Plain English with Derek Thompson - What’s the Matter With America’s Food?

Episode Date: September 26, 2025

In the past few weeks, we’ve done several episodes on obesity, GLP-1 drugs, and nutrition science. What we haven’t talked about as much is the politics of food. And today’s guests say: If you really want to understand why Americans are so unhealthy, you have to see that the problem is not just our willpower, and it’s not just our food itself. It’s our food policies. Kevin Hall was a former top nutrition researcher at the NIH who retired after accusing RFK Jr. and the Department of Health and Human Services of censoring a report that questioned their description of ultra-processed foods. Julia Belluz is a longtime nutrition and health journalist. Together, they’ve written a new book, 'Food Intelligence: The Science of How Food Both Nourishes and Harms Us.' If you have questions, observations, or ideas for future episodes, email us at [e-mail]. Host: Derek Thompson Guests: Julia Belluz and Kevin Hall Producer: Devon Baroldi Learn more about your ad choices. Visit podcastchoices.com/adchoices

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of the way. In the last few weeks, we've done several episodes on this show about obesity, GOP1 drugs, and nutrition science. What we haven't talked about as much is the politics of food. And today's guests say, if you really want to understand why Americans are so unhealthy, you have to see that the problem is not just our willpower. It's not just our food itself. It's our food policies. Why, for example, is it so easy for food companies to introduce additives to our food with so little scrutiny? Because our laws make it easy. Why is it so easy to sell supplements and vitamins with vague but big sounding promises in the label despite no evidence that they actually do anything? Well, again, because our laws make it easy.

Why can food companies confuse consumers with ingredients, or sell junk food to kids, or even get tax deductions for advertising in a way that subsidizes junk food marketing to our children? Again, because of our laws. Now, some of this might sound like it's been ripped from the pages of Maha, the Make America Healthy Again movement that's associated with RFK Jr. and the Trump administration. As I've always said, I think there's a lot that Maha gets right, particularly when it comes to emphasizing the importance of diet. exercise, and a greater awareness of our food systems, what we put into our bodies. But today's guests are not Maha. Kevin Hall was a former top nutrition researcher at the NIH before he resigned, after accusing RFK and the Department of Health and Human Services of censoring a report

that questioned their description of ultra-processed foods. You'll hear a bit more about why he left RFK's NIH in a few minutes. Julia Ballo's is a long-time nutrition and health journalist. And together, they've written a new book called Food Intelligence, the science of how food both nourishes and harms us. Today we talk about the policy history of American food, going all the way back to the early 1900s, what it would take to actually fix our food supply,

what Maha gets right and wrong about the science of food, and why, more than anything, what American food could use more of today, is precisely more science. I'm Derek Thompson. This is plain English. Kevin Hall, welcome at the show. Thanks for having me.

Julia Ballouz, welcome to the show. Thanks so much for inviting us. I've been reporting on food and diet for a few years, and one thing that I keep hearing is, we have to fix the food supply. We have to fix the food supply. But I feel like very few people who actually say and repeat this over and over again

articulate what they actually mean by this. What is the food supply? Who controls it? Who regulates it? What are the relevant laws and rules that we would have to change to fix it? And so that's what I want to dig into with both of you today.

You've written this wonderful book that outlines the path forward, and I think we can make some real progress on this really important question. Juliet, let's start with you. Your thesis is that America struggles with weight and chronic disease, not because of personal failures,

but because of our food environment. In other words, it's not us, it's the food. What does that mean? So I went into this area of reporting and researching this book with a personal question. I was one of the people, like probably many of the listeners who had struggled with their weight, and I'd always blame myself.

I would try different diets or exercise programs or whatever the thing was, even supplements when I was a teenager. And I carried around this, feeling when I couldn't lose the weight that somehow I had failed. And when I started to talk to researchers like Kevin and others who work on sort of understanding this symphony of internal signals that we have that guides our eating behavior, I realized how much of the decisions we make about what we eat are happening beyond our conscious control. And what I came to appreciate through writing this book and working with Kevin was the extent to which the environment kind of interplays with

these internal signals that we have that are guiding our eating behavior. So whether you're going to eat an avocado and eggs in the morning or just turn to a donut or whatever, these hundreds of decisions we make about what we're going to put in our mouths every day, there's a lot of evidence that, you know, this isn't something we have the control over that we thought we did. And therefore, yeah, it's not us. It's the food environment over the years where we saw this explosion. of diet-related chronic diseases, including obesity, our genes didn't change.

