Officer Thomas Nutzmann described being at sea in the Navy Times: “There’s no Monday, Tuesday, Wednesday, it’s just a day…You can only do so much to keep morale up before you hit a stalemate … and that’s where the deterioration is.”

Four million meals in nine months at sea

Since the USS Abraham Lincoln was deployed in November, the seven galleys on board have served about 4 million meals. That’s a small miracle in itself, but with troops going so hungry they are losing 20 to 30 pounds on a deployment that is not yet over, that’s a major system failure.

Let them eat steak and lobsters, like they deserve

It seems unprecedented and an indicator of how arbitrary and unpopular the Iran War is, but the Lincoln is now sailing home from the Middle East, on the strong winds of public outrage and media attention. I hope at some point before they get to port, the Lincoln will be able to get a few thousand ribeyes on board and just as many lobsters to give the sailors and Marines the Navy’s traditional steak and lobster dinner to thank them for their extended service.

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“It’s scientifically proven to function!” Rose Byrne and Seth Rogen scream repeatedly and absurdly about the energy drink to which their characters have become addicted in an episode of the series Platonic.

But is that energy drink scientifically proven to function, and, if so, to do what?

Today I look at the place of energy drinks in our food environment, their health risks, and how the Big Tobacco playbook has been used to stop efforts to protect our youth from those risks.

Red Bull, Monster Energy, and Celsius are the top three energy drinks in America. Coca-Cola owns about 20% of Monster Energy and Pepsi-Cola is in a partnership with Celsius. There are plenty of other brands, some of which highlight their drink’s health benefits, but the inclusion of caffeine is universal, usually anywhere from a cup of coffee’s worth or up to double that amount.

The sugar fix is in

Red Bull, Monster, and Rockstar Energy (another leading brand) feature over 50 grams of sugar (200+ calories) in their sugar-sweetened products, which is the bulk of what they offer. That amount of sugar is double the American Heart Association recommended daily limit for women and 50% more than the daily limit for men.

The appeal

These three brands seem to target young males with extreme sports as the centerpiece of their marketing, often along with images of women in poses meant to appeal to men and boys.

The energy drink demographic ranges from adolescents to young adults. The Gorilla Mind brand’s flavor lineup is typical:16 flavors all in the genre of Blue Raspberry, Rocket Frost, and Candy Apple

Like Gorilla Mind, a number of other energy drinks market their ability to sharpen your brain. FOCUSAID claims it provides “brain boost” with nootropics, also called “smart drugs” or “cognitive enhancers.” These are unfamiliar ingredients like GABA, alpha-GPC, and acetyl-L-carnitine.

Are these products safe?

There are a lot of concerns. The high sugar content; the heightened caffeine consumption that may be accelerated by drinking a cold, sweetened beverage; the ultraprocessed mix of ingredients; and perhaps, most of all, the glorification of these drinks in association with dangerous sports, including race car driving, stunt bikes, and ultimate fighting.

For example, Monster Energy and the motorcycle jump: from the top of a thirty-foot high cliff straight down to land on a pile of dirt. This is not what most parents would want to watch their 17 year old do, no matter how prepared with caffeine, sugar, and vitamins.

Energy drinks + alcohol: the wide-awake drunk

Add to this the rising concern about the frequent use of energy drinks in conjunction with alcohol: it’s called the wide-awake drunk. Stunts like going off a thirty-foot high cliff on a motorcycle somehow seem more likely if alcohol were to be involved along with an energy drink.

Red Bull bought the research it needed

Red Bull, in yet another example of the Tobacco Playbook being employed to create biased, bad, and misleading research, funded at least five studies examining the health and behavioral effects of combining energy drinks and alcohol. Those research projects found no harm. Unfortunately, the results of those studies were the foundation of the European Union’s Food Safety Authority’s report on energy drinks that provided a stamp of approval subsequently accepted by many countries.

A new investigation by The Examination, published by STAT and done in collaboration with other media outlets including Der Spiegel and The Toronto Star, identified over 100 studies of the risks of combining energy drinks with alcohol. Almost all of the studies funded by Red Bull or in which the researchers had a financial conflict of interest with Red Bull, found no increase in risk from mixing energy drinks with alcohol. Yet, about 80% of the studies where there were no Red Bull financial ties or funding found that risks did increase when energy drinks were consumed along with alcohol.

However, Red Bull was able to parlay the research it had funded into widespread governmental acceptance of energy drinks and, with vigorous lobbying, has effectively stopped most efforts to impose regulations on energy drinks, such as banning sale of them to minors.

The soda tax SWAT-team approach with energy drinks

Sugar-sweetened beverage taxes, aimed at reducing the negative health effects of sodas, have been shown effective in reducing sales. Forty countries have them at the national level. Whenever a sugar-sweetened beverage tax has been proposed in the U.S., the soda manufacturers have taken a SWAT-team like approach, sending in lobbyists to squash the idea. Of dozens of proposals, none have passed at the state level and many on the local level have failed as well. Around ten cities have a sugar-sweetened beverage tax.

This SWAT model seems to have been adopted by market leader Red Bull, who has taken a vigorous approach to monitoring threatening proposals and, when they arise, sending in academic researchers or company representatives to, usually, successfully dissuade legislators from imposing any restrictions on energy drinks.

Strong public health leadership can prevail

While the energy drink manufacturers are trying to deflect regulation in the U.S. using tricks we have seen employed by Big Tobacco, it is worth noting that, led by strong public health leadership from the federal government, tobacco use among youths has dropped from a high of 36% in 1997 to 4% in 2021. It seems the right leadership can create change when it comes to harmful substances in our environment.

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There have been documented deaths associated with energy drinks, including due to cardiac events. Emergency department visits because of energy drink consumption numbered 20,000 way back in 2011.

The CDC reports that up to 50% of adolescents consume energy drinks and that they can be harmful. The CDC endorses the American Academy of Pediatrics recommendation that adolescents do not drink energy drinks.

RFK, Jr. is strongly opposed to energy drinks, but they are ultraprocessed foods and part of the Big Food and Coca-Cola protectorate, and Kennedy has, so far, made little progress against that political force.

Will Delaware by the first state to do anything?

Members of the Delaware legislature wanted to ban energy drink sales to under-18s, but that proposed law was killed. Maybe if Delaware is successful with its current, feather-light attempt to suggest to retail locations that they voluntarily post energy drink warnings and, a little more significantly, to ban energy drink sales at public schools, other states will take up the fight again and eventually the federal government will gather the political capital to act.

In the words of Delaware State Representative DeShanna Neal, “One caffeine-related death is one too many.”

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RFK, Jr. likes to take off his shirt. In public. On the campaign trail. It works. He won the vote of Alexander Cortes, an astute follower of the issues. Cortes posted on X: “Whoever is most JACKED AND TAN has my vote.”

It is unusual to find someone so high up in government so pumped up. Kennedy has a lot of stuff to deal with: cyclospora, cutting disease surveillance, measles outbreaks, killing vaccines, axing the Agency for Healthcare Research and Quality, freeing peptides for the good of the nation…How does he find time to go the gym? He must be getting his briefings in the tanning salon.

It’s possible that Kennedy has tried to cut his time in the gym by injecting peptides to build his muscles. Or maybe he has tried to skip time in the tanning salon by injecting peptides to make his skin look tan. (Yes, there is a peptide people use for that.) In any case, our Secretary of Health says he has used peptides and, against strong scientific consensus, wants to cut unapproved peptides loose without significant testing and let Americans have at them.

Peptides are amino acids, some of which we make in our bodies and some of which have been synthesized in the lab. I, along with Kennedy and millions of Americans, appreciate peptides, but I only like the very well-tested ones, well-proven to have big health benefits with limited side effects and very good safety. These FDA-approved peptides include, most prominently, insulin for diabetics and GLP-1s like Ozempic, Wegovy, and Zepbound, used to treat obesity and a growing list of other diseases.

To open up the peptide market, Kennedy rigged the process.

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Every day, unless we are in very bad circumstances, we drink water. In today’s America we are lucky to have wide accessibility to what we almost always consider safe drinking water, while for much of the world obtaining clean water is often a struggle.

Contaminated water is the transmission pathway for many bacterial, viral, and parasitic diseases including cholera, typhoid fever, hepatitis A, norovirus, polio, and more. Vaccines, like the polio vaccine, and public water and sewer systems have eliminated or greatly reduced most water-borne risks for most people, and cholera has not been epidemic in the U.S. since 1866 due to our government’s delivery of public health measures. However, in parts of the world the seventh cholera pandemic, which started in 1961, still infects about a half-million people annually and is the seventh largest pandemic ever in terms of lives lost, which may be over 9 million and growing, 65 years into the pandemic.

We’re generally lucky in America, but not everyone has access to the best public health here, and our systems are vulnerable. For example, at last count, we are experiencing an outbreak of over 11,500 reported cases of cyclosporiasis in the U.S.

The story of Snow, cholera, oysters, pandemics, and miasma

Today I’m telling the tale of how a great disease detective, John Snow, put the clues together to save perhaps thousands of lives in the 1854 cholera outbreak in London. Snow became the father of epidemiology, the science of disease source detection that has saved millions of lives.

And I’ll talk about water-borne disease in America today; oysters, yum or yuck, however you feel; how measles got to be as rare as cholera in America; and that we need to acknowledge, as we face the corruption of our public health systems, funding, and status in the U.S., that we remain susceptible to very bad pandemics.

Plus, I’ll reflect on how the rejection of the evidence by the authorities after Snow’s discovery of the source of the 1854 cholera outbreak is similar to today’s rejection in America of science and proven public health measures.

It all ties together, believe it or not.

Welcome to new subscriber, Ming Yang, Senior Editor for Nature Medicine, and author of the excellent Health Checks on History Substack. Check it out. Londoner Yang knows well the history of the important site we will visit in the podcast today.

The first epidemiologist

John Snow was born in poverty in a neighborhood close to the river in York, England, the son of a coal yard worker and eldest of nine children. Drinking water in the neighborhood was from wells or the polluted river. The unsanitary conditions he experienced growing up likely informed Snow’s later cholera investigations.

Snow’s aptitude for learning won him an apprenticeship with a surgeon-apothecary, giving him five years of clinical training leading to education and certification as a surgeon able to practice medicine. In 1836, Snow entered the University of London to be become an actual doctor. It was there he made his first important epidemiological discovery, although epidemiology had not yet been named as a science.

Snow’s first epidemiological discovery (about arsenic, not cholera)

While performing post-mortems on dead patients with fellow students, Snow noticed that some of his colleagues were becoming sick. Snow deduced that the arsenic used to preserve many of the bodies was causing the illness and published a paper to that effect.

The University discontinued the use of arsenic to preserve corpses for dissection and the medical students stopped getting sick. Snow’s article also caused arsenic to be removed as an ingredient of candles, which burned brighter with some arsenic in the wax but put off toxic fumes.

Snow finished his medical degree in 1843 and would thereafter be titled Doctor.

