However, since 2007 the organic farming sector of the EU has developed rapidly and as foreseen in the Regulation, a review was needed and conducted to consider the experience gained from the application of the rules.

The results of this review showed that the legal framework governing organic production should be improved to provide rules that correspond to the high expectations of consumers and guarantee sufficient clarity.

To accommodate these needs, a new Council Regulation was negotiated – it took three Council Presidencies (1.5 years) to work out the proposal and 18 trialogues during 4 Council Presidencies (another 2 years) to negotiate the details – and finally in 2018, a new Regulation on organic farming was published: (EU) 2018/848 of the European Parliament and of the Council on organic production and labelling of organic products (further: 2018 Regulation).

So, what changed with this 2018 regulation?

1. Categories

The 2018 Regulation defines three main categories of products that can be organic certified:

1. Live and unprocessed agricultural products (such as animals, plants, seeds, mushrooms)
2. Processed food
3. Feed

Apart from these, Annex I. of the 2018 Regulation provides a list of products that are not clearly covered by these categories but still can be certified.  This list includes but is not limited to specific yeasts, maté, vine leaves and palm hearts.

It also includes sea salt and other salts for food and feed even if those are not living organisms.

2. Objectives and Principles

The 2018 Regulation encourages short distribution channels and the local production.  A new and positive principle is the concept of production connected to the soil, reinforcing the contribution to a non-toxic environment, long fertility and biodiversity.

As for processed food, the exclusion of food containing engineered nanomaterials is new.

3. Production Rules for Food Processors

One of the most significant changes will be that whilst now all natural flavours are permitted in organic food production, the 2018 Regulation strongly restricts their use.

From 2021, only natural flavours originating from the mentioned ingredients can be used in organic food processing meaning that for example “natural lemon flavouring” is only allowed if it is at least 95% obtained from lemon.

The rules for obtaining natural flavours are detailed.  Cleaning and disinfection products permitted in organic food production are also listed.

There is slightly increased flexibility regarding the origin indication of ingredients.  Currently, if the producer would like to highlight the origin of an ingredient, at least 95% must be farmed in the indicated place, not 98%.

Other areas where the rules are relaxed a little, include

• concern group certifications in the EU where a small group of farmers can get certified as a single entity;
• annual physical inspections will not be mandatory for everyone but will be planned and carried out on a risk based assessment
• retailers only selling pre-packaged organic products will not need certifications but will be checked as part of the general official controls legislation.
• Member States have the possibility to exempt farmers selling small quantities of organic products directly to the final consumer from certification.

4. Imports

The 2018 Regulation recognises two systems to import organic products from countries outside the EU (a.k.a. third countries):

1. Trade agreements: Third Countries (13 now) must renegotiate their terms for trade agreement under the 2018 EU procedure.
2. Certifiers: the Commission established a list of recognised control bodies / authorities authorised to perform controls and certification in Third Countries.

These rules were implemented from the 1^st of January 2021.

Updates to the Organic Regulation 2018/848

The European Commission published its guidance document that clarifies some of the questions and challenges around the 2018 Regulation.

Below, there are some highlights on several clarifications as they have a direct impact on our business.

Can food supplements be organic?

Food supplements are foods in accordance with the General Food Law, Regulation (EC) 178/2002.  The 2018 Regulation defines the scope of the organic regulation, which includes “processed agricultural products for use as food”.

Hence, food supplements produced from agricultural ingredients fall under the scope of the 2018 Regulation and can be labelled as organic.  However, food supplements produced from vitamins and minerals are outside this scope and cannot be labelled as organic.

Is it possible to certify algal oil rich in DHA (docosahexaenoic acid) as organic food?

It is possible, but under very strict conditions.

Algae are included as agricultural products in the Annex I of the Treaty of the Functioning of the EU (TFEU), therefore an algae oil rich in DHA is an organic processed food when produced in accordance with the 2018 Regulation.

DHA is also a micronutrient, its use in organic processed food is strictly limited in the 2018 Regulation.  In summary yes, DHA rich algae oil can be certified as organic, but its use, due to the DHA content is limited.

Can steviol glycosides (E960) be used as food additive in organic production?

When the 2018 Regulation was introduced, an implementing regulation was created to define the substances that can be used in the processing of organic food products, this is Regulation (EU) 2011/1165.

This regulation lists all substances that may be used as food additives, processing aid or carriers, in organic food production.  Steviol glycosides are not authorised in this regulation and therefore cannot be used as a food additive in organic products.

Although some Member States requested the inclusion of steviol glycosides, the independent Expert Group for Technical advice on Organic Production found that steviol glycosides are not in line with the principles of organic legislation and thus cannot be included there.