What changed was the food environment. So, yeah, that's sort of what we mean by that. Kevin, I want to dive into specifics and evidence here. There's a ton of observational research on nutrition. Hey, we followed these 1,000 people, and we kind of got some surveys about what they ate, and we sort of made a connection to what kind of food is better for them and what kind of food is worse.

you are one of the only researchers in the world to have conducted several randomized clinical trials, gold standard trials, on the impact of ultra-process foods in our diet. What did these trials do? What did you find? And how were those findings consistent with this idea that, as Julia put it so beautifully, our food environment disrupts the symphony of metabolism inside of us? Right. So we were actually trying to isolate the effects of the foods per se, right? So there's all these other aspects of the food environment that Julie alluded to, the kind of the social environment that we find ourselves in, the advertising, the cues in our environment, the expense, the time commitments that it takes to require to prepare healthy foods or unhealthy foods, as the case may be. We decided to try to remove all of that from these experiments. And we brought people in, to the NIH Clinical Center where I used to work, and we basically remove people from their

normal food environments. Created this very artificial food environment for them just to kind of isolate that food environment and basically expose them to diets that had plenty of calories, more than double the number of calories that they would require to maintain their weight, tried to match them for as many of these different sort of nutrients of concern that we often hear about, the salt, sugar, fat, carbs, glycemic load of the diets matched again for the total calories that we presented to people with. And in one instance, we presented them with a diet that contained none of these so-called ultra-processed foods. And in another occasion, we presented them with a diet that contained 80% of calories from ultra-processed foods.

And just gave people very simple instructions in this new food environment. You know, we're interested in seeing how it affects your biology. We're going to be poking and prodding you, putting you in respiratory chambers, measuring your body, decomposition, all sorts of things. What they didn't know was that we were going to be measuring all their leftovers. And we would basically be trying to figure out how much of the food presented to them did they actually eat, which foods did they eat, which ones did they leave on their plate? And really simple instructions. Eat as much or as little as you like. Don't be trying to change your weight at all. And what we ended up finding was that despite matching for the presented

calories and all these different nutrients, when people are exposed to this ultra-processed food environment, they tend to overeat calories. Again, they're not being advertised to them. They're not having to buy or purchase the food or make the food or anything like that. Just something about the meals that we gave to them led them to consume more than 500 calories a day on average than when the same people were exposed to the food environment that didn't contain these foods. When they were in the ultra-processed food environments, they were gaining weight and gaining body fat. They didn't know about these measurements. They were wearing loose-fitting scrubs. They couldn't tell if their clothes were getting tight. or looser, and when they went to the ultra-processed food environment, they spontaneously lost weight

and lost body fat. And so it did seem to be, even over and above these broader environmental consequences of our food environment and how it's changed, there seemed to be something about the foods themselves that we were presenting to these folks that led them to over-consume calories and gain weight. Just one level deeper, right? Because your thesis is that eaters don't have as much willpower as they think, to a great extent they are objects of their environment. How are these foods specifically acting on individuals at the biological level that is making us, not just in the lab, but clearly outside of the lab where 40, 50 percent of Americans have obesity overeat?

Yeah, great question. So you're pointing out something that's really fundamental that I think a lot of folks still have this mythology about that they control everything that they eat and that This is just a matter of willpower. The fact of the matter isn't something that we've learned through, you know, almost a century of work now, is that food intake is a biologically controlled phenomenon and that we actually try to regulate our body weight through the symphony of internal signals that somehow integrate with environmental cues in ways to basically generate a weight at which we are regulating. I know you had Randy Seeley and as a guest on your podcast before. he's been working on what is it that determines where that body weight is defended and what are

those internal signals and how do they act in the brain in order to give rise to this. And I think one of the fundamental questions that we still don't quite have answers to is what is it about ultra-processed foods? What is it about the calorie density of the foods? What is it about how the nutrients and flavor pairings that might be disrupted in ultra-processed foods with certain additives, how that might affect the gut brain signaling that is one of the pathways of this biological symphony of signals that are integrated in our brains to control our food intake over long time periods. How does that interact with hormones like leptin, which are

being secreted by fat cells over long periods of time to give our brains the index of how much stored energy do we have on board to be able to kind of do things like have babies or go for long sort of, you know, adventures out into the wilderness to explore new areas of the world? these biological questions are still being worked out. And we're still at the stage right now, even in our research, of trying to figure out, well, what is it specifically about the foods themselves that cause these disruptions? And then more broadly, what is it about the food environment

with all of these other social and environmental consequences of these foods being marketed to us on a regular basis and the defaults being the calorie-dense, hyper-palatable foods? Julia, the thesis that Kevin seems to be advancing here is that our food environment is making us sicker. It's making a sicker over time a chronic way, and therefore we need better science and ultimately better policy in order to fix that food environment. Who is Wiley, and what did he do? So Wiley was the chief chemist at the U.S. Department of Agriculture in the late 18, early 1900s. and he was interested in this question.

