It’s a big worry.

From the Cleveland Clinic: Bird flu (avian influenza)

Bird flu (avian influenza) is an infection from a type of influenza (flu) virus that usually spreads in birds and other animals. Sometimes, humans can get bird flu from infected animals. Like the versions of flu that people usually get, bird flu can make you severely ill.

It has infected  and, in the case of dairy herds and poultry flocks, mass culling:

• Wild birds
• Domestic Chickens
• Domestic Turkeys
• Domestic Ducks
• Dairy cattle
• Raw milk
• Wild and captive mammals
• Pet dogs and cats
• People

What is the government doing?

• USDA Announces New Federal Order, Begins National Milk Testing Strategy to Address H5N1 in Dairy Herds
• FDA: Investigation of Avian Influenza A (H5N1) Virus in Dairy Cattle
• USDA: Detections of Highly Pathogenic Avian Influenza
• CDC: H5 Bird Flu: Current Situation

The CDC says: “The best way to prevent H5N1 bird flu is to avoid sources of exposure whenever possible.”  Thanks a lot.

From the New England Journal of Medicine

• Highly Pathogenic Avian Influenza A(H5N1) Virus Infections in Humans
• The Emerging Threat of H5N1 to Human Health

Comment: For producers of dairy and poultry, H5N1 is already a disaster.  “Only” about 66 people have been infected and human-to-human transmission does not seem to be occurring—yet?  If ever a potential epidemic needed a coordinated response, here is a truly alarming example.

As for its effects on the food system?  Higher prices, for sure: Egg Prices Are High. They Will Likely Go Higher.

Charles Platkin sent me this  article from Food Manufacturing: “Eating pork linked with better handgrip strength, industry group says.”

I quickly found the The Pork Board’s press release.

And went right to the source.

The study: Jung A-J, Sharma A, Chung M, Wallace TC, Lee H-J. he Relationship of Pork Meat Consumption with Nutrient Intakes, Diet Quality, and Biomarkers of Health Status in Korean Older Adults.  Nutrients. 2024; 16(23):4188. https://doi.org/10.3390/nu16234188

Objectives: We evaluated the association between pork meat consumption and nutrient intake, diet quality, and biomarkers of health among older adults (age ≥ 65 years) in Korea.

Methods: Our analyses utilized dietary and health examination data from the 2016–2020 Korean National Health and Nutrition Examination Survey (n = 2068).

Results: Pork consumption was associated with  a higher intake of energy and [some] nutrients…Diet quality was modestly higher among…pork consumers. Differences in biomarkers were clinically irrelevant…Handgrip strength was slightly higher.

Conclusions: In Korean older adults, pork consumption may contribute to a higher intake of energy and most nutrients, improved diet quality scores, higher vegetable intake, and small improvements in health biomarkers.

Funding: Funding for this research was provided through an investigator-initiated educational grant from the National Pork Board (#22-056) to Think Healthy Group, LLC. The sponsor had no role in the design, analysis, interpretation, or presentation of the data or results. The authors and sponsor strictly adhered to the American Society for Nutrition’s guiding principles for private funding for food science and nutrition research. M.C. did not receive salary support or consulting fee from this grant.

Conflicts of interest”: T.C.W. has received scientific consulting fees as a current member of the Science Advisory Board for the National Pork Board. He has also received other investigator-initiated educational research grants from the National Pork Board. All other authors have no conflicts of interest to declare.

Comment: Applause to Food Manufacturing for noting the industry  source in its headline: “industry group says”.  Note the effect size: “small improvements in health biomarkers.”  Nevertheless, the Pork Board thought it was worth a press release—it had paid for the study, after all.  The Pork Board runs a USDA-sponsored checkoff program; it collects fees from pork producers and uses them for purposes like these.  Worth it?  A lot of pork producers don’t think so, but the USDA insists and manages it through its Agricultural Market Service.  I wonder if the new administration will take interest in such programs…?

OOPS: A reader alerted me that all links have been taken down by the new administration.

In his last weeks in office, former President Biden issued a Fact Sheet on the food system investments achieved by his administration. A reader, Ethan Wolf, sent in a link from the Wayback Machine. Fact Sheet on the food system investments achieved by his administration

The Fact Sheet divides the achievements into several categories.

