Emily K. Abel.  Gluten Free for Life.  NYU Press, 2025.

I was surprised to be asked to do a blurb for this book, since I don’t have to worry much about gluten and rarely comment on clinical medicine, but after reading it I was glad to do one.  It’s a really good book.  My back cover blurb:

This important book is a rousing call for action—medical, dietary, social, and political–to protect people with celiac disease from the gluten proteins that make them sick. Emily Abel’s analysis of the barriers to avoidance, from unaware doctors to food companies’ lobbying against labeling to widespread ignorance of where gluten lurks in food, should convince us all to insist that gluten be labeled and products monitored to ensure they really are gluten free.

Celiac disease turns out to be a genetically determined autoimmune reaction to digested fragments of gluten proteins. The autoimmune reaction destroys the lining of the intestine, causing serious digestive illness and preventing nutrient absorption.  People with celiac disease display nutrient deficiences and many other symptoms beyond digestive.  These are more difficult to explain and put this disease in a category similar to that of other poorly understood multi-symptom diseases.

Wheat, rye, and barley contain gluten proteins.  Corn and oats do not, but they are easily contaminated with wheat in silos or trucks.

Symptoms of celiac disease ought to disappear when people strictly avoid foods containing sources of gluten.

But this book emphasizes that strict avoidance is practically impossible for most people with this condition.  Why? Gluten proteins seemingly are everywhere in the food supply, not least because food preparers don’t realize what they are.

Abel makes a strong case for celiac disease—and gluten—as deeply misunderstood, maligned, and neglected.

She quotes the voices of many people with this condition, in despair over how long it took them to be diagnosed, how hard it is for friends and relatives to understand what it takes for them to avoid gluten, and how often they are “glutened” in error.

As a result of reading this book, I will join calls for better labeling—-and for rigorous, scrupulous efforts to make gluten-free mean what it says.

I’ve been interviewed a lot lately about ultraprocessed foods.  See, for example:

• New York Times Well Challenge: Day 4: Grocery shop like a nutrition scientist
• New York Times 10 Ways to Eat Better 
• The New Yorker:  Why is the American Diet So Deadly?

And Gary Ruskin of US Right to Know sent me this collection of fact sheets.

• Overview: Ultra-processed foods tied to cancer, diabetes, dementia, depression, early death, and more
• Ultra-processed foods and early death
• Ultra-processed foods: increased risk of cancer
• Ultra-processed foods: obesity and weight gain
• Ultra-processed foods linked to increased risk of Type 2 diabetes
• Ultra-processed foods: increased risk of dementia, Alzheimer’s disease
• Ultra-processed foods: increased risk of depression and anxiety
• Ultra-processed foods increase risk of cardiovascular disease
• Some ultra-processed foods are as addictive as cigarettes and cocaine

I’m hearing an awful lot of fuss about difficulties defining ultra-processed foods and how some conditionally ultra-processed foods (e.g., whole wheat bread and yogurt) are healthy.  Maybe so, but the overall concept makes a lot of sense to me, especially with research demonstrating that ultra-processed foods encourage greater calorie intake.  That alone is reason to minimize intake.

If you are a long-time reader, you will know that I have a particularly hard time understanding agricultural trade disputes.  I understand the basic principle: every country wants to protect its own.  Where I need help is with how the rules work and are applied.

Here’s a good place to start on this one: US corn growers secure major victory in USMCA dispute with Mexico: Panel rules Mexico’s GM corn import ban violates trade agreement, marking a triumph for American agriculture..

In a significant win for U.S. corn producers, a dispute panel has ruled that Mexico violated its commitments under the United States-Mexico-Canada Agreement (USMCA) by issuing a decree banning genetically modified (GM) corn imports in early 2023. This decision comes as a relief to the National Corn Growers Association (NCGA) and other advocates who had urged the United States Trade Representative to file the dispute.

The USMCA panel’s decision is here.

How to interpret this?  Fortunately, Chuck Abbott explained the background in FERN’s AgInsider (alas, he’s no longer writing this).

The 2023 [Mexican] presidential decree imposed an immediate ban on imports of GMO white corn used in making dough and tortillas, an everyday food of Mexico, and gradual elimination of imported GMO corn for industrial food uses and for livestock feed. So-called yellow corn is fed to livestock…Corn originated in Mexico and holds deep cultural significance in the country; it has five dozen native varieties. Conservationists, Indigenous communities, and traditional farmers have sought for two decades to keep the country’s heritage seeds free of GMO traces.

And even more fortunately, Tim Wise to the rescue: U.S. Wins Controversial Ruling in GM Corn Dispute with Mexico.

According to the U.S. government, the final report from the tribunal, announced December 20, ruled that “Mexico’s measures are not based on science and undermine the market access that Mexico agreed to provide in the USMCA.” In fact, the trade panel’s ruling was more limited, demanding that Mexico comply with the trade agreement’s procedures for carrying out risk assessments based on “relevant international scientific principles”…The ruling will not settle the debate over the health and environmental risks of GM corn and its associated herbicides, In the course of the dispute, Mexico produced extensive peer-reviewed scientific evidence that showed ample cause for precaution given the risks associated with both GM corn and its associated herbicide glyphosate.

