Lurking food danger: What you need to tell parents

Rachel Shaffer, MPH

From prepared foods to plastic containers, chemicals are all around us and in the foods we eat. Now, pediatricians are being urged to talk to parents about their children’s exposure to chemicals and how parents can help clean up their diets.

A new policy statement from the American Academy of Pediatrics (AAP) reveals that more than 10,000 chemicals are permitted to be added to or have contact with foods. Although some of these are considered “generally safe” for use by the US Food and Drug Administration (FDA), mounting evidence in recent years suggests that the volume of chemicals used in food and food contact “may contribute to disease and disability.”

Children are particularly susceptible to the effects of these chemicals, the report notes, because of their size, development stages, and metabolic states. The report does not address chemicals inadvertently added to foods, such as pesticides and other contaminants, or genetically modified foods.

Rachel Shaffer, MPH, a PhD student in environmental toxicology at the University of Washington School of Public Health, Seattle, coauthored the technical report,¹ published with the policy statement² in Pediatrics, and says the goal of the report was to review the harmful effects of common chemicals in foods and the growing evidence that these chemicals cause harm.

“We took this opportunity to review and synthesize the data for the public, clinicians, and policymakers,” Shaffer says. “Chemicals in food additives have been linked to hormone disruption, obesity, reproductive development, and neurodevelopment.”

Some specific health concerns raised by the researchers include disruptions to endocrine system development and function that have been tied to chemicals, including perchlorate. An antistatic agent used in plastic packaging for foods, perchlorate is known to disrupt thyroid hormones, according to the report. Other chemicals of concern are perfluoroalkyl chemicals (PFCs) that are used in grease-proof paper and packaging, and that also have been linked to thyroid disruptions as well as to reduced immune responses to vaccines. Food colorings and additives such as nitrates-common in processed meats-are also addressed in the report.

The researchers say that although the data on the effects of these food additives are vast, one of the biggest problems is finding a way to collect better information about the use of these chemicals in foods. They found little data on safe levels of use for many of the chemicals found in food and food preparation or storage, particularly those food additives that enter the market under the FDA’s “generally recognized as safe” (GRAS) classification. In a review of FDA evaluations of these chemicals, 22.4% were found to have been evaluated for GRAS designation by the chemical’s own manufacturing company; 13.3% were completed by consulting firms hired by manufacturers; and 64.3% were completed by expert panels appointed by manufacturers. None were completed by third parties, according to the AAP report.

Given the limitations of the government in addressing these food safety issues under the current system, the AAP’s report suggests that pediatricians offer guidance to parents, and advocate for improved research into the use of these chemicals in order to reduce exposure to food additives, especially in low-income populations that may utilize prepared or processed foods at higher rates.

The report also urges the modernization of the Federal Food, Drug, and Cosmetic Act to help improve regulation of food additives, including the approval process for the FDA’s GRAS designation. Pediatricians can help by advocating for change with policymakers, the report notes, and by working with patients and their families to reduce exposures.

“We hope that clinicians will incorporate this guidance into their patient visits so that families can make informed decisions to minimize their exposures to food additive chemicals,” Shaffer says. “In addition, we hope that clinicians will join in advocating for policy changes, so the burden does not rest upon individuals to avoid these chemicals.”

The AAP report suggests that clinicians begin their education for patients and parents with an emphasis on the consumption of fresh or frozen fruits and vegetables when possible; the avoidance of processed meats, especially during pregnancy; avoiding microwaving foods and beverages in plastic, particularly infant formula and pumped breast milk; and reducing the use of plastics in food storage and preparation.

When plastics are used, parents can limit exposure to chemicals by choosing plastics that are “biobased” or labeled “greenware” and that are not marked with recycling codes 3, 6 and 7 because these contain phthalates, styrene, and bisphenols. The report also encourages parents to avoid washing plastic containers in dishwashers. Many of these suggestions would require big lifestyle changes for families, but Shaffer says pediatricians could help families develop plans that work for their situation.

“We suggest that clinicians work with patients and their families to develop a realistic plan for minimizing exposure to food additive chemicals. Some of our suggestions overlap with other public health aims. For example, prioritizing fresh or frozen fruits and vegetables instead of fast food and processed food, which is one of our recommendations, can also help families reach nutritional goals,” Shaffer says. “If cost presents a burden, clinicians can help families search for assistance programs, such as the [Special Supplemental Nutrition Program for Women. Infants, and Children (WIC)] Farmer's Market Nutrition Program.”

References:

1. Trasande L, Shaffer RM, Sathyanarayana S; Council on Environmental Health. Technical report: Food additives and child health. Pediatrics. 2018;142(2):e20181410. Available at: http://pediatrics.aappublications.org/content/142/2/e20181410. Accessed August 28, 2018.

2. Trasande L, Shaffer RM, Sathyanarayana S; Council on Environmental Health. Policy statement: Food additives and child health. Pediatrics. 2018;142(2):e20181408. Available at: http://pediatrics.aappublications.org/content/142/2/e20181408. Accessed August 28, 2018.