Could shilajit powder be authorised under Article 25 of Regulation (EU)2018/848 as non-organic agricultural ingredient to be used in organic production?

Shilajit is a natural exudation of rocks and consists of a complex mixture of organic humid substances and plant and microbial metabolites.

This cannot be considered as an agricultural ingredient as it is not covered by any category listed in the TFEU and not listed in the Annex of the New Regulation, therefore it cannot be authorised as a non-organic agricultural ingredient.

Could enzymes be used in organic food?

Yes, enzymes can be used in organic food.  The 2018 Regulation specifically mentions food enzymes as a substance that can be used in organic food production, if it would normally be used as a processing aid in food processing and is not produced form Genetically Modified Organisms.

What are the flavourings that can be used in organic food processed products?

This is a complex question, as flavourings to be allowed in organic production must comply with several requirements at the same time.

Strictly speaking, only natural flavourings that are obtained exclusively or by at least 95% from the source material that reflects the flavour or the taste of the flavouring component, may be used in organic products – this means that flavourings that would be defined as “natural X flavouring” or “natural X flavouring with other natural flavourings”.

Note that some certification bodies may interpret the 2018 Regulation that natural flavourings can also be used, so this needs to be checked in advance.

A recent OECD- and GLP-compliant safety assessment of a fully characterised root-and-leaf ashwagandha extract demonstrated no genotoxicity, no treatment-related adverse effects in a 90-day study, normal liver findings and no adverse endocrine effects, even at exposure levels substantially above typical consumer use¹.

These findings are consistent with published clinical studies showing standardised ashwagandha extracts to be generally well tolerated and provide an important evidence base for future regulatory evaluations.

Standardised ashwagandha extracts have been evaluated for safety and tolerability in a range of human clinical studies, some of which are summarised in Table 1.  Over the past decade, however, ashwagandha has come under increasing regulatory pressure across Europe.

Table 1. Safety and Tolerability Evaluations of Standardised Ashwagandha Extracts

In recent years, several EU member states have introduced or proposed measures affecting its use in food supplements, ranging from limits on daily intake to reclassification and, in some cases, national restrictions; others continue to keep it under review.

These differing national positions reflect an evolving and, in places, contested regulatory picture rather than a settled EU-wide consensus.

In June 2024, the EU Heads of Food Safety Agencies recommended initiating a formal review procedure that could result in no regulatory action, an EU-wide restriction or prohibition¹².

A central and recurring issue throughout this regulatory debate has been the limited availability of publicly accessible toxicology datasets generated to internationally recognised testing standards, contributing to differing interpretations across jurisdictions.

In 2026, Summan et al.¹ addressed that gap by providing a comprehensive safety evaluation of a standardised ashwagandha root-and-leaf extract, conducted in accordance with Organisation for Economic Co-operation and Development (OECD) Test Guidelines and Good Laboratory Practice (GLP), and published in peer-reviewed literature.

Why do OECD and GLP Matter?

Not all safety studies are conducted to the same standard.

OECD Test Guidelines provide internationally recognised methods that allow safety data to be evaluated consistently by regulators around the world.  GLP ensures that studies are planned, conducted, recorded and audited according to strict quality standards.

OECD Test Guidelines  — a standardised method

• OECD Test Guidelines are internationally recognised study designs. Because every laboratory follows the same protocol, results generated in one country can be evaluated consistently by regulators anywhere in the world.

GLP-certified conduct  — audited quality control

• GLP (Good Laboratory Practice) means the study was planned, conducted, recorded and audited according to strict quality standards. It is a check on the integrity of the process itself, not only the result.

Regulator-ready data  — fit for independent review

• Combined, these frameworks produce a standardised, auditable and reproducible dataset. That is what allows a regulator to evaluate the findings independently.

Together, these frameworks help ensure that safety findings are reliable, reproducible and suitable for regulatory review.  So, these frameworks establish how a study is conducted and the next question is what the test conditions are.

Why Test at such High Doses?

Safety studies are intentionally designed to challenge an ingredient at levels far above commercial use.  The objective is not to replicate consumer intake, but to determine whether adverse effects emerge under conditions of substantial exposure.

For example, in the recent Summan et al.¹ 90-day study, an Ashwagandha root-and-leaf extract was administered daily at doses up to 4,000 mg/kg body weight, providing a safety margin 19 times the standard dose of 125mg.  No treatment-related adverse effects were observed at any dose tested, establishing the highest tested dose as the No Observed Adverse Effect Level (NOAEL).

Understanding Safety Assessments

In the food and dietary supplement industry, understanding how risks to health are identified, evaluated and managed protects consumers and ensures regulatory compliance.