A pioneering anesthesiologist

Snow is known for his epidemiology, but anesthesiologists know Snow because of his pioneering research to safely administer ether and, later, chloroform. His reputation as London’s top anesthesiologist was solidified when Queen Victoria insisted Snow administer chloroform to her for the birth of the last two of her nine children.

But it was Snow’s work on understanding, mapping, and eliminating the source of the cholera outbreak in the Soho section of London in 1854 that is most acclaimed.

Cholera came to England from the Ganges delta in India in 1831, starting the first of four English epidemics. In 1848, the second and most fatal cholera epidemic, with over 40,000 deaths, was manifesting itself in London. The prevailing view of scientists at the time was that transmission of cholera was in something called miasma, essentially the bad smell that accompanied unsanitary conditions. Snow understood how respiration worked from his experience with anesthesia and realized that if it cholera was carried in the air, people who worked in the worst smelling places like slaughterhouses and emptying cesspits, would be the most prone to get sick. That wasn’t happening.

Snow and others formed the London Epidemiological Society, meeting first in 1850 at the end of the second cholera epidemic. The new Society was committed to understanding not only cholera, its primary motivation, but to working on other diseases, including smallpox and smallpox vaccination, a topic on which it was very influential with the government. For my fellow epidemiologists, it’s worth noting that some members of this new group also belonged to the Statistical Society of London, which had been formed in 1832.

So the drive to solve the mystery of cholera gave birth to a whole new science, just in time to address the third epidemic, where its methods would result in the saving of many lives. Epidemiology today employs sophisticated mapping and statistics and toxicological testing. All three of these fundamental techniques were integrated by Snow in two groundbreaking investigations of the third cholera epidemic.

Around September 1^st, 1854, at word of a sudden outbreak of cholera deaths in the Soho neighborhood where he had his office, Snow leapt into action, quickly obtaining the addresses of the first 83 fatalities, which he went to visit. Snow noticed they were all within a short distance of a communal water pump on what was then called Broad Street. Snow immediately suspected the pump as the source of infection.

Porter beer was the Gatorade of 19^th century London, except probably better for you

The doctor interviewed many of the families of the deceased, finding 61 that had definitely or likely drunk water from the pump. Snow noticed that there were only a few deaths of workers from the brewery near the pump. The brewery owner told Snow that the workers received a daily allotment of porter beer to take home, the low-alcohol dark beer being a popular and safe hydration alternative to the available water. Also, the brewery had its own water well the workers could use.

Wait a minute, beer used for hydration? Doesn’t alcohol cause dehydration? Yes, generally, but with the low 2% to 3% alcohol content of the working-class’s porter, the body retains more water than it loses from the diuretic effect of the alcohol. Plus, the hard-working porter drinkers got significant calories from the beer as well as important B-complex vitamins.

Adding to Snow’s growing evidence, just around the corner from the pump was a workhouse, a horrible, jail-like, last resort for people who were poor or disabled. Snow found a water well within the workhouse grounds and only five cholera deaths among the 535 workhouse inmates. His Broad Street pump theory was further supported.

Snow sought toxicological evidence and had the pump water examined under a microscopic. Flaky organic matter was found, but otherwise the results were inconclusive.

Microscopy at the time could not easily see some transparent microbes like the cholera bacterium, Vibrio Cholerae. As it happened, an Italian professor, Filippo Pacini, identified the rod-like bacterium, called a bacillus because of its stick shape, in the 1854 Italian epidemic. But Pacini’s findings were not widely read, including not by the famous German bacteriologist Robert Koch, who went to Egypt during its cholera epidemic in 1883 and identified the Vibrio Cholerae bacillus in corpses.

Koch’s widely disseminated findings convinced the scientific world that a bacterium was the agent of cholera and put nails in the coffin, as it were, of the miasma theory.

By Snow’s account, three-fourths of the residents quickly fled the neighborhood of the Broad Street pump soon after the onset of the outbreak with its hundreds of deaths. But many remained, and when Snow took his evidence to the local authorities, he managed to convince them to remove the pump handle

With no more water flowing, there were no more infections and the worst of the deaths ended within ten days, as those already sick at the time of the handle removal had either died or were destined to survive.

Following the Broad Street pump investigation, Snow continued that same year with his second and larger epidemiological study of cholera, which he called the “Grand Experiment.” Snow tallied the cholera deaths in 32 districts of London. The Lambeth Company supplied neighborhoods with water from the Thames above London, and the Southwark and Vauxhall Company supplied water from the Thames below where sewage was discharged in London

Snow’s statistics and map showed that the homes and community pumps supplied with water from the upper Thames had a low risk of cholera and few cases, and those supplied with heavily polluted water from the Thames within London had a high risk of cholera and many cases.

Unfortunately, even with the additional hard evidence of the second study, the higher authorities and most scientists were still not persuaded to give up their miasma theory. It was not until the fourth and final English epidemic in 1866 that polluted water was finally accepted as the primary source of cholera.

Unfortunately, Snow died of a stroke before the truth of his findings was accepted. He was a 45-year-old vegetarian and teetotaler when he passed a few years after his Broad Street pump investigation. Perhaps his experiments perfecting anesthesia, which had exposed him to large amounts of toxins, contributed to his early death.

Snow chronicler Michael Ramsay points out that while the doctor was never honored with a knighthood, he did receive the next highest honor for an Englishman and had a pub named after him, although ironically, as I said, Snow was an abstainer.

The John Snow Pub is located next to the handle-less commemorative pump standing in the spot of the original, where Snow correctly determined the Broad Street cholera outbreak began.

Excavations of the street after the outbreak was over determined that the Broad Street well was located three feet from a cesspit built to collect sewage and that the wall of the cesspit had deteriorated. A sick infant had lived across the street from the pump, and her fecal matter had leaked into the well. The infant died after five days. Her father got cholera the day the pump handle was removed, but with the handle removed his contaminated contributions to the cesspit until he died could not infect others.

Cholera today

The cholera epidemics of the 19^th century are a reminder that even at a time when our world was bound together with trade using only small, slow sailing ships, the transmission of new disease from one part of the globe to another could and did lead to the death of millions. Today travel is fast and planes and ships are large. Truck drivers, business people, aid workers, and vacationers drive and fly easily from country to country, bringing with them Ebola, Covid, HIV, dengue, malaria, Zika, influenza, measles, and TB, among other diseases.

And cholera still travels, with the seventh and ongoing 1961 pandemic having spread across 45 countries, with many millions sick and hundreds of thousands dead. After its 2010 earthquake, our close neighbor Haiti had 665,000 cholera cases and over 8,000 deaths.

Fortunately, the CDC in combination with the World Health Organization, from which the U.S. withdrew this year, stepped in with a million doses of cholera vaccine and other prevention and treatment measures, saving thousands of lives.

Cholera in America

We haven’t had a major cholera outbreak in the United States since 1866. Our public water treatment and management systems have become robust and serve 87% of the population.

Eighty percent of the population are serviced by public sewer systems. The remaining primarily use septic tanks, which meet sanitation codes. It is presently unlikely that contamination of untreated water from wells and other sources could result in a cholera outbreak here, especially given the small number of cases coming from abroad. Most or all of the 12 cases recorded in the CDC’s “Cholera and Other Vibrio Illness Surveillance System,” COVIS, in the last year of reported data, 2024, occurred in travelers returning from countries where cholera is endemic.

Very rarely, cholera is contracted from consuming raw shellfish, particularly oysters, from the Gulf of Mexico. But cholera isn’t the only Vibrio species that can cause illness, even death. More commonly, a dozen or so other species of Vibrio bacteria cause vibriosis, which, when contracted from food or ingesting seawater, is a milder intestinal illness associated with diarrhea, vomiting, and fever. Vibrio bacteria can also get into open skin wounds of swimmers in salt or brackish water and cause infections, sometimes serious, with necrotizing of the flesh, or flesh-eating, as the media like to say. Infections from the bacteria species Vibrio vulnificus send people to the hospital and were fatal in one out of five cases reported to COVIS, although it’s likely that large numbers of less serious cases are usually not identified by state health departments and thus not reported to COVIS.

Vibriosis infections in 2024 were estimated by the CDC at 52,000 from food contamination, usually raw oysters, and 28,000 from, primarily, swimming. COVIS records all reported Vibrio infections, but the total of 80,000 estimated cases is 20 times the number of cases reported by state health departments to the CDC. Additionally, since last year, the Trump administration made reporting of Vibrio infections to the CDC’s FoodNet surveillance system optional for states.

Your risk of vibriosis from raw oysters? Very small, but ask your doctor, as the pharmaceutical ads say, if raw oysters are right for you – folks with certain medical vulnerabilities should be cautious.

To give you some numbers so that you can get a sense of your vibriosis risk if you like to eat raw oysters, it is popularly reported that two and one half billion oysters are consumed, cooked and raw, in the U.S. annually. There is some indication, but no hard data, that half or more of these 2.5 billion oysters may be consumed raw. That might total, very rough estimate mind you, 1-1/4 billion oysters and 52,000 cases of vibriosis. Perhaps not a high risk, statistically, but not nothing.

Here are a couple of fun facts: If the 2.5 billion number is correct, we are eating about a half-dozen oysters every year per American. However, in the late 1800s, before overfishing and pollution, wild oysters were so abundant and cheap, New Yorkers ate an average 660 oysters annually. Today, most people don’t know that 93% of oysters in the U.S. are farm-raised, about 1/3 from Louisiana and Texas, and the rest mainly from the East and West Coasts.

To review, vibriosis from raw shellfish or swimming in salt or brackish water is not common but a risk, the magnitude of which depends on an individual’s health status. Cholera in the U.S. is extremely rare, with just 12 cases in 2024, like measles in 2020, with just 13 cases. In fact, I have to note, in a triumph of public health, in the year 2000 measles was declared eliminated in the U.S., with the only cases being those brought into the country by travelers coming from abroad.

Unfortunately, MAHA politics, charlatan wellness influencers making money off their falsehoods, and anti-vaccine ideology have been prioritized over science. Witness the rise in measles cases from 13 in 2020 to 2,289 in 2025. As of July 24^th, this year’s count is running double 2025’s, with 2,318 cases already reported. That this has been allowed to happen is tragic and alarming.

Under Trump, generally our public health protections have been corroded, eliminated, or deprioritized when in conflict with the wants of business interests. Relative to water-borne disease and nutrition, Trump is relaxing water quality and sewage fertilizer standards and has cut food inspections and disease surveillance funding here and abroad.

In a clear example of why Trump’s cavalier attitude toward public health is a danger, cyclospora infections in the current outbreak have hit an all-time high in America at 11,500 cases, with reports of new cases continuing to come in. Cyclosporiasis is spread primarily through irrigation water contaminated with human feces or fertilizer containing sewage. The administration’s fostering of the corrosion of trust in, and functionality of, the CDC and FDA has hampered the federal response to the cyclospora outbreak. Removal of obligatory reporting of cyclosporiasis from the CDC’s FoodNet surveillance system and the lack of stricter safety measures and accountability for cyclospora-vulnerable food producers is not a productive approach to reduce outbreaks. Vibrio infections, like cholera and Vibrio vulnificus, have also been removed from the FoodNet surveillance’s obligatory reporting, further blinding our government to a public health concern.