So this is a time when America is urbanizing. People are moving off of the farms and into cities further away from the food supply. And basically food manufacturers are trying to figure out how do we keep food safe and feed people when they're basically not living on the farm anymore. And one of the ways they did that was they started to add preservatives and other additives to food. I think we all have this idea that, you know, our great, great grandparents, were sort of eating this pure, like lovely meals that we don't have access to anymore. But in this time, it was not uncommon to leave lunch or dinner with like a raging stomachache

and to even, yeah, be acutely poisoned from your food because there was basically no regulation of the food supply in this moment. So there's a wonderful book by the science journalist Deborah Blum, and she details, it's a Wiley biography, and she details all this. gruesome things food manufacturers were doing in this time. So it was like to milk, to kind of give it this illusion of cream at the top of yellow cream at the top of the milk, they would add ground calf brains. It was just horrendous what was happening. So Wiley becomes interested in, can we isolate what the poisons are? And so he designs these famous poison squad trials that were actually very similar to what Kevin was doing. He randomizes, it was young men at the time, and

I'm clerks in the Department of Agriculture to two groups. One group just gets, you know, they eat all their meals in this room in the Department of Agriculture. And the other group is getting the meals plus little tablets containing the commonly used preservatives. And so he's trying to isolate with graduated doses. When might these preservatives start to cause, or additives start to cause problems for people? then it was his research along with the jungle by Upton Sinclair that ends up resulting in the establishment of basically the food, what we know is the Food and Drug Administration today. Kevin, it's a really important point that Julia just made.

There's this nostalgia for 100 years ago when people didn't die of obesity. Well, maybe they didn't have time to get fat because they were dying young of ground calf brains and lead in their milk and in their food. But thanks to Wiley and thanks to his work, we have regulatory. guard rails in place to prevent acute food poisonings. But today, our food environment is fattening and sickening us on timescales of years and decades. They're chronically sickening us. And here you look at all of the money that we spend on American science, just over 1% of all NIH-funded research projects today address the role of diet and nutrition. Shortly after your ultra-processed food study was published, your bosses tried to close the research facilities that you and your colleagues

used to study nutrition and metabolism. How dire is our lack of science and research and funding in the space of nutrition? Yeah, no, it has been a problem for quite some time. You know, the NIH has traditionally been very focused on finding cures and treatments, which is a great thing to do, and very little focused on prevention, at least when it comes to supporting the research from a monetary basis. And, you know, it's a huge problem because if we don't have the science to understand explicitly what is it about, you know, for example, ultra-process foods that are driving some of the problems that we've seen, then the sort of blunt instruments that we might have from a policy perspective become, you know, somewhat misguided. or if we are targeting certain aspects of foods that are not based on really solid science, then they might have expending all this political capital on something that's not going to make much difference.

And I would argue many of the things that the current administration does in the name of Maha wins are currently in that category. You know, things like targeting high fructose corn syrup for replacements with, you know, cane sugar as a, you know, a new brand of Coca-Cola products is not going to move. the needle on public health because it's not relying on good science about what it is about Coca-Cola products that are probably contributing to poor public health. And so I think that the point here is that we need this dramatic improvement in nutrition science to better understand what are the specific roles of our foods and our food environment and even do the kinds of research like what policy changes do we need to make. What changes in the food environment are going to be the most effective?

You know, even if our studies said there was nothing about the foods themselves that were driving this problem, it was just the fact that they're being marketed and promoted in such a way to make excess calorie consumption occur because we have so many calories available to us. We need some science to better understand, well, what are the policies that are going to be most successful? We had a few things about menu labeling at one point, and we have some policy research on soda taxes, and that things like that, but nowhere near the amount that would be required to really inform some of these things to really know if the policies that you're going to put forward are going to make a dent in the public health of the nation. Yeah, no, it goes back to where we started this conversation. Like, there's this great book, The Tyranny of the Gene, where the author talks about basically this obsession with genes and individuals and treatments and biology when so much of what is shaping health is environmental, and we just don't look there and we don't fund that research. One thing we mentioned in the book, Kevin, you know the specifics.

