John Snow, the great disease detective, and how, even in its infancy, public health science struggled with the false beliefs of those in charge
vendredi 31 juillet 2026 • Durée 22:50
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 1st, 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 19th 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 19th 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 24th, 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.
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!
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Eating on Board: A seafaring celebration of the 250th anniversary of our freedom and food stories tied to Tall Ships
dimanche 19 juillet 2026 • Durée 09:00
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.
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Coffee and the Ngäbe indigenous people in the mountains of Panama
mercredi 15 juillet 2026 • Durée 05:17
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.
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Pesticide makers are having a field day: Trump delivers 3 wins in 3 weeks.
dimanche 12 juillet 2026 • Durée 08:37
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.
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The bite of the Lone Star
dimanche 5 juillet 2026 • Durée 05:40
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 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.
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Refining a highly-refined food definition
vendredi 19 juin 2026 • Durée 07:45
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-19th to mid-20th 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 21st century as we enter what some have termed a Fourth Industrial Revolution, but it may be too early to define the current era.
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A travel tip for when little uninvited friends spoil the party. I don't mean monkeys.
vendredi 19 juin 2026 • Durée 04:02
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.
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.
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A simple Highly- and Ultra-Processed Food definition
mercredi 17 juin 2026 • Durée 17:01
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.
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Alcohol causes cancer, Mr. President
dimanche 14 juin 2026 • Durée 08:12
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.
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Survivor, Surgeon General: who will be voted off next?
mardi 26 mai 2026 • Durée 10:34
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.
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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 4th. 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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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.
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:
* Spinach
* Kale, collard and mustard greens
* Strawberries
* Grapes
* Nectarines
* Peaches
* Cherries
* Apples
* Blackberries
* Pears
* Potatoes
* 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:
* Pineapple
* Sweet corn (fresh and frozen)
* Avocados
* Papaya
* Onions
* Sweet peas (frozen)
* Asparagus
* Cabbage
* Cauliflower
* Watermelon
* Mangoes
* Bananas
* Carrots
* Mushrooms
* 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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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.
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.
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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.
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.
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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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.
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 21st 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.
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-18th to mid-19th 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-19th to mid-20th 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.
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.
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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!
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.
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.
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.
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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