• Building new markets and income for farmers and ranchers
• Modernizing the middle of the agriculture and food supply chain: food processing, aggregation, and distribution
• Creating more fair and competitive markets
• Improving food access, nutrition security and health
• Enchancing food safety
• Supporting breakthrough agricultural rewearch and innovation

To highlight just one—food safety:

• USDA issued a rule to classify raw poultry products contaminated with specific Salmonella levels and serotypes as adulterated.
• USDA also finalized a rule declaring Salmonella an adulterant in raw breaded stuffed chicken products exceeding 1 colony-forming unit per gram.
• FDA launched the “Closer to Zero” initiative (C2Z), which sets forth a science-based approach to continually reducing exposure to lead, arsenic, cadmium, and mercury to the lowest levels possible in foods eaten by babies and young children.
• FDA has issued numerous action levels for toxic elements: draft levels for lead in juices; final levels for lead in foods intended for babies and young children; and a final level for arsenic in apple juice. 
• FDA revoked authorizations for the uses of brominated vegetable oil (BVO) in food because of the potential for adverse health effects in humans.
• FDA also revised its regulations and revoked prior-sanctioned uses of partially hydrogenated oils (PHOs) because studies consistently link consumption of PHOs (industrially produced trans fat) with heart disease. 
• Before the end of the term, FDA also plans to revoke the authorization of Red No. 3, a red dye used in certain medications and various foods and beverages, including candies, cakes, frostings, and frozen desserts, due to studies showing that the dye caused cancer [it did this].

Perhaps coincidentally, Lisa Held at Civil Eats published How Four Years of Biden Reshaped Food and Farming: From day one, the administration prioritized climate, “nutrition security,” infrastructure investments, and reducing food system consolidation. Here’s what the president and his team actually did.

Her categories are somewhat different:

• Taking on Consolidation and Corporate Power, and Supporting Farmer Livelihood
• Tackling the Climate Crisis
• Regulating Pesticides and Other Chemicals
• Focusing on Food Safety
• Linking Hunger, Nutrition, and Health
• Supporting Food and Farm Workers
• Advancing Equity

Here’s my excerpted summary of her analysis of Taking on Corporate Power.

With much fanfare, the FDA released its proposed rule for a new front-of-package summary of the Nutrition Facts panel.  I’ve written about the history of this previously.

Of all the options tested (Food Fix had the best summary), the FDA picked this one—not my first choice.

Why not?  I don’t think it’s much of an improvement over this one, produced by industry to head off something that might be more useful.  This one is easy to ignore and pretty much everyone does.  The FDA’s is a bit better, but not nearly enough.

I was hoping the FDA would at least use traffic light colors.  Even more, I wish the FDA had used “High in” warning labels used in Latin America.

These have been shown to be highly effective in discouraging purchases of food products high in sugar, saturated fat, sodium, and calories—the point of this exercise, after all (and why the food industry so opposes it).

Will this label do as well?  We will have to wait and find out.

In the meantime, this is your chance to comment.  Please do.

To Submit Comments

Comments on the proposed rule can be submitted electronically on http://www.regulations.gov by May 16, 2025.

Written comments can be submitted to:
Dockets Management Staff (HFA-305)
Food and Drug Administration
5630 Fishers Lane, Rm. 1061
Rockville, MD 20852
All written comments should be identified with the docket number FDA-2024-N-2910 and with the title “Food Labeling: Front-of-Package Nutrition Information.”

So much is happening on the alcohol frontier these days that it is getting hard to keep up.  Let’s start with the multiplicity of reports on alcohol and health arriving one after another.  I’ve written about the NASEM and Surgeon General’s reports recently.  I’ve also written recently about their implications for the forthcoming Dietary Guidelines.

I.  The ICCPUD report.  Now we have yet a third report from the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD).  This one says:

• Males and females who consumed 1 drink per day had an increased risk of liver cirrhosis, esophageal cancer, oral cancer, and injuries, but a lower risk for ischemic stroke…females had a higher risk for liver cancer and a lower risk for diabetes mellitus when they drank 1 drink per day…even infrequent high per-occasion drinking may eliminate the lower levels of risk for ischemic stroke.
• Alcohol use is associated with increased mortality for seven types of cancer (colorectal, female breast, liver, oral cavity, pharynx, larynx, esophagus [squamous cell type]). Increased risk for these cancers begins with any alcohol use and increases with higher levels of use. Women experience a much greater risk of an alcohol-attributable cancer per drink consumed.

II.  The Alcohol industry’s reaction to the ICCPUD report. The reaction to this from a group of National Agriculture, Beverage and Hospitality Associations is pretty tough.  In an email and press release titled “New U.S. Alcohol Report Tainted by Bias, Conflicts,” its representative said:

The controversial report, which is based on observational studies rather than any randomized controlled trials, is blatantly biased, with many panel members failing to disclose conflicts of interest, including affiliations with and funding from anti-alcohol and international temperance organizations…it’s essential to consider the findings of the recent Congressionally-mandated report from the National Academies of Science, Engineering and Health (NASEM), which found moderate drinking may be healthier than teetotaling (Axios).

Its recommendation

We urge the Secretaries of Agriculture and Health & Human Services to uphold the integrity of the DGAs to promote informed and responsible decision-making around alcohol. The agencies should disregard the ICCPUD report in their final assessments for the 2025-2030 Dietary Guidelines.