How much did we spend on the precision nutrition? So there's this, yeah, I think that the biggest single investment that the NIH has ever made in nutrition research is this nutrition for precision health program, which is kind of interesting from a scientific perspective, but they're spending like $170 million or more just trying to figure out, you know, what is the best diet for every individual based on, you know, maybe their gut microbiome or some genetic factor, when everybody knows that the food environment is not allowing Americans to, you know, take up the dietary guidelines for Americans at a reasonable rate. We don't produce enough fruits and vegetables in the country to feed everybody, even if they were

to magically start adhering to the guidelines. So I think that, again, we're sort of focused on these whiz-bangs sort of really interesting ideas at the individual level about how to optimize your health and what supplements we should prescribe to you and what wearable devices you should wear, whereas the broader questions about what is it about our food environment, how is it driving poor health, what is it about, how is it affecting our biology, what are the specific attributes of ultra-process foods, and only a subset of that very broad category that are causing the problems in which ones are actually probably poised to help us into the future. Julia, I really like this framing that we used to die in America of acute food poisoning,

and we developed a policy regime to fix that problem. But now millions of Americans are dying of chronic overeating or chronic eating of the wrong foods, and we don't have a policy regime to fix that problem. What is the original sin here that you see? Why are we so unprepared in our laws and our regulations to fix the food supply. So I think this original sin probably goes back to Wiley's time. What actually gets Congress to act on the findings of his poison squad trials is a book called The Jungle by Epton Sinclair that you might have read in high school. So Sinclair is interested in exposing how horribly workers are being treated in meatpacking plants in Chicago and kind of telling the story of the plight of the American laborer.

But because of the work and all the advocacy Wiley had been doing, the public was primed to read it another way as more evidence of just this tainted food supply and how terrible and unsanitary the conditions for food processing are at that time in the U.S. And so there's this public uproar that ensues, and other countries start to boycott imports of U.S. meat. And in 1906, two laws get passed.

So one is the Pure Food and Drug Act that leads to the creation of FDA and this regulation of food and drugs. And then the other one is the Meat Inspection Act. And this is giving authority to the USDA to do pre-market health and safety checks for meat, including having USDA inspectors present in slaughterhouses. and the meat industry to be able to actually do that, lobbies heavily to get USDA a big budget for food safety. And the result is that it's bigger than FDA's entire food safety budget,

even though FDA is responsible for regulating something like 80% of the American food supply. So you have this well-resourced USDA program for meat and this historically under-resourced FDA food safety program for the rest of what we eat. And then lots of what happens with the rest of food is that we basically rely on companies to do the right thing. And there's no pre-market vetting of much of what we eat. So in the 20th century, in the early 20th century, Wiley and Upton Sinclair bring attention to acute food poisoning and the conditions of these meat plants. And we get the FDA and lots of funding for USDA meat inspections. But over time, there's less attention paid to the rest of the food supply.

Julia, why don't you keep the story going? What happens in the 1950s? In the 1950s, there's this increasing concern about rising cancer rates and how they might be linked to preservatives and additives in foods. And so this food additives amendment gets passed and it's saying that companies that are using additives need to make sure that they're not causing cancer and they need to seek out FDA pre-market approval when they want to use a new additive in food. but they also include this loophole for substances that are generally recognized as safe or grass. And by the late 1990s, the FDA also says that companies can self-determine whether additives that they're using or grass or not. And if you flash forward to today, something like 99% of the new additives that entered the food supply since 2000 entered through this self-determined grass loop. pool. So that means much of them were just vetted by companies, not by regulators or other independent experts. In fact, that's one of the reasons why you have petitions like David Kessler's

recent petition to the FDA, saying that there's a whole bunch of highly processed carbohydrates that are part of ultra-processed foods that should no longer be generally recognized as safe, which is a category of ingredients or additives into food that are basically pretty under-regulated in some sense. Many of these things are self-affirmed, and when they were affirmed for these kinds of ingredients, folks weren't thinking about diet-related chronic diseases. They were thinking about this acute food safety aspect and not necessarily cumulative exposures, given the conditions of use that are now present in our food environment. Kevin, I want to follow up with that because while I think I agree with you,