It requires money for food producers to take cyclospora containment measures. Taylor Farms, the producer of the lettuce involved in the current historically large outbreak, donated $1 million to Trump’s MAGA Inc. PAC after Trump took office last year

To return to the topic of large scale pandemics and our ability to cope with them, let’s not forget HIV and Covid, third and fifth on the all-time list of pandemics in terms of global deaths. Like the ongoing seventh cholera pandemic, which happens to be currently at the number seven spot as a killer on the list of pandemics, HIV continues to be a pandemic. Life without pandemics is not coming soon on this Earth.

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We can all remember the chaotic, stumbling response of our government, and the world as a whole, to Covid six years ago. Scientists like Anthony Fauci struggled to quickly understand the epidemiology of Covid in order to propose the most rationale responses. But we had a president, Donald Trump, who in the early weeks of the epidemic claimed Covid was no more severe than the flu and would disappear “like a miracle.” He later suggested in a press conference that injecting bleach or using ultraviolet light inside the body would kill the virus. He was adamant that the malaria drug hydroxychloroquine was a cure for Covid and wanted federal agencies to promote its use, although there was zero evidence that it could work. It was extremely bad leadership, harmful to our nation and likely expensive both in the loss of life and the wholeness of our social fabric. Trump should be testifying to Congress today, not Fauci, who has been sitting before Congress as I write.

We can speculate about why the English authorities of John Snow’s time balked at accepting the truth about cholera, that it was not from a mysterious miasma but from water contaminated by fecal matter. Perhaps they were afraid to acknowledge the government’s failure to protect public health. Maybe it was too embarrassing that the very foul, sewage-laden Thames was being used for drinking water. Perhaps regulating the private suppliers of water was politically difficult, or a government takeover of the responsibility for supplying clean water deemed too expensive. Or maybe, on some level, the leaders didn’t care that much because they were rich and could afford distilled water. Perhaps important scientists who had espoused the existence of a toxic miasma were unwilling to accept their error. For whatever reasons, solid science was ignored in favor of the false impressions of those in charge. Exactly like today in America.

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Stay hydrated and healthy!

Tall ships in Boston and a world of the past

A collection of tall ships have sailed from New Orleans to Boston, the last stop on their US tour celebrating the birth of our nation, 250 years ago. Sixty ships from the U.S., Europe, Asia, Oceania, and South America are part of the gathering. The oldest is likely the U.S.S. Constitution, built in 1797 and permanently docked in Boston. Most of the ships involved were built in the 1900s, some as naval training vessels and others for pride and beauty. These boats evoke a world very different from what we see, use, and experience today: extraordinary bravery in exploration of the world, Leif Erikson, Columbus, Magellan, and nature, Darwin and the HMS Beagle, empire building and naval domination, the shipping of African people who had been enslaved as cargo for trade, the theft of gold from the Americas, pirates, cannon battles, the retreat 250 years ago of the British fleet from Boston Harbor under the surprise threat of George Washington’s cannons, the Star-Spangled Banner withstanding the bombardment of the British fleet in Baltimore in the War of 1812, and an explosion of trade spanning the globe.

In the hold: food, opium, tobacco

More than half of that trade was in food and substances for consumption, like opium and coffee. Tobacco was the most valuable export of England’s American colonies, and a tax on the tea which kept Americans going resulted in the Boston Tea Party and stoked the fires of the American Revolution.

Sugar, rum, and the Great Boston Molasses Flood

Sugar was another substance that crossed the Atlantic with a massive amount of it going to Boston in the form of molasses to be distilled into rum for the heavily drinking American colonists and their British countrymen. To be fair, contaminated water was a big issue, so consumption of beer, hard cider, and rum was a common way to quench thirst. At the time of the Revolution, men were drinking three pints of rum a week on average. Rum distilling in Boston continued to be huge right up to 1919 when a 2.3 million gallon tank of molasses ruptured in the North End, very near Revolutionary hero Paul Revere’s historic home, releasing a tidal wave that killed 21 as it poured through the streets.

I’ll give you a horse for that pineapple?

America was a big grain exporter from its early colonial days, sending barrels of flour and unmilled wheat from the Chesapeake and mid-Atlantic, along with salted beef and pork, dried and pickled cod, and rice. But sailing ships also brought the imperialists back a wealth of new food. Columbus brought back the first pineapple, which started a 150 year craze. Pineapples could cost thousands of dollars and were rented out to the middle class for display at dinner parties. They were valuable mainly because so few specimens could survive the Atlantic crossing without refrigeration. Many other new fruits arrived in Europe, but perhaps most transformative was one of the plainest of produce products: potatoes from the Andes. The success of potato farming fed massive population booms in Ireland, Germany, and Russia. Corn was also a big introduction to the European diet along with tomatoes and chili peppers.

Of course, many people today would be happiest that the New World yielded its invaders chocolate. Or is it a toss-up between chocolate and coffee?

Naval food: a source of enduring innovation

But apart from what was in the holds of the sailing ships, what happened in the ship galleys was a source of important nutrition innovation and discovery.

During the 1700s scurvy killed thousands of British sailors, more than died in sea battles. In 1747, a naval surgeon, Dr. George Lind, ran the first medical clinical trial to determine the best treatment for scurvy. Although the vitamin C deficiency disease had been diagnosed and treated since the ancient Egyptians, Lind’s comparisons of the effectiveness of citrus vs. hard cider vs. vinegar vs. vitriol, which was likely a copper or iron sulfate liquid, vs. seawater concluded what many sailing cultures already knew, namely lemons and limes were the best treatment and prophylactic for scurvy because of their high concentration of vitamin C.

The Napoleons better the lives of their sailors (or at least try to)

Then there were the Napoleons and the prizes they offered to improve their navies’ food by improving its lifespan. Napoleon Bonaparte was immensely successful with the invention of canning, a massive boon for food preservation, but Napoleon III’s effort was a miss. The third Napoleon offered a prize for the invention of a butter replacement, the unrefrigerated dairy product spoiling after a week on board ship. After some years margarine was produced from beef fat in 1869, but it was so disgusting that neither the French sailors nor France’s poorest people would eat it. Margarine from plant oil was finally invented in 1901 and eventually became a huge hit due to its low cost and great health advantage over butter. Only the health advantage was merely imagined and marketed, and, in fact, plant oil margarine, which is essentially transfat, is quite toxic to human health. See https://www.eatinginamerica.co/p/a-horror-story-from-long-ago-about for the story of the 1945 health testing of margarine vs. butter using orphans as subjects: completely unethical research commissioned by the margarine manufacturers.

More evidence for World War II as the crucible of the era of ultraprocessed food

As the industrial technology of highly- and ultra-processed food advanced (I classify canning as moderately processed and margarine as highly-processed), the better served were the short term health, nutrition, and morale needs of the seafaring and the worst served were the long term health needs of the land-based population. In World War II, which was the engine that propelled us into the highly-and ultra-processed food era we live in now, the needs of transporting hundreds of thousands of soldiers aboard ships sparked the U.S. to invent dehydrated foods like powdered milk, instant coffee, and instant mashed potatoes.

The amazing rowing journey of Kelsey Pfendler and the 4th of July cup of Joe!

Interestingly, descendants of these same dehydrated meals were on board Kelsey Pfendler’s 24 foot row boat when she embarked from California in May to row to Hawaii, landing in Honolulu on July 4^th. Powdered milk and dehydrated camping meals were staples of Pfendler’s 4,500 calorie a day diet. She told NPR, that it was, for sure, not a good diet for long term health. Her addictive but completely essential substances on board included lots and lots of chocolate and sugar. Pfendler had a supply of caffeine pills for emergencies, but had gotten herself off coffee before she left. However, the first thing in her hands when she landed in Oahu: fresh hot coffee!

The everyday shipboard hero was in the galley

So the seagoing life is never going to provide a nutritional model for the rest of us. But the ship does provide a model for the role of the chef, the cook, as a person who can deliver hope, love, warm memories, sustenance, community, and family. On a naval boat the chef is the cruise’s biggest hero three times a day, meticulously planning meals and packing every inch of available space with food for the voyage. The chef is the creative innovator, especially when things go wrong, and brings joy and a sense of pace to the voyage with a traditional, homey, fried chicken Sunday dinner, along with dependable birthday cakes and surprise treats. When the depth charges start exploding 100 meters down in battle, it’s the submarine’s chef who makes sure to hand pass sandwiches down the line to the far ends of the boat. Sort of a super-mom or super-dad.

The highlight of the week? A can of pre-made coffee in the middle of the Pacific.

And those mid-voyage treats? Even Kelsey Pfendler, who rowed a tiny but heavy boat 55 miles a day through ocean waves (I’m a rower and that is incredibly amazing) where every gram of weight counted, brought a can of coffee to celebrate reaching the mid-point of her 43 day journey.

Congratulations to Kelsey Pfendler and all the sailors, and especially their galley cooks, who sailed the oceans to help celebrate the founding of one of the world’s most profoundly important and often beautiful democracies, a nation where all men are certainly created equal and, someday, we hope all children will be well fed. Let freedom, and the mess bell, ring.

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The Trump administration is supporting the financial interests of Big Agriculture and pesticide manufacturers like Bayer-Monsanto instead of the health concerns of its Make America Healthy Again constituency. MAHA is mad and sees it as a betrayal of their support for Trump. But all of America should be mad.

The big win for Roundup: Trump helps Bayer-Monsanto win at the Supreme Court

Trump fully backed Bayer-Monsanto at the Supreme Court, which ruled a few weeks ago that the Roundup manufacturer was immune from lawsuits from thousands of people claiming their cancer was caused by the glyphosate in Roundup. This ruling is expected to be extended to other pesticides that have been approved by the EPA and negates the ability of those claiming glyphosate harms to challenge the manufacturers for damages in state courts.

But what is the big picture with pesticides, which include herbicides like glyphosate, and health?

Glyphosate is by far the most widely used pesticide in America with 300 million pounds used annually in the United States on crops including corn, soybeans, wheat, oats, spinach, and almonds. In urine testing, the CDC found 81% of Americans had glyphosate in their system. According to the CDC, fruits, vegetables, and cereal grains are possible sources of glyphosate in people. Glyphosate has also been found in baby formula.

Glyphosate/Roundup health effects

So it’s in us every day. What about the health effects? The International Agency for Research on Cancer long ago declared glyphosate a probable carcinogen. But the EPA, relying heavily on a 2000 paper that reviewed the evidence, has said consistently that glyphosate is not a health risk.

However, according to the Washington Post, that very widely cited 2000 paper was withdrawn last year because authors on the paper may have been Monsanto employees, other authors may have been paid by Monsanto, and the studies cited in the review were unpublished and written by Monsanto. The credibility of the paper which was the basis of wide belief in the safety of glyphosate has crumbled, but still the EPA clings to its stance of glyphosate safety.