Risk assessment is a stepwise process used to identify potential hazards and adverse health effects.  By completion of a safety assessment, an evidence-based risk analysis of an ingredient can be provided.

Rather than relying on a single study, regulators expect evidence accumulated from several research studies.  Each study is designed to answer a different safety question such as would a single large exposure cause harm?  would it damage DNA?  would daily use affect organs or physiological systems over time?

A battery of genotoxicity tests examined whether a standardised ashwagandha root-and-leaf extract could cause mutations, chromosome damage or other genetic changes to identify potential for long-term health concerns¹.  The authors concluded there was no evidence of toxicity or genotoxicity observed under the test conditions¹ (Table 2).

Table 2.  OECD-Compliant Toxicology Assessment for an Ashwagandha Root-and-Leaf Extract¹

Regulatory Relevance

The publication of a comprehensive OECD-compliant safety package provides regulators with a standardised toxicological dataset to support the independent assessment of ashwagandha root-and-leaf extract.

In addition to the studies summarised in Table 1, the recent Summan et al.¹ contributes evidence in several areas that have been central to current regulatory evaluations, including liver safety, endocrine-related effects, and genotoxicity.

While regulatory decisions are informed by multiple lines of evidence, the availability of these data helps address a longstanding gap in the safety dossier for root-and-leaf ashwagandha preparations and strengthens the overall evidence base available for regulatory review.

Addressing Liver-Safety

Recent regulatory scrutiny of ashwagandha has been driven in part by case reports of liver injury associated with a range of ashwagandha-containing products.

While case reports can help identify potential safety signals, they do not establish causality or isolate the contribution of a specific ingredient or extract to the health concern.

Summan et al.¹ who conducted an oral toxicity study under controlled conditions found no evidence of treatment-related liver pathology following administration of an ashwagandha root-and-leaf extract, including at the highest dose evaluated (4,000 mg/kg/day) ¹.

In addition, liver histology remained normal and key liver biomarkers (ALT, AST and ALP) showed no evidence of hepatotoxicity¹.  These findings provide a controlled toxicological dataset that can be considered alongside clinical and real-world evidence when evaluating liver safety.

The US National Institutes of Health has noted that causality in reported cases remains uncertain, citing product adulteration, mislabelling and co-ingestion of other supplements as plausible contributing factors¹³.  These findings, taken together, underscore the importance of using fully characterised, standardised extracts evaluated under controlled conditions when assessing ingredient-level liver safety.

In Summary

As regulatory scrutiny of ashwagandha continues to evolve, the availability of high-quality safety data is increasingly important.

The recent OECD- and GLP-compliant safety assessment of a fully characterised root-and-leaf ashwagandha extract¹ provides a robust toxicological dataset, demonstrating no genotoxicity, no treatment-related adverse effects in a 90-day study, normal liver findings and no adverse endocrine effects under the conditions tested.

Importantly, these findings are consistent with the broader clinical evidence showing that standardised ashwagandha extracts are generally well tolerated.

Together, the data highlight the importance of evaluating fully characterised extracts using internationally recognised methodologies to support evidence-based regulatory assessment and informed safety conclusions.

An estimated 4.3% of the global population are affected by food allergies with reactions ranging from mild symptoms to life-threatening anaphylaxis¹.

While the labelling of intentionally added allergen ingredients is mandated in regulations, the procedure for “may contains” statements covering the unintentional presence of allergens varies widely and remains unregulated in many parts of the world.

As a result, it can be difficult for consumers to judge the actual level of risk and some may unnecessarily avoid foods that are safe or lose confidence in the warnings and simply ignore them.

The unintended presence of food allergens or cross-contamination can occur during food production, even when the allergen is not an ingredient.  For example, a cereal bar without nuts produced on the same line as nut-containing products may still contain traces of nuts despite cleaning procedures.

Allergens may also be transferred during ingredient handling and storage and therefore precautionary allergen labelling (PAL), including statements such as “may contain”, is often used to alert consumers to potential residual risks.

However, guidance is needed to prevent unnecessary PAL by ensuring warnings are only used when the risk has been scientifically assessed and cannot be adequately controlled through good allergen management practices.

The new Codex guidance recommends a qualitative risk assessment which can be supplemented with a quantitative risk assessment of unintended food allergen presence.

Reference doses for individual allergens are also included in the guidance and serve as the basis for establishing action levels.

The intention is that PAL shall only be used when, following the application of appropriate measures, the unintended presence of a food allergen(s) is above the action level for the allergenic food based on the reference doses for IgE-mediated food allergy and for coeliac disease.