there's also a way in which I want to be careful about adding regulations before we have information. So in a New York Times excerpt from your book, you wrote, quote, ultra-process foods that don't meet FDA definition and that can drive over consumption should be treated as recreational substances to which we must apply aggressive tax policies. front-of-pack warning labels, marketing restrictions, and more, especially for foods marketed to children, end quote. This is in a way treating ultra-processed foods as a category a little bit akin to something like, say, cigarettes. Cigarettes, we have decades' worth of incredibly specific studies that show it clearly, causally leads to lung disease and other maladies. But you just told me a few minutes ago that we don't have enough government-funded science in the realm of nutrition to know basic facts about how or what ultra-processed foods at the individual food level are doing to us.

I had a previous conversation on the show where I helpfully learned that within the category of UFP, you have things like Twinkies, which I can definitely believe are bad for me, and almond milk, which I think is probably not that bad for me. So to what extent are we stuck a little bit at the policy level? Because if we're honest with ourselves, we actually don't know what exactly it is we want to regulate and how. Yeah, so I think an important clarification about what we talk about in the book and in that piece is that what we were trying to do is say what subcategories of ultra-processed foods are probably perfectly fine and should be actually recommended. and those would be the category of ultra-processed foods that already meet the FDA's definition of a healthy product. And so if it doesn't meet the definition of a healthy product, it could be perfectly neutral for health, in which case you don't also want to aggressively attack those products. So what we said was what subcategory of ultra-process foods that is not already in the FDA definition of healthy,

which is based on a long, long history of dietary guidelines from not just America, but around the globe, of promoting an amount of vegetable intake and fruits and nuts and legumes and low in saturated fat, low in added sugar, low in sodium, all the things that we have a wealth of data behind what looks like a healthy diet. And if they don't meet that definition, and they also don't, if they do promote overconsumption of calories because they're calorie dense, for example, or because they contain hyper-palatable combinations of nutrients, that's the subcategory, the very small subcategory of this wide variety of ultra-processed foods that we say, yeah, we don't want to remove those from the market, but we want to minimize their use as much as possible.

And we want to promote the kinds of ultra-process products that actually do meet the FDA healthy definition. So instead of demonizing this entire class of foods, like you mentioned, we want to basically be much more targeted in our policies and focus on what do we know about what makes up a healthy diet, which is quite a lot, and there's quite a bit of consensus around the world about what that looks like, and promote ultra-process products that actually promote that kind of diet for people to make it convenient, inexpensive, affordable from a time perspective as well. And so that's the kind of the way that we're approaching this problem. So, Julia, can you help me understand how in this

regulatory regime that Kevin's describing, I, as a shopper for my family with my two-year-old daughter, would confront products in a grocery store. Like, I'm walking down the aisle, and I see almond milk, I see Cheetos, I see Twinkies, right? I can't possibly believe that almond milk and twinkies deserve the exact same label. So what am I seeing as I'm walking through the grocery store and looking at what are both ultra-processed foods, but almost certainly have a very different effect on me at the metabolic and biological level. Yeah, I think what Kevin was just trying to get out,

that's a really important distinction, is the science that what we're advocating for is based on, this is decades of research, there's quite strong evidence that overconsumption is linked to these two factors that Kevin mentioned, the energy density and hyper-pallitability. And right now, as a consumer, there's basically no way to differentiate products that are more or less hyper-palatable

and more or less energy-dense unless you're maybe a little bit more knowledgeable about nutrition and even then it can be difficult. So it's these types of things. And I'm talking to you here from Paris where there is a system of warning labels on food and it's not perfect, but you can at least as a consumer navigate with a little bit more ease than you can in America right now. So we're thinking of things like that, but I think the ultimate goal is

how do you invert this extremely toxic food environment where the deck is stacked against everyone to make the best choices for themselves and their families? It seems like these ideas, ideas like front-of-pack warning labels or marketing restrictions to children, they might be good ideas, they might be bad ideas, they might be good ideas that just don't do very much.

Like, for example, it's not entirely clear to me that calorie labels on large restaurant menus have like significantly and immediately changed the overall trajectory of obesity in America. It seems like we did something that is useful to people who look to calorie numbers and not as useful to people who might not look to calorie numbers. None of this seems to directly fix the food supply, right?