Wise cites recent studies showing negative health impacts, along with the Science Dossier Mexico presented as evidence.  The tribunal rejected this evidence.

Wise describes Mexico’s response:

It remains to be seen how the Mexican government will comply with the ruling. It has 45 days to respond. Already, President Claudia Sheinbaum has reiterated her support for a constitutional amendment to enshrine a ban on GM corn cultivation and consumption in tortillas. A “Right to Food” law passed last year mandates labeling of foods containing GMOs. No tortilla seller wants such a label on its products, because Mexican consumers are clear that they do not want GM corn in their tortillas.

I like President Sheinbaum’s way of putting this: “Sin maíz no hay país” [without corn, there is no country].

In the meantime, President-elect Trump is threatening Mexico with tariffs on exports—also in violation of USMCA rules, but we will have to see how that goes.

As I said, complicated.  Food politics in action, for sure.

The 2025-2030 Dietary Guidelines Advisory Committee did not make a recommendation about alcohol.  The agencies, HHS and USDA, will do that later based on two expert reviews.

I wrote about the first, from the National Academies, last week: Review of Evidence on Alcohol and Health.

I also wrote about the Surgeon General’s Advisory on Alcohol and Cancer Risk

Still to come is the report from the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD).

At issue is the amount of alcohol that is safe to drink, if any.

Just for fun, I did a summary of what the Dietary Guidelines say about alcohol from 1980 to 2020.  Note that the Moderation advice has not changed since 1990 (but then see the note on 2020).

                                      Alcohol recommendations: Dietary Guidelines for Americans

*From the 2020 Dietary Guidelines Advisory Committee report: “evidence points to a general rule that drinking less is better for health than drinking more. Therefore, the focus should remain on reducing consumption among those who drink, particularly among those who drink in ways that increase the risk of harms. The Committee concluded that no evidence exists to relax current Dietary Guidelines for Americans recommendations, and there is evidence to tighten them for men such that recommended limits for both men and women who drink would be 1 drink per day on days when alcohol is consumed.

Despite the language in the 2020 guideline, the agencies did not change the overall recommendation about moderate drinking.

Will the Surgeon General’s Advisory and the upcoming third report cause the agencies to suggest no more than one drink a day for men?  Or suggest that no level of alcohol intake is safe?

I’m looking forward to finding out.

Resource: the process for alcohol in the Dietary Guidelines

In its scientific report, the 2025-2030 Dietary Guidelines Advisory Committee recommends substituting plant proteins for animal proteins.

The Committee recommends that the proposed Eat Healthy Your Way Dietary Pattern emphasizes dietary intakes of beans, peas, and lentils while reducing intakes of red and processed meats….The Committee also proposes reorganizing the order of the Protein Foods Group to list Beans, Peas, and Lentils first, followed by Nuts, Seeds, and Soy products, then Seafood, and finally Meats, Poultry, and Eggs.

It did not take long for the meat industry to respond: Animal vs. Plant Protein: New Research Suggests That These Protein Sources Are Not Nutritionally Equivalent.

As is my habit, I went right to the study.

The study: Connolly G, Hudson JL, Bergia RE, Davis EM, Hartman AS, Zhu W, Carroll CC, Campbell WW. Effects of Consuming Ounce-Equivalent Portions of Animal- vs. Plant-Based Protein Foods, as Defined by the Dietary Guidelines for Americans on Essential Amino Acids Bioavailability in Young and Older Adults: Two Cross-Over Randomized Controlled Trials. Nutrients. 2023; 15(13):2870. https://doi.org/10.3390/nu15132870

Conclusions: “The same “oz-eq” portions of animal- and plant-based protein foods do not provide equivalent EAA content and postprandial bioavailability for protein anabolism in young and older adults.”

Funding: “This research was funded by the Pork Checkoff and the American Egg Board—Egg Nutrition Center. The supporting sources had no role in study design; collection, analysis, and interpretation of data; writing of the report; or submission of the report for publication.”

Conflicts of Interest: “When this research was conducted, W.W.C. received research funding from the following organizations: American Egg Board’s Egg Nutrition Center, Beef Checkoff, Pork Checkoff, North Dakota Beef Commission, Barilla Group, Mushroom Council, and the National Chicken Council. C.C.C. received funding from the Beef Checkoff. R.E.B. is currently employed by Archer-Daniels-Midland (ADM); the research presented in this article was conducted in a former role and has no connection with ADM. G.C., J.L.H., E.M.D., A.S.H. and W.Z. declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.”

Comment: Amino acids, the building blocks of protein, are the same whether they come from plants or animals (or us).  Food animals are closer to us evolutionarily than are plants; the animo acid composition of their proteins is more like ours than the amino acid composition of food plants.  That is why protein complementarity matters; mix and match the plants you eat and their amino acid compositions will complement each other and fill in the gaps.  This doesn’t even have to be done at every meal.  Overall, it’s easier to get the needed amino acids from animal foods but it’s not all that hard to get them from plants as long as they are varied and you eat enough of them.  So the study isn’t wrong; it’s just not telling the whole story.