PAL should not be used when the unintended presence of a food allergen(s) is at or below the action level.

The guidance also includes other points of clarification as for example, how to label in the case where the unintentional source of the gluten cannot be verified by risk assessment and how and where the PAL should appear on label.

The guidelines were adopted as part of the 49th Session of the Codex Alimentarius Commission², held in Geneva, Switzerland, from 6 to 10 July 2026 and will be included as an annex to CCFL’s General Standard for the Labelling of Pre-packaged Foods (CXS 1-1985)³.

The guidance complements existing Codex standards on allergen declaration and food allergen management, including the Code of Practice on Food Allergen Management for Food Business Operators (CXC 80-2020)⁴.

While Codex guidance is voluntary, it often serves as an internationally recognised benchmark that supports national legislation and assists international trade.

Currently the European Commission⁵ is considering the adoption of harmonised requirements for the use of voluntary PAL statements and the UK are also exploring options⁶.

Notes: Established by FAO and WHO, the Codex Alimentarius Commission develops international food standards, guidelines and codes of practice to protect consumer health and promote fair practices in the food trade.

From Broad Concepts to Operational Definitions

The debate around “ultra-processed foods” (“UPFs”) is entering a new phase.  At the end of 2025, The Lancet published a 3-paper series on “UPFs”, covering health associations and policy recommendations¹.

Much of the evidence underpinning this classification comes from observational studies that rely on dietary assessment methods not originally designed to assess food processing².

While these studies identify associations between dietary patterns and health outcomes, they do not establish cause and effect or determine the independent contribution of specific ingredients to the observed associations.

One of the most significant developments from the Lancet paper series was the proposal of moving beyond the broad descriptive Nova classification by Monteiro et al.³ toward a more operational definition based on “markers of ultra-processing” (MUPs).

These MUPs tend to include ingredients and additives not generally used in home cooking.  In practice, however, they also represent a subtle but important shift in how “UPF” is being conceptualised.

The discussion implicitly moves away from processing towards ingredients and formulation-level classification systems capable of being applied at product level and at scale.

This distinction matters because it means there are more questions to be answered such as which classification system is being applied, how is it operationalised, and what happens when it is used across real-world datasets.

These questions reflect a broader transition taking place across nutrition policy, where the conversation is increasingly focussed on data infrastructure, challenges, opportunities and implementation of health metrics.

The Lancet UPFs series¹ expands upon the related literature by moving from a classification widely used in observational studies to a definition that can be applied in practice for policy purposes.

Yet, at the time of writing this article, these ingredient-level approaches have not been empirically tested against health outcomes.

Existing Policy Landscape Remains Primarily Nutrient-Based

Despite growing policy and scientific attention on food processing levels, most regulatory approaches for enabling healthier food choices (e.g. taxation, marketing restrictions, labelling) still operate primarily through nutrient-based thresholds.

© Copyright 2026 Global Food Research Program at UNC-Chapel Hill.  Base map copyright © FreeVectorMaps.com

Front-of-pack warning labels in countries such as Chile and Mexico focus on nutrients of concern and, in some cases, sweeteners.  Restrictions in the UK on products high in fat, salt, and/or sugar (HFSS) rely on a nutrient profiling model.

Similarly, the Nutri-Score in certain European countries evaluates products through nutrient composition for labelling.  China requires sugar and saturated fat labelling and health warnings for children for mandatory implementation in 2027.

Although these systems do not classify foods according to their level of processing, food processing and ingredient-level definitions are now being considered in discussions around dietary guidance, marketing restrictions, taxation and/or front-of-pack labelling.

As these policy approaches use different underlying criteria, this raises an important question: what additional value does classifying foods by their level of processing provide beyond existing nutrient-based systems?

The Rise of Ingredient-level Classification

The proposed MUPs approach attempts to create a more scalable and standardised way of identifying “UPFs” using ingredient list data.  In theory, this allows classification to be applied consistently across large manufacturer and retailer datasets, but it also raises unresolved questions within the food processing debate.

One question is whether regulation is ultimately targeting specific ingredients or foods as a broader category.  Discussions often move interchangeably between emulsifiers, stabilisers, sweeteners, flavourings, industrial formulations and processed foods themselves, despite these not necessarily representing equivalent policy targets.

Another challenge relates to evidence translation based on the available science to date.  As a result, it leaves a gap between the descriptive categories used in dietary surveys and ingredient-level systems proposed for regulatory implementation.

The growing shift toward ingredient-level operationalisation therefore changes the nature of the debate.  At the same time, implementation remains inherently difficult.

Currently, there is no globally harmonised MUP framework, raising practical questions around who determines the official list of markers, how lists are updated and how disagreements are resolved as (re)formulation practices evolve.