Cancers aside, research published in 2023 found when children were exposed to glyphosate there was the chance of an increased risk of liver disease, high blood pressure, prediabetes, obesity, and high cholesterol.

This research studied children in an agricultural area in California, with some in homes close to a lot of glyphosate spraying. Exposure levels for some of the children were higher than normally found just through eating contaminated food. This allowed differences in exposure levels to be used to evaluate differences in disease outcomes.

It is unclear to me how the exposures in that setting, the Salinas Valley in California, translate to the experience of the majority of children, who are exposed to glyphosate mainly from the food on their tables. Another unknown is how much exposure any kid is getting from the Roundup used widely for weed control on lawns and in parks.

We’ll get to this question of how much to worry and how to worry about pesticides in a moment.

Newly approved pesticides

If the backing of Bayer-Monsanto by Trump and the ensuing Supreme Court decision in favor of Roundup weren’t distressing enough, a few days later the EPA ignored substantial evidence of possible risks and approved a number of new pesticides including, based on suggestive evidence from animal studies, two that may have a risk of cancer and another that may have a risk of endocrine-disruption, that’s hormones for metabolism, reproduction, mood, and growth. One of the new EPA approved pesticides is a PFAS, a “forever chemical.” The health risks of PFAS chemicals are multiplied because they are designed to never breakdown and can stay in our bodies and environment, well, forever. This was the fifth PFAS pesticide approved by the Trump Administration. One previous PFAS approval was by Biden’s EPA.

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PFAS “Forever chemicals,” now appearing in pesticides

In the midst of all this, the FDA rejected a petition to set thresholds for seafood and milk for two of the most common and dangerous of the 16,000 PFAS compounds, namely PFOA and PFOS. The FDA is ignoring evidence linking these “forever chemicals” to cancer, bad reproductive and child development outcomes, high cholesterol, liver disease, kidney disease, and decreased immunity.

And the EPA has found that most of the PFAS in our body comes from food, and the FDA has found that 60% of the seafood it sampled had PFAS. In limited testing, Consumer Reports found PFOS or PFOA in six out of 50 milk samples in 4 out of 5 milk brands, organic and not organic. There’s a good chance the milk you buy is occasionally positive for a PFAS. Blueberries, kale, and beer are among other foods that can contain PFAS. And, of course, PFAS can be found in nonstick cookware and other kitchen products.

With all these concessions from the EPA and FDA, the pesticide manufacturers must be very happy with the Trump administration.

Where does this leave us as consumers?

Even if we think eating organic makes sense in reducing our pesticide exposure, and I do, most of us cannot afford to eat all organic or are not willing to limit ourselves only to the foods we can find that are organic. Informed choices can be made!

The Dirty Dozen

The Environmental Working Group (EWG) publishes its famous Dirty Dozen list, created by analyzing USDA data. The Dirty Dozen is a great place to start. Here’s the 2026 list:

1. Spinach

2. Kale, collard and mustard greens

3. Strawberries

4. Grapes

5. Nectarines

6. Peaches

7. Cherries

8. Apples

9. Blackberries

10. Pears

11. Potatoes

12. Blueberries

I prioritize my organic dollars on those twelve.

The Clean Fifteen

EWG also provides a clean fifteen list, which is also very useful for picking produce likely to have the least toxic and lowest amounts of pesticides:

1. Pineapple

2. Sweet corn (fresh and frozen)

3. Avocados

4. Papaya

5. Onions

6. Sweet peas (frozen)

7. Asparagus

8. Cabbage

9. Cauliflower

10. Watermelon

11. Mangoes

12. Bananas

13. Carrots

14. Mushrooms

15. Kiwi

I buy non-organic produce freely from this list.

No matter where you live or the means you have to apply to healthy eating, my sense is that the health benefits of eating vegetables and fruit generally outweighs the risks linked to pesticides. But starting with the EWG tested rankings of the best and worst is a great way to have the vitamins, minerals, and fiber of produce while minimizing the bad stuff. Also, remember that frozen and canned vegetables and fruit can be just as nutritious as fresh, and frozen organic produce can be more affordable and sometimes more available than fresh.

As for meat, EWG points out that pesticides can accumulate in the fat of animals, making another area of the supermarket with choices to think about.

Finding the balance

With so many choices in what we eat and consume these days, for me reaching an informed balance is the goal. For example, what I spend on organic for berries, apples, and other items on the dirty dozen offsets what I save on non-organic items from the clean fifteen. And there are days when the local non-organic strawberries or peaches are just too beautiful and delicious, and they have to come home with me.

My approach suits me, and equally rationale approaches could be much stricter or much more relaxed. We are light years from having health data that can predict our individual health outcomes, and in any event what data we have has to be weighed against our individual circumstances. What we can say with some certainty is that if we greatly limit or eliminate the most toxic pesticides, we will have less pesticide-related disease in our children and the world.

I would love to hear in the comments about your choices and thoughts on the chemicals in our food.

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The Lone Star Tick, not named after Texas but for the single white spot on its back, has begun moving in to the Lone Star State along with the alpha-gal syndrome it can cause. This dangerous tick might already be in your state.

What’s a tick got to do with eating? Lot’s, because it’s bite can cause a meat allergy, the alpha-gal syndrome. And for many victims, alpha-gal creates a dairy allergy as well.

Getting a food allergy from a tick bite is strange but very real. Alpha-gal syndrome can cause rashes, hives, low blood pressure, dizziness, nausea and vomiting, sometimes severe, and even anaphylactic shock.

Alpha-gal’s double delay and double avoidance

Alpha-gal is tricky. There is a double delay with the symptoms. The allergy itself can take weeks or months to develop after a tick bite, and the symptoms take two to eight hours to appear after consuming mammalian meat or, for some, dairy.

Once an allergy has developed double avoidance is required. Mammalian products are out of the diet and out of the medicine closet and the wine rack: some pharmaceuticals contain gelatin and some wines are clarified with gelatin. Avoiding a second tick bite is also important. The allergy can subside in some people, and another Lone Star bite can reinforce or reactivate the meat and dairy sensitivity.

450,000 suspected cases

There were over 110,000 suspected alpha-gal cases in the U.S. from 2010 to 2022, but the estimate including unreported cases is 450,000.

The Lone Star Tick has been spreading out of the Upper South with high rates of alpha-gal syndrome in parts of Kansas, Oklahoma, Mississippi, Alabama, Georgia, Florida, the whole of Delaware, and hot spots as far north as Martha’s Vineyard in Massachusetts and northern Minnesota. The Pacific Coast states have diagnosed cases extending inland to most of Arizona. There are no states that are entirely alpha-gal free. And in Texas, the Lone Star coast up to Oklahoma is encountering more Lone Star ticks.

If you have it

A lot of care providers are not yet familiar with alpha-gal, so be informed. If you contract symptoms an allergist may be needed to help with the diagnosis. You’ll likely want to get an epi pen to have on hand. An allergist doing food challenge testing on 250 patients who ate pork sausages or a similar meat to see if it provoked a reaction, found 15 to 20% of the patients needed an epi pen rescue. No one in my family has alpha-gal that I know of, but I will be traveling with the antihistamine Benadryl from now on, just in case symptoms appear at a time when getting to a pharmacy or doctor is not convenient.

If you have the syndrome, the Pill Clarity website lists animal free pharmaceuticals and the FIG (Food Is Good) app scans product barcodes against its database to provide go/no-go information for your dietary restrictions, including alpha-gal. On Martha’s Vineyard, many restaurants now list their alpha-gal safe dishes and some food products on the store shelves there and in some other hot spots are labeled as alpha-gal friendly. You can buy organic wine to be sure gelatin wasn’t used for clarification.

Proposed legislation before Congress

The Alpha-gal Allergen Inclusion Act has been introduced in the House of Representatives. The bill would add alpha-gal to the list of major food allergens and require package labeling. An excellent website covering all things alpha-gal is alphagalinformation.org.

It’s a Lone Star! Run?

Unlike most ticks, including the deer tick plaguing the Northeast, Mid-Atlantic and Upper Midwest with Lyme disease, the Lone Star tick does not wait passively to be brushed by a passing animal. The Lone Star detects movement vibrations and carbon dioxide from breathing and moves fast towards its victims, aggressively climbing boots and clothing.

What to do if you are a nature lover or work in a vegetated area? Take maximum tick protection measures. Here is an, er, fascinating video from an entomologist. She uses double-stick carpet tape on her boot, DEET, and permethrin-treated clothing to stop an alarming swarm of Lone Star nymphs climbing up her boot. This video was not staged.

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By the way, the Lone Star tick not only can confer a nasty food allergy on its victim. It is also host at times to a bunch of other pathogens, including those causing tularemia and Rocky Mountain spotted fever.

Why the name “alpha-gal”?

All mammals except humans and a few primates make a form of galactose sugar which is a little different from the galactose we humans produce when we break down lactose from milk in our small intestine. This mammalian alpha-galactose is also found in the salivary glands of Lone Star and many other ticks around the world, causing an eventual immune reaction to mammal food products in many humans they bite.

Thank you for reading. Please support my work by subscribing, if you haven’t, and with your likes, comments, and shares.

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The most special person I have met recently is Marilyn Monroe. That’s her name as she said it, and she didn’t explain why. She was pretty much the opposite in every way of the Marilyn Monroe of the silver screen.

Marilyn was a five-year old Latina niña when she started picking coffee on the finca where her mother worked and lived in the volcanic mountains near Boquete, Panama. As she grew, her employer, the farmer, saw her potential and paid for her school, including university. Marilyn went on to get a law degree, married another lawyer, moved to Panama City, and had a little girl. When her husband died at a young age, Señora Monroe and her daughter, Lorraine, discovered he had purchased a coffee finca near where she had grown up. Leaving her law practice, Marilyn followed Lorraine and her son-in-law back to the mountains.

Marilyn and Lorraine were passionate about growing organic coffee, more to be a model for other farmers than as a commercial producer. And Marilyn was even more passionate about giving opportunities to the thousands of indigenous Ngäbe people whose labor made coffee farming possible in the region. Marilyn was very excited that it was the role of the Ngäbe in coffee production that I was most interested in hearing about. I thought she was going to hug me.

Panama has the second highest per capita income in Latin America but severe income inequality, with skyscrapers in Panama City looming over slums. In the mountains and along the remote Caribbean coast, over 90% of the Ngäbe live in extreme poverty, and 1/3 are illiterate.

Very close to the beautiful two-night rental my wife and I had found above Boquete was a large coffee finca. Below this farm was a dingy, shabby migrant camp of shacks surrounded by a high, plastic-shrouded fence topped with barbed wire. Outside the gate to the camp, unsupervised boys crawled through a dirty drainage pipe as their playground. A barefoot girl in a traditional Ngäbe dress passed by inside.

It was February and still the middle of coffee picking season.