You're regulating the downstream marketing and selling of food to individuals, which might not be good, but it doesn't fix the food supply at the food supply the source. What are the better ideas for fixing the food supply upstream? There's perhaps a misconception that many of these things that seem to be targeted towards the consumer don't have upstream consequences when they actually do. And one of the things, we have historical precedence for this. Once the Nutrition Facts Panel mandated that trans fats

be labeled, the amount of trans fats on products be labeled, the food industry rapidly reformulated their products to remove trans fats. And it was only many years later that they were actually banned from the food supply, in other words, removed from the list of things that you could put in food. And so these things do have dramatic upstream consequences in terms of the food industry and what foods are grown. I mean, if there was a demand and the FDA made it a mandatory that all products that met the FDA definition of healthy had to have those on the first.

of the package as opposed to right now it's really a voluntary program. And the food industry doesn't even like the voluntary program. If they mandated that all foods that met the FDA definition of healthy were on the front of the package, then the food manufacturers are going to start looking for ingredients that are going to allow for them to advertise, to have that formulation so that they will do that. And that will create upstream pressure on the kinds of inputs that are going to be required in order to meet the FDA definition of healthy. And so in similar ways, you can use these sort of economic incentives and policies to kind

of create pressure both downstream on the consumers by changing prices and changing labels, but those labels and prices and incentives that you can put in place by clever taxation and subsidies will influence upstream, what foods are grown, how they're grown, and what are the inputs to the foods that end up on our dinner plates. The solutions also need to be real about how people eat now. Like one big thing that I think a lot of people don't talk about is that the reason we have this proliferation of ultra-processed foods is because we have two people working in most households. So women went to work and stopped cooking as much and the food industry heavily targeted working moms with these convenience products. And so we've talked a lot about taking things away and labeling bad things, but we need to also offer these.

healthy, convenient alternatives to people. We commissioned this morning consult survey for the book, and we ask people, what's the biggest barrier standing between you and a better diet? And the top answers were affordability, time. Like, I don't have the resources and the time to be cooking the way I want to. So we also, I think, need to meet that reality with options for people and different solutions. And right now, those products are actually, available to folks. They end up in a specific aisle of the grocery store that has a premium price

associated with it, right? So they are, you know, the healthier for you versions of many of these products that you can get. Like I can, you can get a really crummy, microwavable frozen meal for lunch, or you can pay, you know, 40% more for a relatively healthy version. I tend to choose the healthier version because I have the privilege of doing so, but most folks don't have that privilege. And so how do you flip that? How do you, what kinds of policies do you put in place to make it the incentive for the food industry to make more of these healthier for you? They might be ultra-processed because they have some additives and technology in them that allow you to kind of make these things heat up properly in a microwave. But they, from the FDA definition of healthy,

might meet all of those requirements. Kevin, I have to ask a question that must be bouncing around in a lot of listeners' heads, which is a lot of the recommendations that I'm hearing here, sound exactly like what I would hear if I had someone from the Maha, Make America Healthy Again movement on my show. You left the NIH citing censorship under RFK Jr. Clearly listening to you, you think that Maha's right about emphasizing the quality of our food supply, but also given your recent history, you clearly depart meaningfully from this movement. So how do you cash out what Maha is getting right and wrong? Yeah, I mean, I think that part of the potential problem here is that in my experience, the folks in the political leadership of the Maha movement,

not the grassroots folks, but the political leadership, were not interested in hearing what the science had to say. In other words, they thought that they already knew the answers to what they wanted to do. They thought they had the policies that they wanted to implement, and they had certainly the rhetoric around, for example, ultra-processed foods are as addictive as crack cocaine, for example, is one of the quotes that I remember hearing about. But when we were doing science to actually see, well, does do ultra-processed foods, high and fat and sugar actually generate the same neurobiological processes as consuming cocaine? The answer was no.

There was active suppression of that bit of data from the science to regular everyday folks. And my concern was that, you know, they're really not interested in funding the science to actually support the best policies. And what I've observed is that, you know, there's, well, there's a lot of rhetoric and the rhetoric I agree with. And as you pointed out, sounds a lot like what I'm saying. There's not a lot of action that's going along with that rhetoric that's supportive, right? You can't have this rhetoric and at the same time say, oh, we're going to eliminate, you know, the USDA programs that provide, you know, farm fresh fruits and vegetables to school programs and food banks. You can't kind of eliminate, uh, snap

dollars and SNAPED when you're saying that you've got to actually improve the quality of the diet of the nation. These things don't actually track. You can't say that you're concerned about the way our foods are produced and the kinds of inputs that are used in our agricultural system and eliminate, you know, the parts of the EPA that are involved in monitoring the pesticide use and the runoff into our waterways and whatnot. So I think the rhetoric sounds right.