Emerging Attempts to Bridge the Implementation Gap

In May 2026, Healthy Eating Research (HER) convened an expert panel to evaluate existing UPF definitions and approaches for guiding policy development⁴.  The report acknowledged that processing alone is not sufficient to determine the overall healthfulness of foods and instead is as an additional lens that may complement existing dietary assessment approaches.

In addition, inclusion of specific markers is not necessarily because those ingredients are individually harmful, but because they are viewed as indicators of foods categorised as “ultra-processed”.

However, while broader dietary patterns classified as “UPFs” may have been associated with adverse health outcomes in observational studies, it remains unclear whether the proposed ingredient-level markers used for policy capture those same associations.

The HER panel brought practical implementation challenges into sharper focus. These included maintaining and updating ingredient databases within rapidly evolving food supply chains, ensuring sufficient transparency around formulation practices, and managing the reality that static marker lists may quickly become outdated.

At the same time, the project reflects expansion of the field by applying proposed metrics to more than 90,000 products, highlighting how food classification systems need to consider real-world data to understand policy implications.

Reformulation and Shifting Incentive Structures

One of the most important implications of ingredient-level approaches relates to reformulation incentives.  The Lancet series critiques nutrient reformulation by arguing that reductions in fat, salt and/or sugar may increase the use of additives or industrial ingredients.

Yet ingredient-level operationalisation could itself create a different set of reformulation incentives, which may take the form of optimisation away from “less sugar” towards “less emulsifier”, expanding previous trends on “clean(er) label” or “natural” ingredient substitution strategies.

If ingredient-level criteria become the primary regulatory gatekeeper, reformulation may lead to prioritisation of additive substitution and formulation optics over measurable nutritional improvements.

This creates a broader policy question: what exactly is regulation trying to incentivise – nutritional composition, degree of processing, category restrictions, ingredient familiarity, formulation simplicity, eating behaviour, or some combination of these factors?

California as an Emerging Real-World Test Case

A number of these tensions are now beginning to materialise in regulatory approaches.

California has become one of the clearest examples of attempts to operationalise the level of food processing within legislation.  In 2025, the state introduced a formal “UPFs” definition for school food restrictions through AB 1264.  More recently, AB 2244 proposed applying this classification through a certification scheme for non-“UPFs” and preferential retail placement for certified products.

Rather than relying solely on Nova categorisation, California’s approach combines ingredient-level markers with nutrient thresholds.  Products may be classified as “UPFs” if they contain one or more listed additives while also exceeding thresholds for saturated fat, added sugar or sodium.  However, products containing non-nutritive sweeteners or polyols may still fall within the definition even where nutrient thresholds are not exceeded.

The result is a system where HFSS does not always equal “UPFs”, and vice versa, which creates potential divergence.  Nutritionally poor products may avoid “UPF” classification through “natural” substitutions, while products that have improved nutritionally may remain within restricted categories because of ingredient composition.

Alongside policy-led approaches, a growing number of third-party certification schemes have also been developed, particularly in the US, to certify foods as non-“UPF”.  These schemes often apply different criteria and thresholds, further illustrating the fragmentation currently emerging within operational definitions.

Product-Level Data is Becoming Central

One of the clearest changes emerging is that the debate is moving beyond a single classification and increasingly overlapping with wider discussions on data infrastructure.

Policy impact ultimately depends not on whether a classification system appears coherent theoretically, but on what happens when it is applied across real-world products, retail environments, purchasing and consumption datasets.

A framework may appear conceptually robust yet generate unexpected divergence, inconsistencies or implementation challenges once operationalised at scale.

Questions around ingredient transparency, data access, and successful implementation are therefore becoming central to the future of food and nutrition policy.

Final Reflections

A key challenge for “UPFs” moving forward is considering where the concept genuinely adds value beyond existing policy approaches.  Most stakeholders working in this space ultimately share similar goals: supporting healthier and more sustainable diets.

However, before “UPF” becomes embedded within regulatory frameworks, there needs to be greater clarity around what the concept is intended to achieve and whether current operational approaches remain coherent when applied consistently across real-world food systems and datasets.

Whatever direction the conversation takes, the future of “UPFs” feels likely to become more data-led, not only “definition-led”.  As such, the next chapter may depend less on continuing debates around classification itself, and more on understanding what happens when these approaches are applied in practice.

Without this, there is a risk that unintended consequences and potential divergence beyond existing nutrient-based approaches remain poorly understood, particularly as regulatory development in this area continues to accelerate.

Infertility affects millions of individuals worldwide and remains one of the most emotionally and medically challenging conditions in reproductive health.