In the evening the camp was full of Ngäbe men and women and older children returned from the mountain slopes. The best pickers had spent a long day filling six to eight latas, 20 liter, or 5-plus gallon, containers, with ripe, red coffee cherries they had twisted one by one off the trees. Each full lata weighs about 30 pounds, but the bags of coffee cherries the Ngäbe carry weigh much, much more. Marilyn said they would receive $5 per lata, meaning a typical picker would earn about $25 and the quickest, hardest working about $40 per day.

Most of the pickers had walked as a family to the Boquete fincas from their remote mountain homes where they subsistence farmed. Some live in the region and work year round on the fincas, earning $75 or $80 a week.

Every evening Ngäbe women, each with daughters dressed in colorful dresses bordered with patterned ribbons, climb the steep mountain roads around Boquete. They do not have phones. I don’t know where they are going.

Eco Horqueta is Marilyn Monroe and Lorraine’s finca. Lorraine has built four cabins for guests. She and her husband, Pol Piñol, are European-trained chefs and prepare the meals. It is a beautiful spot, and the Eco Horqueta organic coffee is great. It’s a calm and quiet place to get away. Several dogs and cats occupy the sofa in the dining area.

The finca seems remote, but a taxi from Boquete will get you there in 20 minutes. I drove a Landcruiser up the narrow, windy mountain road, dreading an oncoming car would approach, since one of us would have had to back up a long way or come dangerously close to the edge to pass.

The Nagbe’s reported reluctance to talk to strangers outside the tribe was confirmed when I asked directions from three men waiting for a bus. None would look at me or answer my question, asked in Spanish. They may not have been Spanish speakers, but I knew they understood me when I asked for “Eco Horqueta.” It was two hundred meters away.

I don’t blame them. The Ngäbe picked a fight with Christopher Columbus on his fourth voyage and won, but have lost to the Spanish ever since.

The Boquete region is famous for its high-quality coffee, especially the $50 per pound Geisha, more than half the weekly wage of an Ngäbe farm helper. The coffee is good, but the people I met were better. I was lucky to have met the petite Marilyn Monroe and Lorraine, who came down from a luxury tower to go up into the mountains where I believe Marilyn will figure out ways to give a boost to Ngäbe children, the way she was lifted up as a child.

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This post is in the “totally bonus” category. This short, summarized description of a proposed highly- and ultra-processed food definition is for scientists and policy makers familiar with this important issue as well as anyone with an interest. So if you missed the first version of this piece a couple of days ago, maybe because it was a lot longer, here is a chance to hear the essence of it. And some of the ideas have been revised or clarified since then.

If you feel done with HUPF for the moment, a podcast on coffee production in the mountains of Panama is coming in the next few days. I recently had an interesting visit there and got to ask about the role of the indigenous people on the coffee plantations.

Back to HUPF:

A federal definition of Highly- and Ultra-Processed Food (HUPF) is coming. How HUPF is defined is important to two opposing interests: Big Food with its future profits at stake is certainly lobbying hard on the issue with the Trump administration, and the American people with their health in jeopardy have the voice of RFK, Jr., who has been badly losing on the HUPF fight to date.

Using the original definition by Carlos Monteiro from 2009, 55% of the calories Americans eat are HUPF and those HUPF calories have strong links to chronic disease. If a clear, strong definition is achieved, it could provide the basis for policy that grows in effectiveness over time and minimize the opportunities for Big Food to lobby and connive its way out of regulation.

A durable, strong definition will be clean and simple, which I suggest is best achieved by identifying the technology that is essential to the creation of HUPF and using the historical timeline a technical framework provides.

This timeline is easy to determine. All HUPF is a product of innovations in technology in the last two hundred years. It was the Second Industrial Revolution (mid-19^th to mid-20^th centuries) and Third Industrial Revolution (the post-World War II Digital Age) that enabled the creation of new food products and additives that humans had not previously encountered or consumed. The great bulk of these have been created in the Third Industrial Revolution since 1945. Of course, we are continuing to create new food substances and additives in the 21^st century as we enter what some have termed a Fourth Industrial Revolution, but it may be too early to define the current era.

The proposed definition is:

Highly- and ultra-processed food is produced from food or chemicals modified or newly created with methods of the Second or Third Industrial Revolution, or moderately processed food that has become a health risk because it is mass produced with new technology and can now be over-consumed.

That is a strong, simple, working HUPF definition in 46 words.

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There are several tenets to this working definition:

1. HUPF is unnatural food.

2. Everything that is natural food predates the Second Industrial Revolution and has been consumed by humans for a long time. (This claim bears checking, but I can’t think of a natural food that was created after the Second Industrial Revolution began.)

Intuitively, hundreds of millions of humans have manipulated their available natural foods with any tools and chemical processes at their disposal over the course of human history. Invention of moderate food processing techniques to create new foods and additives – many fermented foods are ancient examples – will have played itself out by the time of the Second Industrial Revolution.

3. Because of our accumulated cultural experience, natural food tends to be healthy, how we tend to eat it.

4. HUPF is not, by this working definition, unhealthy, but for most of the thousands and thousands of HUPF substances, healthiness is not well certified.

This definition provides room for nutritionists to weigh as appropriate to each implementation the healthiness of individual substances and categories, some of which may be ambiguous, like bread with reconstituted whole wheat flour and the category of seed oils.

Everything that is HUPF is a new industrial invention, or it is a food that is a new risk because of mass production, which is made possible by a high level of processing. Newly over-consumed substances like refined sugar, highly refined flour, salt, and white rice are in this sub-category of HUPF.

5. While the beginning of the Second Industrial Revolution likely marks the point after which any newly created food or additive is HUPF, it seems reasonable to assert that any food substance or additive created after 1945, approximately the beginning of the Third Industrial Revolution, is HUPF. This includes most HUPF, thousands of which have not been identified, catalogued, or certified by our government.

We can say no new natural foods have entered human food environments since at least 1945 and any food or additive created after 1945 is HUPF. Some HUPF is older. Hydrogenated vegetable oil, for example, was invented in 1901. It’s possible the watershed date should shift 100 years earlier.

6. Any definition of HUPF, simple or complex, will require exceptions when implemented in law, policy, regulations, or programs. Exceptions will be added based on the circumstances of jurisdiction, institutional setting, nutritional needs, economic and financial dictates, or political influences. In order to have a defensible policy, the exceptions should be added to the language of the implementation and not be part of the main definition. In definitions offered and enacted so far, exceptions have been embedded in the definition – where they invite argument. I cannot think of any exceptions inherent to the simple working definition offered.

7. The proposed HUPF definition is in harmony with the original 2009 definition of Monteiro that has been the foundation of most research on the effects on health of HUPF. This compatibility provides an evidence-base for policy that could be implemented using the simple definition.

It was the youthful Hippies in the late 1960s who intuited that during their short lives our food environment had gone bad, with our diets co-opted by lab-created, unnatural products. The Sixties Counterculture’s insight into the dichotomy of natural/unnatural food is fundamental to understanding what HUPF is. Ironically, the Hippies valuable contribution, aimed at restoring the health of our food environment, has been co-opted by the commercial sector, with 557 Whole Foods stores worldwide stocked with aisles of HUPF.

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The health risks are bad, but the economics favor HUPF. In every implementation of an HUPF definition, policy makers may consider that HUPF can provide convenient, cheap calories, whether it is the increased costs of reduced-HUPF school lunches in California or the cost of calories in vegetables versus the cost of soda calories when sugar-sweetened beverage taxes are formulated.

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It’s vacation travel season, so I thought I might be helpful sharing a preventative health tip I recently became aware of. It involves eating.

A chance encounter with the wrong bacteria or virus can create an unpleasant GI problem even here in America, so I always travel with Pepto-Bismol.

But it turns out the pink tablets are good for more than just treating a tummy problem. They can be a very effective preventative.

Imodium is always in by toiletry kit as well, just in case things get bad, or I have to be on a plane or somewhere else I can’t be guaranteed of getting to a restroom quickly. Pepto-Bismol is sufficient in most cases, but Imodium is the quick lock-down solution when needed. Pro tip: To avoid constipation, stop Imodium as soon as relief is found, and keep drinking plenty of water throughout the whole episode. Also, step up the fiber after stopping Imodium.

You likely know all this.

Perhaps, like me, you didn’t know that taking two Pepto-Bismol tablets every three hours during eating hours is very good at preventing diarrhea. Pepto-Bismol has an anti-bacterial and anti-viral effect, which has a chance to work - most of the time -because the Pepto-Bismol also helps your body absorb water from the intestines. In order for it to work best, take the Pepto-Bismol on schedule so it is in your GI tract when you eat. Take a maximum of 8 tablets every 24 hours.

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For Eating in America friends around the world or those looking for help after the fact in a farmacia in Latin America or a drugstore in Africa, you can ask for bismuth subsalicylate. Kaopectate in America also contains bismuth subsalicylate. Imodium’s generic name is loperamide.

Although bismuth subsalicylate is effective for indigestion and nausea as well as diarrhea, you’ll want to limit your use of it. It’s banned or very restricted in Western Europe because bismuth is a heavy metal, although research shows it has low toxicity. I don’t worry, but I wouldn’t take it regularly for indigestion.

Bismuth subsalicylate when taken as a prophylactic is mostly protective. In a randomized-control trial of American students who stayed for three weeks in a country where Americans often have traveler’s diarrhea (I won’t tell you about when I was there a few months ago and who on the trip had it) those on the placebo were three times as likely to get diarrhea as those on the full preventative dose of Pepto-Bismol. Forty percent of the students on the placebo got diarrhea!

Whether you take Pepto-Bismol or not, greatly reduce your chance of getting diarrhea when outside the U.S., Canada, Australia, Japan, and Western Europe, by never eating uncooked vegetables (including those bits of lettuce on your sandwich), fruit you don’t peel yourself, or street food. Never drink water or allow ice in your drink that you are not sure is purified. Be sure your food is freshly made and steaming hot, and avoid those sauces that have been on the table for hours or days. I know everyone has heard this advice or most of it, but a lot of people don’t fully follow it, and, when I travel, I have seen most of those people get sick.

Finally, if you’re traveling someplace more “iffy,” especially if you’ll be any distance from reliable medical care, you might ask your doctor for an antibiotic prescription to have on hand just in case of a real emergency.

Pay attention to all drug precautions, check in with your doctor with your status and questions, and remember my advice cannot replace that of a trained medical professional.

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Please note that a small portion of the text of this podcast is taken from an Eating in America Note, published on EatingInAmerica.co this week.

I propose a new, simple definition for highly- and ultra-processed food, the definition of which shouldn’t be, but nonetheless has become, perhaps the most important nutrition issue of 2026. It has been made an issue as a tactic of delay by the Big Food lobby, which will exploit any opening to postpone the possibility of regulation of highly- and ultra-processed food.

You haven’t heard from me as much as usual lately because I have been working on this definition intensely over the last few weeks. My hope is to provide a fresh perspective that provides a framework for the clearest, simplest, most durable way forward.

Highly-processed food = ultra-processed food

Highly-processed food and ultra-processed food are two terms for the same thing. This is supported by the new Dietary Guidelines, which uses the term highly-processed instead of ultra-processed. I will use the abbreviation HUPF, standing for highly- and ultra-processed food.