I have not been convinced that any of the acts. actions that have been taken are promoted by good science or are really interested in hearing about the good science and investing in the sciences that are actually going to make meaningful policy changes in the future that have the potential to benefit public health. I'm very interested in Maha's relationship to pharmaceutical therapies versus supplements. So you hear from RFK Jr. often a deep skepticism toward big pharma, a skepticism toward a vaccines, skepticism essentially toward technologies that have phase three clinical trial evidence that they make us healthy. At the same time, out of this general Maha space, especially in the

podcast world, you've got a huge fondness for supplements, and in many cases supplements are directly funding a lot of these podcasts and shows. Well, as I learned from your book, thanks to the Dietary Supplement Health and Education Act of 1994, there is no need for any supplement sold in America to demonstrate any proof of effectiveness. That is to say when you buy a supplement, you are buying something that exists in the supplement aisle precisely because it's never even been tested to do anything that it says on the label. How do you make sense of this weird relationship that Maha seems to have with, let's call it more broadly, medicine, where they're skeptical about the therapies that have been shown to be effective,

but trusting of the pills that have no proof of effectiveness. I wish I could explain it. I don't have a good... I don't see a rational explanation for this because you're right in pointing out that if a pharmaceutical or other sort of device

that is generating some sort of claim of effectiveness for treating a disease or a condition, it has to undergo trials and demonstrate both safety and effectiveness, whereas dietary supplements have to undergo neither. They don't have to demonstrate safety nor effectiveness. I guess the only way I can kind of wrap my brain around this is the idea that some folks will say, well, I'm taking supplements to prevent illness. I'm not actually trying to treat anything. But there's no evidence that they prevent illness either.

It's in, and it just, it boggles the mind. I think that the cynic in me would say, well, it's exactly what you say. It's an easy way for folks to fund the kind of rhetoric that has promoted them to levels of political power that are enabling them to make changes into our food system. And hopefully they'll have a beneficial effect. I haven't given up on them entirely. But, yeah, that is a source of revenue for many of these social influencers who have now influenced at the highest levels of political power at the Department of Health and Human Services. I was going to say, they also offer solutions for many of the things that medicine is ingrained.

Like, you're fatigued, you have brain fog, you're dealing with symptoms of menopause, whatever the thing is, you know, that these wellness influencers have these kind of, very elegant, quick fixes that seem like they might work, but ultimately there's no evidence for them. So I think they prey on these, like, not insecurities, but these areas of vulnerability that people have and offer solutions where maybe traditional medicine is failed or mainstream medicine has failed. I feel like a larger theme of this show, this interview,

is that American Food and Drug Policy is very scattershot, terms of where we regulate and where we underregulate. So since the days of Wiley, we regulate acute food poisoning, but we don't devote similar resources to regulating the origins of chronic food sickness. We regulate therapies. We don't regulate supplements or vitamins. We devote lots of resources to investigating meat facilities, but very few resources to investigating other parts of the food supply. Am I wrong to pick this up as a theme of your work that America's food policy is, is simultaneously both maybe over-regulating in some spaces and under-regulating in others?

Yeah, I think you touched on something that's really interesting. I think regulating to prevent chronic illness is something that's just really difficult relative to what Wiley was doing, singling out, you know, you don't want formaldehyde in your food or lead or whatever the thing is, to tease out which components of food are sickening us over these timescales of decades when chronic diseases develop is a lot, I think it's a bigger challenge, but it's not impossible. And one thing I think you had wanted to touch on that we didn't get to was this, that where grass evolved from, it was a concern about food additives causing cancer in the 1950s.

And cancer is obviously a chronic illness. So there was this effort to start to regulate for that, but then they added this amendment with the grass additives that allowed what, what was. became this flood of additives onto the food supply that ultimately are basically unregulated. I don't know if you want to get into that in more detail at this stage, but I think there have been efforts made to recognize these chronic health issues and to prevent them, but I think it's a little bit more difficult. And we've also allowed these like gaping loopholes to emerge that they don't solve the problems we are setting out to solve.