At the recent Growth Asia Summit 2026 in Singapore, Dr Celia Ning, Senior Director of Scientific Affairs at Kerry, presented From Hormonal Chaos to Cycle Confidence: Creating the PMOS and Fertility Ecosystem.

Celia highlighted that female infertility is an increasingly significant health concern across the Asia‑Pacific (APAC) region, shaped by a unique combination of metabolic, environmental, immunological and demographic factors.

Among these, polycystic ovary syndrome (PCOS), most recently re-named a Polyendocrine Metabolic Ovarian Syndrome (PMOS), is one of the most prominent contributors, affecting an estimated 10–13% of reproductive‑aged women.

The key characteristics of PMOS and treatment strategies for female infertility and PMOS in APAC were presented.  Dr Ning emphasised that current PMOS treatments should combine:

• Lifestyle and nutrition interventions
• Pharmacological options
• Assisted reproductive technologies.

Although PCOS treatment approaches in APAC are broadly aligned with international guidelines, Dr Ning highlighted that variations in healthcare infrastructure and cultural influences can affect timely access to care and treatment uptake.

Combined with the region’s distinct metabolic profiles, evolving lifestyles, and varied environmental exposures, these factors may be contributing to the rising prevalence and impact of PMOS-related infertility across APAC.

However, a growing body of evidence shows that PCOS is fundamentally a metabolic endocrine condition with reproductive consequences, not the other way around.   Clinicians knew the name “polycystic ovary syndrome” was inaccurate and misrepresented the condition.

From 14 years of global collaboration between experts and those who lived with the condition, a consensus was published in May 2026 announcing that Polycystic Ovary Syndrome (PCOS) is now termed Polyendocrine Metabolic Ovarian Syndrome (PMOS)⁴.  According to Teede et al.⁴ transition to the new name will occur over a three-year period.

Why PMOS and not PCOS?

PMOS is primarily a metabolic endocrine disorder.  Research consistently shows that insulin resistance is present in up to 75% of women with PMOS, even at normal BMI, and nearly 95% of women with PMOS who have overweight or obesity⁵.

Insulin resistance drives excess androgen production, disrupted follicular development, anovulation and/or increased cardiometabolic risk.  This metabolic foundation is why many experts argue that the term “PCOS” under‑represents the true nature of the condition.

Polycystic ovaries are not required for diagnosis⁶.  Ultrasound findings are not necessary for diagnosis, not specific to PCOS and common in healthy adolescents and young adults.  The name “PCOS” overemphasises a feature that is neither universal nor central.

Furthermore, the metabolic risks extend far beyond fertility.  Women with PMOS have higher lifetime risks of type 2 diabetes, gestational diabetes, dyslipidaemia, hypertension, non‑alcoholic fatty liver disease and/or sleep apnoea^6,7.  These risks persist long after reproductive years, reinforcing the need for a metabolic‑focused terminology.

Why “PMOS” Better Reflects the Condition

The proposed term Polycystic Metabolic Ovary Syndrome (PMOS) highlights the⁴:

• metabolic drivers: insulin resistance, inflammation and adipose dysfunction are central mechanisms.
• ovarian consequences: anovulation, hyperandrogenism and infertility arise because of metabolic dysfunction.
• need for metabolic‑nutrition interventions: lifestyle and nutrition strategies are first‑line therapy because they target the root cause.
• lifelong nature of the condition: this is not just a fertility disorder—it is a chronic metabolic condition requiring long‑term management.

Why This Matters for Nutrition and Health Professionals

A metabolic‑focused name aligns with what research has shown for years:

• Diet quality, insulin sensitivity and body composition are central to symptom management.
• Women in Asia‑Pacific and South Asia show higher insulin resistance at lower BMI, making metabolic framing especially relevant.
• Nutritional interventions (e.g., low‑GI patterns, whole‑food diets, vitamin D optimisation, inositol supplementation) directly target the underlying physiology.
• A metabolic lens helps reduce stigma by shifting the narrative away from “cysts” and toward systemic health.

In Summary

The overarching aims of the group behind the PCOS name change are to build greater awareness, strengthen diagnostic accuracy, elevate the quality of care and patient experience and ultimately improve outcomes across all aspects of the condition⁴.

The renaming of PCOS to PMOS reflects a deeper understanding of the condition as a metabolic‑endocrine disorder with reproductive manifestations, rather than a purely ovarian syndrome.

For the more than 170 million women living with PMOS worldwide, the implications are tangible.  PMOS management demands an integrated, individualised approach — one that addresses the symptoms experienced by each woman living with PMOS.