III.  Call for public comment on the NASEM and ICCPUD reports

From the HHS Office of Disease Prevention and Health Promotion (I am an alum)

HHS and USDA will invite the public to provide input on two separate but complementary reports [ICCPUDand NASEM] on the relationship between alcohol and health starting January 15. These reports and the public comments received will be considered by the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Agriculture (USDA) as the two departments collaborate to develop the next edition of the Dietary Guidelines for Americans. The comment period will close on February 14, 2025. Additional details on this public comment opportunity are available on DietaryGudelines.gov.

IV.  Treasury Department proposes new and more informative labeling of alcohol drinks, also with a call for public comment  

TTB Proposes Mandatory Disclosures of Major Food Allergens and Alcohol Facts in the Labeling of Wines, Distilled Spirits, and Malt Beverages.

Allergens: In Notice No. 238, we propose to require a label disclosure of all major food allergens used in the production of alcohol beverages…labels must declare milk, eggs, fish, Crustacean shellfish, tree nuts, wheat, peanuts, soybeans, and sesame, as well as ingredients that contain protein derived from these foods, if used in the production of the alcohol beverage.

Alcohol Facts: In Notice No. 237, we propose to require Alcohol Facts label disclosures for alcohol beverages subject to TTB’s regulatory authority under the Federal Alcohol Administration Act. This disclosure would include the serving size of the product; the number of servings per container; alcohol content as a percentage of alcohol by volume; the number of fluid ounces of pure ethyl alcohol per serving; the number of calories per serving; and the number, in grams per serving, of carbohydrates, fat, and protein.

Wow!  This has been a long time coming.

To comment:

• For Allergens see Notice No. 238 and/orDocket No. TTB–2025–0003 at Regulations.gov and this comment form. 
• For Alcohol Facts see Notice No. 237 and/or Docket No. TTB–2025–0002 at regulations.gov and this comment form.

Electronic comments submitted via Regulations.gov are due by 11:59 p.m. ET on April 17, 2025, and comments submitted by postal mail must be postmarked by that date.

A reader, Maria Birman, alerted me to this new report in Lancet Diabetes & Endocrinology from the 56-member Commission on the Definition and Diagnosis of Clinical Obesity.  The commission recommended shifting the definition and diagnostic criteria for obesity away from the BMI and instead defining obesity in two categories based on health status.

• Clinical obesity: signs and symptoms of organ or other dysfunctions; a disease requiring effective health care treatment
• Pre-clinical obesity: high levels of body fat but no signs of dysfunction but higher risk for chronic disease, requiring support for risk reduction.

Maria writes:

I’m astonished by the full two-page “declaration of interests” (no conflict there, of course not!). Naturally Eli Lilly and Novo Nordisk are very much interested in obesity being considered a disease, and a treatable one at that. And doctors and scientists paid by these companies authored this paper which is posed to be very influential.

I took a look at the conflict-of-interest statement.  It is indeed astonishing as it goes on and on for nearly two pages in four columns.

Maria saved me from having to go through the analysis.  Here are her counts.

• Of the 56 authors, 47 declared conflicts of interest; only 9 did not.
• All 8 authors on the steering committee declare financial ties to drug companies.
• Novo Nordisk (Ozempic, Wegovy) is mentioned 60 times by 38 authors.
• Eli Lilly (Zepbound) is mentioned 39 times by 27 authors.
• Authors report financial ties to other pharmaceutical companies: AstraZeneca, Pfizer, Merck, Johnson & Johnson, Eurodrug Laboratories, Sanofi., and others.
• Authors report consulting fees, fees for educational purposes, research grants, speaker fees, co-authorship of manuscripts, medical writing assistance, and personal honoraria as a consultant and speaker, among others.
• Authors report financial ties to food companies such as Nestlé, which makes the Vital Pursuit line marketed to people on Ozempic.

Comment

No question, the BMI is an imperfect measure of the health risks of obesity, although it works pretty well as a first step.  Defining obesity as a disease may well help get treatment for people who need it.

I wish we had a health care system that could help people with obesity find out whether they have the clinical or pre-clinical form.  In the absence of  a functional health care system, we have drugs—effective and without deleterious side effects for some people, but for the great majority, highly expensive and hard to get.

This commission appears as an arm of the pharmaceutical industry.  Its findings require careful scrutiny.

Today is Martin Luther King Day and it’s worth thinking about what he stood for as we inaugurate a new President.

Nneka M. Okona writing in Food & Wine tells us: Dr. Martin Luther King, Jr.’s Taste in Food Shows Us Who He Was: Sunday suppers at home and simple meals in restaurants give insight into the man behind the speeches.

I found that eating and following his tastes is as central to understanding him as a human and a thinker as his ideologies for the liberation of Black people and the poor. For King, eating was sustenance but also importantly, a time to pause, to take a reprieve, to be still, to connect with the most primal, urgent needs of his body. To experience pleasure while ensconced in the pain of racism’s brutalities.

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.