HUPF and disease

HUPF has been linked to many chronic diseases, including obesity, heart disease, cancer, diabetes, and dementia.

The Tobacco Playbook: the chapter about delay.

Big Food knows HUPF as a category is bad for our health and that it will be increasingly regulated at various levels of government. But Big Food has had close ties to the tobacco industry, so, like Big Tobacco, they have learned all the tricks and moves to fight regulation, including those in the chapter about delay in the mythical but often cited Tobacco Playbook. This is the set of schemes and strategies that has been used not only by Big Food, but the alcohol industry and opioid manufacturers, and is being employed now by the gambling industry.

To interfere with the growing momentum toward regulation, the question of a viable definition of ultra-processed food has been pushed by the HUPF food lobby, America’s biggest. RFK, Jr.’s Health and Human Services department and the USDA have been struggling to settle on a definition of ultraprocessed food that can be used for writing policy and regulations. Kennedy says the definition is finished and is awaiting the approval of Trump now. This holding pattern means Big Food is not done lobbying on the issue.

A simple definition of HUPF is needed

I predict the Trump administration will come out with a not-simple, maybe even tricky, definition that is as favorable as possible to Big Food while maintaining the appearance of addressing the concern with HUPF that is a core issue of Trump’s important constituency, the Make America Healthy Again movement.

The Big Food lobby and HUPF

However, what Americans actually need is a clear and simple definition of HUPF that can’t be corrupted by Big Food.

I can ‘t know for sure that the federal HUPF definition will be compromised by Big Food’s influence but, given the record of this administration and the record of success and power of the Big Food lobby, it is a safe bet that industry profit will be considered at least equally with public health in the forthcoming Health and Human Services and USDA definition.

For examples of the power of Big Food, their lobby got the word “ultra-processed” taken out of this year’s Dietary Guidelines, even though RFK, Jr. is an avowed enemy of HUPF. And the Make America Healthy Again Strategy Report, of September 2025, mentioned ultraprocessed only once, in the context of the need for a definition.

Before RFK, Jr. and the USDA issue their Big Food-compromised definition, I have a proposal.

First, some background.

Carlos Monteiro, the scientist who invented and popularized the term “ultraprocessed food,” did the world a huge service in identifying how the food we are eating is industrial, formulated to be addictive, heavily marketed, all about profitability, and not healthy. Monteiro defined ultraprocessed as generally bad and not ultraprocessed as where the good lies, which is all true. But his definition of ultra-processed was too inclusive and not simple and clean enough to be used for policymaking.

Clarity from an unlikely source

I respectfully offer a simpler way to view what has happened to our food environment and how it happened, a clear dichotomy that was popularized in the late 1960s by none other than the Hippies.

Without the benefit of science or research, the love-beaded, bell-bottomed folks of the Counterculture Revolution intuited that the direction the food environment had gone was all wrong. They understood American diets were being co-opted by the marketing and lab-created, unnatural products of Big Food. They said, “What was the matter with the way we were eating before?”

The natural food movement blossoms

And so the natural food movement was born in earnest. In the words of Crosby, Stills, Nash, and Young from 1969’s Woodstock, “…we’ve got to get ourselves back to the garden.”

Suddenly un-sugared granola and un-sugared plain yogurt were to be found in small urban food co-ops along with raw milk, whole grains, nuts, honey, molasses, organic vegetables, lentils, brown rice, tofu, and sprouted beans. Highly- and ultra-processed food were rejected. To the youth of the Counterculture, this was an entirely new way of eating, but to the grandparents of those Hippies and their grandparents and their grandparents, this was just the way food was supposed to be. Except for the tofu, of course, which was “far out, man.”

The end of World War II and the beginning of the HUPF Era

These twenty-somethings had been born in the years surrounding the dropping of the first nuclear bombs in 1945, ending World War II and beginning the Atomic Age, and the Anthropocene Epoch proclaiming the most pronounced human impact on our planet, and, not coincidentally, the HUPF era.

It is no coincidence that the HUPF era directly follows World War II. The needs of the Allied war machine had driven both the development of new HUPF food products for our soldiers and chemical design and manufacturing that fueled the rapid rise of commercial HUPF after the war.

HUPF harms? We happily swallowed the problem.

Why did it take until the early 21^st century, 60 years after the start of the HUPF era, for concern about the radical change in our food environment to come to the forefront in American society? Money, marketing, and our indulgence and belief in the delightful wonders of HUPF, perhaps. You could say we swallowed the problem. Fortunately, the now almost extinct human subspecies called Hippies – I say that with love and peace – seems to have been created on earth to detect the unnatural change in our food that had occurred and to call out the alarm.

The Hippies’ natural foods is now a commercial sector

We are five plus decades beyond the start of the “back to natural foods” movement. That movement is now a fully commercialized sector of our food system with 557 Whole Foods stores globally. And despite the array of HUPF products in Whole Foods stores, the Hippies did start us on a healthy way forward.

The stark division identified by the Counterculture between new food and natural food is the true way to think about ultra- and non-ultra-processed food and the best starting point for a definition of HUPF.

A new proposed definition

Highly- and ultra-processed food is produced from food or chemicals modified or newly created with methods of the Second or Third Industrial Revolution. That is my definition of HUPF in 23 words.

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There are several tenets to the definition

1. HUPF is unnatural food. Natural food, if processed or modified, is done so with methods that predate the Second Industrial Revolution* (see the footnote for an explanation of the dates and the nature of the first three Industrial Revolutions), and in the case of techniques like fermentation, by thousands of years.

EXAMPLE

Yogurt is a food that can be very healthy in its natural form but is now sold mainly in a modified form with post-industrial ingredients, making it HUPF in those cases. Yogurt is the example almost always cited (to the delight of the HUPF lobby) when the Big Food-inflated problem of defining HUPF is discussed. The question always posed is “What about yogurt with its additives? It’s healthy food!” The answer is “Okay, although healthier in its natural form, but if you want to make a law banning HUPF while making an exception for yogurt: fine, help yourself.”

2. Everything that is natural food has been consumed by humans for a long time. Humans have learned what to eat and what not to eat over millennia. We have adapted some food to our biological needs, or, in some cases, our biology has adapted to the available food. What we eat, works for our health.

EXAMPLES

First, we have developed genetic adaptations in some cases. Lactose intolerance develops in children as a way to force their weaning from mother’s milk in order that their new baby siblings can get adequate nutrition. In northern cultures where animal milk is common, lactose intolerance has evolved out of the genetic pools, allowing more resilience to famine. Second, a traditional Inuit diet, which is all protein and fat and lacks vegetables and fruit, adapts the available food by including raw organ meat like seal liver and caribou brain which is rich in vitamins. Furthermore, evolution within the Inuit genes allows the metabolization of fat from their hunted food in a way that reduces bad cholesterol and heart disease.

3. Everything that is HUPF is a new or relatively new industrial invention, or it is a food that is a new risk because of mass production allowed by a high level of processing.

a. All of the many thousands of food products and additives created after 1945 are HUPF. Keep in mind, please, that 1945 is not a hard and fast date, pending further investigation and discussion of how far back it could be pushed. For now it is a safe and convenient date to mark the watershed after which no new natural food could have been created. We can say no new natural foods have entered human food environments since at least 1945 and any food or additive created after 1945 is HUPF.

b. Some HUPF is older.

EXAMPLE

Hydrogenated vegetable oil, or transfat, as in margarine or Crisco shortening, was invented in 1901. It was marketed as a healthy alternative to butter, but in reality, is very toxic to heart health.

c. Second Industrial Revolution processes made some moderately processed food into HUPF. These foods had been tolerated without great harm in small amounts in our diets, but they became significant health risks when they became widely and cheaply available by virtue of mass production, made possible by a high degree of processing. The nutritional and structural character of these foods was the same as it was in the pre-industrial age, but industrial processing and mass production lowered cost and allowed over-consumption.

EXAMPLES

Refined sugar, highly refined flour, salt, and white rice are in this sub-category of HUPF.

4. Where natural food is available in sufficient quantity and quality, it is sufficient nutritionally. In such an environment, HUPF brings few nutritional advantages to the table.

The health risks are bad but the economics favor HUPF.

HUPF is an overwhelmingly negative nutritional contributor to diet but has economic value on the basis of convenience and cost per calorie. Policies addressing the pervasiveness of HUPF in our food environment have to deal with these economic factors, whether it is in the potential increased cost of school lunches -- as in California’s HUPF school food ban -- or when creating sugared beverage taxes, which have the greatest effect on lower-income households.

Policy makers are aware that when the choice is between sufficient HUPF calories or insufficient healthier calories, having sufficient calories must win every time. Hungry children, and there are many in America, are not okay. The cost of healthy food is the greatest and broadest nutrition policy challenge in America.

We have to acknowledge that HUPF is not by definition harmful.

Some HUPF substances are toxic. Some might be fine in low doses found in normal consumption but toxic in high doses. But for most HUPF we don’t have safety data, and it would be very difficult to get. Some HUPF likely have benefits outweighing any risks. For example, seed oils are good replacements for animal fats. Some preservatives like nitrites and nitrates reduce levels of dangerous bacteria but present their own carcinogenic risks. I would suggest the sensible default, where we can afford it, is to pass over HUPF unless there is strong evidence it is safe.

HUPF may never be removed from our food supply, but it will hopefully be reduced in many helpful steps and stages.

California leads the way, as usual

Impatient with delays addressing the health harms of HUPF, some states have proceeded with their own definitions and laws. California leads the way, as usual, using Monteiro’s 2009 definition as a basis.

Monteiro’s definition has been widely used in research for approaching 20 years, but it is overly descriptive and inclusive. Nutritionists and policy makers, joined by a happy chorus from the Big Food lobby, have been in consensus that the Monteiro definition is not well-suited for regulatory, law-making, or program-design use.

Complexity and exceptions weaken definitions proposed to date

Other nutrition scientists have offered their definitions, hoping to provide a more independent, scientific perspective than any that will come from Health and Human Services and USDA. Typically, these HUPF definitions are not simple and have exceptions built in. Any complexity and any exceptions will be examined by Big Food for an opportunity either to argue that certain HUPF products are not covered or to re-design their products to avoid coverage by regulation. A simple, solid definition presents less openings for argument and so can be more impervious to corruption by Big Food.

Also, any definition of HUPF, simple or complex, will require exceptions when implemented in law, policy, regulations, or programs. Exceptions will always be added based on the circumstances of jurisdiction, institutional setting, nutritional needs, economic and financial dictates, or political influences. In order to have a defensible policy, the exceptions should be added to the language of the implementation and not be part of the main definition.

EXAMPLE

The usefulness of simplicity is seen in the FDA smoking control regulations where the target was defined simply as nicotine in combustible tobacco products. The streamlined approach to defining the problem helped create an extremely effective regulatory framework for tobacco control.

Conclusion

HUPF consists of thousands and thousands of substances created mostly in the decades since the end of World War II and the beginning of the Third Industrial Revolution.