Hosted by the KHNI and moderated by Mary Shelman, founder of the Shelman Group, this session brought together Wolfram Schlenker, the Ray A. Goldberg Professor of the Global Food System at Harvard University, and Juan Aguiriano, Group Head of Marketing and Sustainability at Kerry.

The discussion examined how climate shocks, environmental pressures, and geopolitical volatility are exposing real fragility – driving all-round disruption leading to unpredictability, supply instability, and price variability.

The panel explored the growing complexity shaping food and agriculture and why resilience must sit at the centre of every decision.  Embedding sustainable resilience into risk management was identified as strengthening a company’s ability to forecast and anticipate disruption and ultimately generate long‑term value.

Speakers highlighted the complexities around trade-offs between sustainability, affordability, resilience, and nutrition – while at the same time meeting consumer expectations.  They pointed to the expanding role of data and AI in enabling more resilient production systems, smarter and more adaptive supply chains, and better-informed consumer decision-making.

The message is clear: sustainable resilience is no longer a cost – it’s core to risk management and long-term growth.  Food’s future lies not in producing more, but in producing better — driven by partnership, innovation, and a mindset built for resilience.

So, while it may sound obvious, a varied and balanced diet that provides adequate nutrients is the foundation of a healthy immune system.  However, some nutrients receive particular attention for their role in immune health, including vitamins A, C and D, as well as the minerals such as zinc and selenium¹.

There is also evidence for the immune benefits of other nutrients and ingredients, such as long-chain omega-3 fatty acids, probiotics and beta-glucans².

Immunonutrition

Read how each of the nutrients listed below support the immune system.  It is important to bear in mind that micronutrients have additional health benefits to immune health.  Click on each nutrient/non-nutrient below to learn more:

• Vitamin A
• Vitamin C
• Vitamin D
• Selenium
• Zinc
• Probiotics
• Beta Glucans

How the Immune System Works?

The immune system is the body’s way of protecting itself from infection by foreign invaders like bacteria and viruses.  It helps the body stay healthy and recover when illness does occur and is made up of the innate (general) and adaptive (specialised) immune system³.

The innate immune system is the body’s first line of defence.  When pathogens like infectious bacteria or viruses get into the respiratory tract or gastrointestinal system, the innate immune system responds by sending cells like neutrophils or macrophages to remove the threat.  These cells try to engulf the invading pathogen or create enzymes to destroy it.

The adaptive immune system specifically targets the pathogen and takes over from the innate immune system.  It is often described as the ‘memory’ of the immune system.  Once exposed to a pathogen, the immune system can remember the identity of that pathogen for the future and quickly mount a defence specific to that pathogen.

Impact of Age and Physical Activity on Immune Health

Immune health becomes especially important in vulnerable age groups like infants and the elderly. Both physical and psychological stress can also compromise the immune system.  Examples include over-exercising, emotional stress and surgery.

This article was published in March 2022 and updated on June 15, 2026.

Some selenoproteins, called glutathione peroxidases, are important for the body’s antioxidant system, which protects DNA and cells from oxidative damage.  This includes protecting the body’s immune cells from damage^{1, 2}.

Selenium also plays a role in activating immune cells ¹ and helping them function, such as assisting macrophages to more effectively destroy or engulf pathogens.  The role of selenium in the response to vaccines continues to be investigated³.

Figure 1. A summary of selenium and immune responses¹.   © 2018 by the authors ¹. Licensee MDPI, Basel, Switzerland.  Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

Recommended Intakes

The recommended daily intake of selenium varies around the world².  The Chinese Nutrition Society⁴ set a Reference Nutrient Intake (RNI) of 60mg per day for adults.  Similarly, in the US the Institute of Medicine has set a Recommended Dily Allowance of 55mg per day⁵.  In addition, the European Food Safety Authority set an adequate intake (AI) of 70mg per day for adults⁶.

Dietary Sources

Meats, eggs, nuts, seeds, seafood and whole grains are good sources of selenium.  The selenium content of foods is linked to the selenium content of the soil (see ‘Deficiency’ section below).

Table 1. Selenium content of common foods in the diet⁷

Deficiency

Selenium deficiency is expected to affect up to 1 billion people worldwide.  This deficiency primarily affects people in areas where the soil is low in selenium⁷ and, as a result, the foods that grow in that soil are low in selenium.

The distribution of selenium in the soil is extremely uneven, with significant differences even within countries.  Regions with lower selenium intakes⁸ include certain areas of New Zealand, China and Italy, among many others.

In areas where the soil is rich in the soil, selenium deficiency is rare.  For example, the average daily intake of selenium in the US is almost twice the daily recommendation.  Certain regions of China, where selenium is plentiful in the soil, also have high intakes of selenium⁹.

