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.

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.