Most of these modified foods and additives have no substantial certification of their safety on record. They are not sold to us for our health. They are produced to profit the corporate coffers of Big Food. The quick creation of an effective regulatory framework for HUPF, beginning with a strong and durable definition, would reduce health harms and deaths from diseases that are linked to HUPF and point to a possible return to a healthy food environment.

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Footnote

*The First Industrial Revolution, from the late-18^th to mid-19^th centuries, was about the transition from the agrarian economy to industrial employment, mainly in textile factories in England. Industrial innovation for the production of HUPF occurred mainly with the Second and Third Industrial Revolutions. The Second Revolution was from the mid-19^th to mid-20^th centuries and saw massive leaps in technology and communications with the dawn of electricity, steel, telephone, internal combustion engines, and expanded railways. The Third Industrial Revolution was, in essence, the Digital Revolution, which began after World War II.

Trump suppressed a major government-led study on alcohol, health, and risk of death meant to guide the writing of the 2025 Dietary Guidelines for Americans. Although a draft of the report had been released for public comment, this was, nonetheless, a big win for the alcohol industry.

This week the scientists who did the research published the results that Trump, Republicans in Congress, and the alcohol industry don’t like. The paper appeared in the peer-reviewed Journal of Studies on Alcohol and Drugs.

We’ll walk through what the research says, and, I’m sorry, it may not be good news if you enjoy alcohol, as I and most Americans do.

But first, here’s what has happened.

The Interagency Coordinating Committee on the Prevention of Underage Drinking, a group with expert scientists endorsed by the USDA, Health and Human Services, and many agencies, was tasked in April 2022 with studying the effect of alcohol on health. Later in 2022 Congress passed a law mandating a similar report from the National Academies of Sciences, Engineering, and Medicine. On paper, the two studies were meant to be complementary and to inform recommendations on alcohol intake in the 2025 Dietary Guidelines. But the National Academies research was tainted from the outset by the strong financial links of some of its scientists to the alcohol industry.

Congress attacks the work of the Interagency Committee

During their nearly three years of work, the integrity of the Interagency Committee process was assaulted by Republican Congressmen acting in tandem with the alcohol lobby, who feared the tightening of the 2020 Dietary Guidelines, which recommended limiting alcohol to two drinks per day for men and one drink a day for women. The lobby also feared the Interagency Report would state that alcohol was a cause of cancer, since that evidence had already been solidified in the scientific literature.

Representative James Comer, Republican from Kentucky, home of Bourbon whiskey, led an aggressive congressional investigation into the work of the Interagency Committee. In January 2025, at the release of the draft report, Comer issued press releases from the House Oversight Committee on Reform accusing the Committee of work that was unlawful, biased, and wasteful, and executed with a predetermined outcome using cherry-picked data.

Meanwhile, the National Academies of Sciences report had been released a month earlier, in December 2024.

National Academies report finds drinking causes breast cancer

The National Academies of Sciences found that drinking was a cause of breast cancer. This was bad news for the alcohol industry but represented the minimum about cancer the Academies report could say, given the mounting evidence. The National Academies scientists also reported there was what they called “mid-grade” evidence, not strong but not weak, that moderate drinking, defined as one drink per day or less, resulted in a 16% decrease in risk of death compared to non-drinkers. The alcohol industry liked this.

Interagency Committee report finds drinking causes seven types of cancer

On the other hand the Interagency Committee draft report found “… the risk of dying from alcohol use begins at low levels of average use” and from there, the more alcohol the more the risk. In contradiction of the 2020 Dietary Guidelines, the Interagency report said men generally have the same level of risk as women, which is a one in 1,000 risk of dying from alcohol use if consumption is more than 7 drinks per week. The risk increases to one in 100 with more than 9 drinks per week. The Interagency Report also found that seven types of cancer, not just breast cancer, were causes of alcohol-related deaths.

These Interagency Committee results were not at all friendly to the alcohol industry, or, frankly, to the many people who drink in what is considered moderation. If the Dietary Guidelines were going to be written in alignment with this study by Health and Human Services and the USDA, the new Guidelines would need to lower the 2020 Guidelines’ recommended limit on alcohol of two drinks per day for men and one for women and add a warning that alcohol is a cause of cancer.

The Interagency report is 86’d

But the Trump administration took office two weeks after the Interagency draft was released and the report was never finished and published.

The 2025 Dietary Guidelines on alcohol are toasted by the alcohol industry

When the 2025 Dietary Guidelines were finally finished and released in January 2026, based on a new made-to-order, quasi-scientific report, the alcohol lobby was flush with success. The new Guidelines removed the recommended limit on drinking and instead simply advised, if drinking, to drink in moderation. Going against the science in both the Interagency and the National Academies reports, the Guidelines made no mention of cancer.

The Interagency research re-surfaces in a peer-reviewed journal

This week the six original authors of the Interagency report, joined by 19 additional co-authors, published a paper with the results of the Interagency research. Their original findings stand that low levels of drinking don’t have a protective effect – a little alcohol isn’t necessarily bad, but it isn’t good for you. A little more alcohol and then the risk of disease, including cancer, and death becomes apparent. At 8.5 drinks per week the risk of an alcohol-related death becomes one in 100, for both men and women. At the previous recommended limit of 14 drinks per week for men, the risk of an alcohol-related death is one in 25.

The publication of this paper is important. It stood up to independent peer review, has four times the number of authors as the original report, and can now be cited by other scientists, policy makers, and program designers going forward.

100,000 cancer cases annually due to alcohol

Studies have found about 20,000 to 25,000 annual American cancer deaths due to drinking. 83% of these deaths could be prevented by drinking within the 2020 Dietary Guidelines of a maximum of two drinks per day for men, one for women. In thinking about the meaning of this statistic for your own choices, remember that these are just cancer deaths, and that cancer cases due to alcohol total about 100,000 annually. Any case of cancer tends to have a bad impact on life.

These two reports raise somewhat different levels of alarm, but both make clear cancer is a risk with drinking.

That alcohol causes cancer has so far escaped the knowledge of 60% of Americans. There will be better awareness of alcohol’s relationship to cancer if and when a warning is incorporated in the Dietary Guidelines, as it should have been this year.

Informing Americans about the risk

The word is getting out there despite the power of the alcohol lobby. In January 2025, just before Trump took over, the U.S. Surgeon General’s office issued a report saying alcohol is a leading cause of preventable cancer. And, don’t tell Trump this, the CDC still has a web page listing the seven cancers caused by alcohol and advising that reducing drinking lowers cancer risk. By the way, the CDC takes the trouble to point out that red wine (or white, for that matter) carries the same risk as beer and hard liquor.

Making personal choices

Given that the National Academies group had financial links to the alcohol industry and was engaged by Congress to provide a counter to the work of the Interagency group, I lean toward the findings of the more worrisome Interagency Committee study. Of course, neither endorses drinking as a safe habit. As someone who enjoys alcohol, I am still weighing my own, personal level of concern.

I do know I am thankful for the work of all the genuine, independent scientists and public health officials publishing and acting on this issue and that the findings of the Interagency Committee and the National Academies were able to be brought into the open despite the efforts of the Trump administration to repress science it doesn’t like. Let us know what you think in the comments!

Thank you for reading.

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Elon Musk and Joe Rogan, eat your hearts out.

In today’s game, three doctors walk into a Fox TV studio for a taping of Survivor, Surgeon General. Two of them work for Fox. Two of them got their medical degrees at schools in the Caribbean. One of them lies about her qualifications. Two of them are selling supplements. One of them isn’t really a doctor and is a recent stockholder in tobacco. Two of them are not completely pro vaccine. Which of these three are qualified to be the U.S. Surgeon General? Who will be voted out? You decide, because you are a whole lot more qualified than the President who nominated them.

Candidate #1

To recap our game so far, Donald Trump named Dr. Janette Nesheiwat as his nominee for Surgeon General two weeks after being elected to his second term. In his statement, the President-Elect repeated Nesheiwat’s lies about being double-board certified and a graduate of the University of Arkansas School of Medicine. In fact, her medical degree is from a Caribbean university, which as a group are best known for accepting those who fail to get accepted into a U.S. medical school. For many though, the Fox commentator’s real fault was that she was pro vaccine and science. People who wanted someone who could be trusted to speak the truth about everything, not just vaccines and science, objected to the nomination, and everyone else wanted someone who would not speak the truth about science, so they objected, too.

“YOU’RE FIRED!”

Warming our hearts with his famous Apprentice reality TV show catchphrase, in May 2025 the President told Nesheiwat, “You’re fired!” as the Surgeon General nominee.

Candidate #2

Next up, vaccine skeptic, supplement seller, tobacco investor, and not-an-actual-doctor Casey Means was the second nominee for the nation’s top doctor. Means is a darling of the MAHA movement, and they love everything about her -- except MAHA folks didn’t mention her holdings in tobacco giants Altria Group and Philip Morris.

With everything else to complain about with Means, the tobacco investments did not get much attention, but to me it was a serious red flag. Surgeons General through the years have played a huge role in turning public attitudes about smoking toward the negative, but there is still a long way to go with tobacco. Smoking remains the leading preventable cause of death in America with a half-million deaths annually. We can’t have a Surgeon General nominee who profits from tobacco.

“YOU’RE FIRED!”

But it was the not-a-real-doctor thing and her vaccine skepticism that tanked Means’ nomination in her confirmation hearing. Trump said, “You’re fired!”

Candidate #2

Trump’s third nominee hoping to be named “Survivor, Surgeon General,” is Dr. Nicole Saphier. Like Nesheiwat, Saphier both graduated from a Caribbean medical school, yup, and was a commentator on Fox News. Like Means, Saphier sells supplements and has expressed ambiguity about vaccines.

Let me be clear, ambiguity about FDA- and, more importantly these days, W.H.O.-approved vaccines is completely inappropriate in a Surgeon General. But since Eating In America is about what we consume in our bodies, I will object to Saphier on the basis that she is yet another snake oil selling nominee, who claims science where there is none, makes health promises where there is no or insufficient evidence or expert scientific consensus, and takes money for products where there is no proven efficacy but there are serious concerns about safety.

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Outrage #1: Saphier proposed as Snake Oil General

Saphier, in addition to her job as a radiologist and work on Fox, is a maker and vendor of a line of wellness supplements. Her company, Drop Rx, sells four elixirs, she calls them tinctures, for about $10 an ounce. They are named “Focus,” “Calm,” “Soothe,” and “FemmeX.” Saphier makes unsupported health claims for these formulations of unquantified herbs and ultraprocessed ingredients and one of them contains an ingredient, kava, that is banned in the U.S. military.

I will come back to this outrage, and the even bigger outrage of the way the U.S. handles supplements, in a moment.

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Don’t mess with the Chinese sea snake

We all may have become familiar with the term “snake oil salesman” by watching American Westerns where men in bowler hats sold cure-all elixirs out of the back of a covered wagon. There is a surprising origin story to these early wellness hucksters.