Excess Intakes

Selenium has a narrow window between adequate and toxic levels.  Getting too much selenium can lead to symptoms like gastrointestinal or neurological symptoms, hair loss, nausea and fatigue, among others⁷.

For this reason, in the US a tolerable upper limit of selenium has been set at 400mg per day for adults³ .  The EFSA recently revised their upper limit to 255mg per day for adults including pregnant and lactating women¹⁰.  Lower limits are recommended for younger groups.

Selenium Supplementation

People who are deficient in selenium are shown to have impaired immune responses² and studies show that reinstating selenium status through supplementation can improve the body’s ability to fight infection.

Those with adequate selenium intake through their diet are unlikely to see additional benefits.  A recent meta-analysis of selenium¹¹ supplementation trials showed a very mixed picture of effects but no conclusive evidence of an beneficial effect on the immune system beyond the recommended dietary intake.

This article was publishing in March 2020 and updated on April 07, 2026.

Dietary Sources

Beta glucans are naturally occurring polysaccharides that serve as energy stores and structural components of plant walls found in a variety of foods including oats, barley and seaweed, as well as many types of microorganisms (bacteria, yeast and fungi).

While they all share a “common” beta chemical bond between the individual glucose units, there are many subtle, but important, differences in structure within the beta glucan family that lead to large differences in function and potential health benefits.

When choosing a beta glucan, it is key to focus on what clinical research is available to support the specific ingredient’s mechanism of action, demonstrate effectiveness for the desired benefit and show the safety of the ingredient.

Mushroom Beta-Glucans

As the chemical composition of each type of mushroom varies, so does the biological activities of their beta glucans.

Although are associated with immune health benefits, their molecular structure is varied and inconsistent, making it difficult to characterise their efficacy².

The most studied strain of mushroom beta glucan is lentinan, a substance derived from Lentinus edodes (Shiitake) with a beta-1,3-D-glucan backbone comprising very short beta-1,6 side chains.

Further clinical research is needed to fully understand how each type of mushroom beta glucan works².

Yeast Beta-Glucans

Yeast beta-glucan are  one of the most extensively studies of the beta-glucans.

A recent review recommends that future research should define the origin, molecular weight and structure of yeast beta-glucans by using standardised tools (e.g. structural analysis, chemical degradation and/or nuclear magnetic resonance) to accurately characterise and clarify structure–function relationships³.

For this reason, choosing a generic yeast beta-glucan may not deliver the targeted health benefit which should be demonstrated using a well characterised ingredient in clinical trials.

Yeast-derived beta glucans usually originate from either baker’s yeast or brewer’s yeast.

Even though both are structured as beta 1,3/1,6 glucan from Saccharomyces cerevisiae, differences in the source (or strain) of yeast and the method used to isolate and purify the yeast beta-glucan are important factors affecting the final structure of the yeast beta-glucan⁴ and may ultimately influence biological activity⁴.

Yeast Beta-Glucans Impact on Immune Health

The immune system has the ability to recognise and eliminate pathogens by first activating the innate (general) immune response, which acts in a fast and un-targeted manner to phagocytose and eliminate the invader.  Innate immune cells can also adapt to challenge and alter subsequent responses, which is referred to as trained immunity.

The current paradigm for the immunomodulating action of yeast beta-glucans is through improving the innate immune system by making key white blood cells better able to find and kill potential pathogens^{1, 5}.

Studies into the cellular and molecular mechanisms of action show that beta-1,3/1,6-glucans are engulfed and processed by macrophages and dendritic cells that later travel to the different immune organs releasing fragmented soluble beta-1,3-glucan particles.

This results in the priming of leukocytes via certain receptors including Dectin-1 and leads to enhanced immuno-surveillance and improved antimicrobial and inflammatory responses¹.  In theory this should translate into enhanced resistance to infection.

Upper respiratory tract infections (URTIs) are the leading cause of acute disease in humans and poses a substantial burden to the healthcare system⁶.   A specific baker’s yeast beta-glucan containing a highly purified natural beta-1,3/1,6-glucan has been shown to reduce either the incidence and/or duration or severity of URTIs in clinical trials with children⁷, athletes⁸ and those engaging in intense exercise^9,10.

A meta-analysis of 13 randomised controlled trials has also demonstrated that yeast beta-glucans could significantly reduce the incidence and duration of URTIs.  However, due to the high heterogeneity and small number of included studies, more high-quality research and clinical trials are warranted¹¹.

Yeast beta-glucans area also being explored for their potential to improve vaccine effectiveness¹².

This article was published in April 2020 and updated on April 14, 2026.