You know, it's a very human phenomenon to focus on acute things and delay discount the future consequences of our current actions. And I think that it's so it's a very human thing to have a food regulatory system that's focused on things that can happen immediately to folks as opposed to, you know, acute food poisoning and death that happens, you know, within days or potentially a week after kind of consuming, you know, a bad batch of spinach or something like that. it's also easier to track down in some sense, as opposed to things that are affecting us over decades, which is what we're now currently experiencing with the rise in obesity and whatnot. It's also kind of driven in part behind the fact that in the history of humankind, we have been devoted to avoiding the problem of starvation. And we've always faced this problem of producing enough protein and calories to feed populations and this specter of mass starvation because the population is growing too fast compared to our ability to increase agricultural production.

This goes back to Thomas Malthus's thesis many, many decades and centuries ago now. We actually have for the first time in human history kind of a mark on what is the plateau of the human population, somewhere around 10 billion people within the next 100 years. and therefore we have a target of what our agricultural system has to actually produce and produce in a sustainable way for the planet and produce in an equitable way for people to actually have healthy diets. And we believe ultra-process foods are going to be a part of that. And we need to start thinking about that long-term transition now

and how we're going to coordinate that. Does that happen from the top down? Not likely. But what sorts of policies can we put in place with the idea of diet related chronic disease, which is, in some sense, it's merely an epiphenomenon of the fact that we front-loaded all of the tech to agricultural tech and food technology to produce and get rid of this calorie glut, as we talk about in our book. And so we have to start thinking past the diet-related chronic diseases, as much as we now have wonderful therapies for those who are

most susceptible to the changes in our food environment, the GLP-1 drugs, and many, many, many others coming down the pipeline and think about, you know, what is it that we have to do to our food system and what kinds of policies do we need to put in place in order to feed the planet, healthy diets in the future? That's going to be partly ultra-processed foods. It's going to be partly the kinds of technologies that we talk about in the book called Food 2.0. I think we need to start seriously thinking about that while we're also thinking about the diet-related chronic diseases we're currently experiencing. Last question. How do you feel about the claim that obesity and ultra-process foods are fundamentally a technological problem, and they require a technological solution? We can futz at the corner with marketing bans for children and black labels for saturated fats and foods that are too energy dense. But at the end of the day, 20, 30 years from now, if we see the obesity curve finally bending, nutritionists and

sociologists will say this is because not of food regulation, but GLP1 drugs. That this ultimately has to be a policy of allowing people to effectively redesign their bodies to be in line with their food environment, right? To the extent that GLP1's work for many people, they seem to work by increasing satiety, slowing gastric emptying, in a way that allows them, to live in the modern food environment in chronic caloric deficit which leads to weight loss. Why isn't the problem here just

tech, tech, tech? No, I mean, I think it is, it's a wonderful thing to be able to have not just this category of drugs that are now currently on the market and are going to get cheaper and cheaper and more generic in pills that will allow people to kind of have access

that currently don't have access. And the pipeline of new drugs, drugs that are coming down the market. I think that what we may be underestimating, although the food industry is starting to look at this, is that there are upstream consequences on the foods that these folks want to eat. It's not just that they're eating less, you know, twinkies and Doritos, right? They're actually changing their fundamental food preferences in ways that are more aligned to healthy diets. Maybe it's because these drugs finally allow people to kind of make those changes. Maybe there's some more fundamental biology going on that we still don't understand.

But I don't want to underestimate the fact that that is also having upstream consequences or has the potential to have upstream consequences on the foods that we all have access to, which ironically might allow us to get through this transition of diet-related chronic diseases in ways that allow us to look at that population of 10 billion people in the future that we have to feed healthy diets that are sustainable for the planet. That's the hope. I truly hope that that's part of the solution. I'm not some sort of Luddite who wants us all to go back to kind of cooking fresh fruits and vegetables and have local farms and these types of things.

These are kind of quaint ideas for the privileged few who can do those sorts of things. They are not the solution to a 10 billion people population sustainably living as part of a sustainable planet. Julia, do you want to have the last word? No, Kevin put it so nicely, but I think what we're trying to get in in the book is that you have to pull, like, that this problem is complex and you have to pull many, many levers to address it. So the reformulation and the drugs, the reformulation of ultra-processed foods and GLP1 drugs are certainly part of the solution, but there are many other levers that we have to pull, including this idea of how do you make healthy meals accessible and available to more people. So I think, the tech is certainly part of the solution, but not the entire solution. Julia Ballouz, Kevin Hall, thank you very much. Thank you. Thank you so much for such smart questions.

Thank you for listening. Plain English is produced by Devin Boraldi, and we are back to our twice-a-week schedule. We'll talk to you soon.