Thanks to Kevin Mitchell for sending this one.

I.  Darius Mozaffarian, a nutrition professor at Tufts University, has an editorial in the American Journal of Clinical Nutrition:“The Dietary Guidelines for Americans—is the evidence bar too low or too high?”

He writes about an analysis of the systematic literature reviews SRs) that form the basis of science-based decisions in the guidelines.  His comments gives an insight into the Dietary Guidelines process worth seeing.

For the 2025–2030 DGAC, I served as a peer reviewer for the SR on UPFs…I felt that the SR’s question, design, and planned methods were appropriate, but that its implementation and conclusions were weakened by important deviations from these standards. For example, contradicting its stated eligibility criteria, the SR included numerous studies that did not appropriately or adequately define or assess UPF. Following inclusion of such heterogeneous studies, the SR concluded that the scientific evidence on UPF was limited due to many studies having serious concerns around exposure misclassification as well as evaluating dietary patterns not directly varying in amounts of UPF. This demonstrated a circular and dismaying reasoning: the SR included studies it should not have that had heterogeneous and poorly characterized assessments of UPF, and then concluded that heterogeneous and poorly characterized assessments of UPF limited the strength of the evidence.

He observes:

Most importantly, the DGA and SR requirements make clear that guiding Americans toward a healthier diet is an unfair fight from the start. The food industry can do almost anything it wishes to our food, combining diverse ingredients, additives, and processing methods with virtually no oversight or required evidence for long-term safety  In contrast, the DGAs and other federal agencies can only make recommendations to avoid certain foods or limit certain manufacturing methods when there is extensive, robust, and consistent evidence for harm. In this severely imbalanced playing field, industry wins again and again.

II.  Senator Bernie Sanders posted on Facebook Sanders Statement on How to Make America Healthy Again.  Among other issues, he’s taking on the food industry.

Reform the food industry. Large food corporations should not make record-breaking profits addicting children to the processed foods which make them overweight and prone to diabetes and other diseases. As a start, we must ban junk food ads targeted to kids and put strong warning labels on products high in sugar, salt and saturated fat. Longer term, we can rebuild rural America with family farms that are producing healthy, nutritious food.

III.  California Governor Gavin Newsom “issues executive order to crack down on ultra-processed foods and further investigate food dyes.”

The food we eat shouldn’t make us sick with disease or lead to lifelong consequences. California has been a leader for years in creating healthy and delicious school meals, and removing harmful ingredients and chemicals from food. We’re going to work with the industry, consumers and experts to crack down on ultra-processed foods, and create a healthier future for every Californian.

Comment

Mozaffarian offers these opinions despite disclosing financial ties to food companies.  Sanders is a welcome addition to the handful of legislators concerned about food issues.  Newsom is making it easier for other states to take similar steps.

Maybe there’s a glimmer of hope for coalition building among advocates for healthier food systems.  Maybe this really is a movement!

How’s that for a cheery thought for 2025.  Happy new year everyone!

How did a nice girl like me end up in New York Magazine’s MAHA issue?  I was amazed to find myself in this.

MAHA is the Trump Administration’s Make America Healthy Again campaign.

For the record: I’m totally for making America healthy, and especially for doing everything possible to reduce risks from chronic disease.  I’m for some of what RFK, Jr wants to do (reduce intake of ultra-processed foods, get toxins out of the food supply, reduce conflicts of interest) but by no means all.

Oh well, I didn’t want you to miss this. Enjoy (?).

Here’s what the FDA says about Use of the Term Healthy on Food Labeling.

To meet the updated criteria for the claim, a food product needs to

1. contain a certain amount of food from at least one of the food groups or subgroups (such as fruit, vegetables, grains, fat-free and low-fat dairy and protein foods) recommended by the Dietary Guidelines for Americans, and
2. meet specific limits for added sugars, saturated fat and sodium.

To qualify, a breakfast cereal, bread, or any other grain food would need to have 3/4 ounce of whole grains, and have less than 10% of the Daily Value for added sugars (5 grams per serving), less than 10% for sodium (230 mg per serving), and less that 1 gram of saturated fat (5% DV).

On this basis, kids cereals won’t qualify.

Oh.  And the FDA is still working on the symbol.

Resources

• Use of the Term Healthy on Food Labeling | FDA
• FDA Finalizes Updated “Healthy” Nutrient Content Claim | FDA
• Constituent update
• FDA’s Updated “Healthy” Claim Definition: Fact Sheet
• Federal Register: https://public-inspection.federalregister.gov/2024-29957.pdf
• New York Times: What Are ‘Healthy’ Foods? The F.D.A. Updates the Labeling Terms
• The Hill: FDA updates definition of ‘healthy’ on food labels for first time in 30 years