180,000 Chinese laborers brought the oil of the Chinese sea snake, the extremely venomous black-banded sea krait, when they came to build railroad lines in the American West in the mid-1800s. This traditional medicine is very rich in eicosapentaenoic acid, or EPA, an anti-inflammatory omega-3 oil. The snake oil might have provided some relief for aches from pounding stakes into railroad ties all day and the other difficult and dangerous work these men were doing. There is some evidence that EPA can help with joint pain. But I can’t help speculating if the crates of snake oil didn’t also contain some bottles of snake venom wine, also a traditional Chinese medicine and a more powerful treatment for pain than snake oil.

The Rattlesnake King

In any case, inspired by the widespread Chinese use of sea snake oil, a man named Clark Stanley showed up in Chicago in 1893 dressed as a cowboy and carrying live rattlesnakes and bottles of supposed snake oil that actually contained only mineral oil, beef fat, red pepper, turpentine, and Stanley’s false claims of healing powers. But Stanley was a good hawker, and the snake oil business took off.

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Snake oil elixir, a new law, and a $20 fine

A surge in snake oil and other elixir sales was part of the reason for the passage of the Pure Food and Drug Act of 1906. That law was the basis in 1917 for fining Stanley $20 for his false health claims. The fine didn’t hurt Stanley, but the bad publicity resulted in him having to shut down his factories and, in fact, his whole operation.

Defining a supplement: food, drug, or a little of neither?

Skipping ahead to 1994, the new Dietary Supplement Health and Education Act categorized supplements as food, not drugs. As a subcategory of food, supplement makers don’t have to prove their products work or are even safe before putting them on the market. Further, while food items aren’t allowed to make unapproved health claims, food supplements are given a lot more leeway. They are not supposed to make health claims, but, well, they do.

The American snake oil supplement system

The system we have is deficient. Americans spend $60 billion a year on supplements that are not reviewed for their health claims or safety.

Some of these supplements are meant to be nutritional, like vitamins, minerals, omega-3 fatty acids, or whey powder protein, for example. These should be regulated like food and held to the same strict FDA standard for food health claims.

Other supplements are, in essence, over-the-counter drugs. These include products containing psychoactive ingredients. Some supplements in this group are meant to calm us, like bacopa monniera, or make us alert, like ginseng. The other supplements in this group are advertised as being associated with a range of health benefits such as stress relief, inflammation reduction, or soothing digestive issues. Like any drug with a health claim, these should be treated by the FDA as over-the-counter medications and verified for safety and the validity of their claims.

Surgeon General hopeful Saphier’s supplement

Let’s check one of Surgeon General nominee Saphier’s Drop Rx products, “Calm.” “Physician formulated. A clean product you can trust. Experience the power of nature, backed by science.”

So, a doctor designed it, Drop Rx says we can trust its safety, and science says it works. Well yes, there is some science that supports the psychoactive calming effect of ingredients, including kava, in Calm. But there hasn’t been the rigorous testing that should accompany any psychoactive product that is, in essence, a drug.

Kava, unfit for service

But, worse, the science also points to kava’s risk of liver damage, which is the reason the U.S. military, UK, France and Switzerland have banned kava, and the FDA published advisories about its potential toxicity in 2002 and 2020.

There is some confusion about the kava in Calm. In two places the Drop Rx website shows the presence of kava in Calm and in two other places on the website the kava is missing in favor of another psychoactive ingredient. But regardless of the quality, safety, and efficacy of Saphier’s elixirs, the fact that she is selling supplements is the basic issue.

What we need in a Surgeon General

We need a Surgeon General who is deeply committed to solidly scientific approaches to saving lives and improving our health, with a desire to communicate about the effectiveness and safety of vaccines, the need to control tobacco and addictive substances including ultraprocessed food, along with addictive media and digital and instantaneous gambling, the need to treat unhealthy weight in Americans, and the urgent need for diligence in the face of new global health threats due to both climate change and the ease of pandemics to spread.

As long as Trump puts forward candidates as inappropriate and unqualified as Saphier, we can only hope the game of Survivor, Surgeon General will go on. But, for better or worse, it seems that the lack of an actual Surgeon General is not going to stop the Surgeon General’s office from issuing Surgeon General advisories. This past week RFK, Jr. went ahead and signed and released a Surgeon General’s report warning about excessive screen time for kids.

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Here’s a story that is so scary and sobering that only a science fiction writer could make it up. Only it is not fiction.

And while a mere epidemiologist like me could not have conceived this story – it is too outrageous given what we know today – the story does provide us, and by us, I mean scientists including epidemiologists, media, and the public, at least several sobering lessons.

I love food history stories. They can be so informative. Here we go.

The butter part of this story started maybe 10,000 years ago, perhaps when some nomads put goat milk into a bladder, and as the nomads walked the bladder bounced around and churned the milk into butter.

Butter has been loved ever since.

The margarine story started in France in 1869. It was not love at first taste. Napoleon III wanted a cheap, hardy alternative to butter to send to sea with the Navy and to feed the bottom ranks of the working class. The resulting margarine didn’t work out for the Emperor. Neither the Navy nor the poor wanted it. But the idea of a cheap butter substitute was too good to throw away, and in 1901 a chemist invented partially-hydrogenated vegetable oil. Crisco, which was 100% partially-hydrogenated vegetable oil, came on the market ten years later in 1911, and by 1930 margarine was made with partially-hydrogenated vegetable oil.

Let’s pause for a reminder. Partially-hydrogenated vegetable oil is a horror story of its own. It is toxic with trans fats, and trans fats can increase the risk of death by a third. 34% to be exact. Trans fats raise the risk of heart attack, stroke, Alzheimer’s, and cancer.

Nutritional epidemiologist Walter Willet and others found solid evidence that trans fats were bad for the first time in 1990. However, the FDA, with its cumbersome process combined with pressure from the ultraprocessed food industry, took until 2015 to revoke the GRAS, or Generally Recognized As Safe, status of industrially made trans fats, banning them from food only eight years ago, in 2018. And yes, partially-hydrogenated vegetable oil can be seen as a very early poster child of the ultraprocessed food industry.

Back to our story, the butter shortages during World War II conditioned the American public to eating margarine, and the gap between butter and margarine consumption narrowed. In the post-war years, the margarine industry saw a bright future.

Convincing the public of margarine’s healthiness with biased-science and media

In the most audacious industry funding of research I know of, around 1945 the National Association of Margarine Manufacturers gave funding to three scientists at the University of Chicago and the University of Illinois to compare the health effects of margarine versus butter.

That grant in itself was not audacious, but it might have been innovative. We think of industry funded research as part of the playbook written by the tobacco industry, which passed the practice on to the ultraprocessed food, opioid, cannabis, and gambling industries. But, in fact, this was a case of the ultraprocessed food industry funding research eight years before the tobacco industry started its massive effort in 1953 to co-opt the science linking smoking to cancer.

Of course, no matter who conceived of the idea of funding science to get advantageous and respectable-seeming results, or, in the case of tobacco, just to cast doubt on the good science coming out, the priorities were always the same, profits before science before health.

The audacious piece is what the Chicago scientists were paid to do. Previously all the research on the healthiness of margarine versus butter was done on animals, almost always lab rats. This grant was to do human research.

To put this in context, this money was delivered three years before German doctors were put on trial in Nurenberg for their concentration camp medical experiments on prisoners. This money came in the middle of the 40-year course of the Tuskegee Syphilis Study which withheld antibiotics from infected men who were Black. This was nine years before the NIH became the first institution to require a review of human subjects research it conducted. By the way, the NIH review program was only to provide itself legal protection, not primarily as a matter of ethics.

Here’s the thing. The doctors in Chicago were paid to conduct their research on orphans in two orphanages. One orphanage ate butter and the other ate margarine. The research went on for two years and was done on 350 children from 2 to 17 years old. They were weighed monthly and their heights were recorded, with blood draws to measure their red blood cell count and hemoglobin. Medical records were checked only to see if one orphanage was seeing a difference in health compared to the other. In their resulting paper the doctors seemed strangely excited the margarine eating children were much healthier than those that ate butter, although they took care to say in the paper that the very good health was certainly not “simply because” of the margarine.

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It was a poor study with a poor design, written up with bias in favor of its funder, but of course the outrageous, nowadays unthinkable aspect is that forcing this study on these children was seen as acceptable. Children cannot give their consent to being subjects of research. Furthermore, these toddlers and kids and teenagers were wards of the state and in an institution where one might imagine they were experiencing some level of trauma or emotional distress on a daily basis. The margarine research equated them to lab rats with human metabolisms.

Having no consciousness about the possible harms of this research to its subjects paid off for everybody but the children. Especially the margarine industry, which saw a favorable paper, “Margarine And The Growth Of Children,” published in the Journal of the American Medical Association, one of the world’s top medical research journals. The very influential TIME Magazine picked up the story, quoting the scientists’ conclusion that “Margarine is a good source of table fat in growing children…”

Within a couple of years as much margarine was being eaten as butter. Margarine continued to grow in popularity, becoming consumed twice as much as butter by 1970.

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Today, Institutional Review Boards, or IRBs, in the U.S., or their equivalent in Europe and elsewhere, but not China or Russia, carefully screen all proposed research plans at universities or any organization doing federally funded research or FDA regulated trials, to ensure strict ethical standards are met. The margarine study would not have passed IRB review.

Are our problems with unethical research solved in the U.S.? Apparently not in RFK, Jr.’s department, home to the FDA, NIH, and CDC, three agencies that fund or review a lot of human subjects research.

At the end of 2025 it was revealed that the CDC had given a no-bid contract to Danish researchers to test the effect of hepatitis-B vaccines on newborns vs. 6-week old babies in Guinea-Bissau in Africa. The researchers are friendly with anti-vaxxers aligned with RFK, Jr. Kennedy has strongly praised one of the researchers. A leaked protocol for the study points to an intention on the part of the researchers to show that withholding the vaccine for six weeks is safer than giving it at the same time as other newborn vaccines. The World Health Organization is clear that withholding the hepatitis-B vaccine at birth is dangerous, risking the long-term development of serious illness and death due to transmission of hepatitis-B from the mother during birth. 18% of adults in Guinea-Bissau have hepatitis-B.

In sum, Kennedy disregarded procedure to give a contract to researchers who designed a study to exploit the high prevalence of a disease in an African nation. The leaked protocol revealed that their intent was to support the CDC’s dismissal under Kennedy of the hepatitis-B vaccine recommendation for newborns. There was no review by an IRB at the CDC of this research. The study has been decried as unethical by the World Health Organization and research ethicists and scientists, and it has been likened to the Tuskegee Syphilis Study. As of March 2026 the study was on permanent hold.

While this began as a horror story about industry-funded, completely unethical research that found that margarine was as healthy as butter, again not true, we ended with another scary story of highly unethical research. Only this latter study was funded by a government politician, RFK, Jr., who happened to be in charge of a group of prestigious scientific agencies and yet had the goal of supporting his own dangerously wrong and unscientific ideas about vaccines.

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