Potential impacts red dye No. 3 has on children

Contemporary Pediatrics®:

Hello and thank you so much for joining us some Joshua Fitch with Contemporary Pediatrics®.

Jamie Alan, RPh, PharmD, PhD

Hi there. My name is Dr. Jamie Alan, I'm an associate professor in the Department of Pharmacology and Toxicology at Michigan State University College of Human Medicine.

Contemporary Pediatrics®:

Dr. Alan, thank you so much for taking the time to join us. Today we're talking about red dye No. 3 in foods in the United States related to the pediatric population. According to CNN and assembly bill in California is seeking to prohibit food products containing this red dye No. 3. First Dr. Alan, what is in this red dye No. 3, what is it, and what are the some of the common foods it's commonly found in?

Alan:

That's a great question. Red dye No. 3 is also known as a risk erythrosine. And this is a blue dye that's made from petroleum products. Other dyes like red dye No. 40 are also made from petroleum as well. This dye red dye No. 3, it's currently in 2876 foods in the United States. And when we're thinking about foods that are most likely to have red dye No. 3, maraschino cherries, that red dye that you see in those for red dye No. 3, when we used to have red pistachios, those aren't widely available anymore, but those also haven't died No. 3, and then think Halloween candy, lots of candy. Lots of processed foods also have red dye No. 3.

Contemporary Pediatrics®:

With this assembly bill in California aiming to eliminate red dye No. 3 in their food products for the state, what association and why are they trying to do this? What is the push behind this? Obviously a big deal.

Alan:

Yeah, this is a great question. Red Dye No. 3 is already banned in cosmetics. And the reason it is banned in cosmetics is because there are studies and rats that show that there is an increased risk of thyroid cancer when the rats consume red dye No. 3. Now there have also been a lot of correlative studies done and there was a great amount of review in 2022. That looked at the effects of red dye No. 3 along with some of the other dyes like red dye No. 40 and yellow dye No. 5. And what they found was in a majority of studies, there is an increase association between red dye No. 3 consumption and an increase or an exacerbation of ADHD symptoms and children. What was interesting is they also found in a majority of these studies was that correlation was statistically significant. Another interesting thing to point out is they did notice that there was an increase in symptoms as reported by the parents for in most of these studies, but they did not see an increase as reported by the teachers in as many of these studies. The other thing that's been looked at is there have been a few studies and also anecdotal reports showing that when parents eliminate dye such as red dye No. 3 from the diets of their children, that they noticed that symptoms of ADHD do improve. Now, I will say that red dye No. 3 is often in combination with other dye and other preservatives. So one of the limitations is that it's really very tricky to dissociate the effects on red dye No. 3, from any effects, the other preservatives or other dye products might be having. But since this dye is purely cosmetic, and just makes food like candy more appealing, It's a perfectly reasonable idea to think about eliminating it from foods.

Contemporary Pediatrics®:

In research that you have studied regarding red dye No. 3, how quickly are these associations being made? Again, more research has to be done, like you mentioned, to further understand how this is affecting children. What are some of those observations that have been made, and the time aspect related to it?

Alan:

Oh, that is a great question. So the studies are not uniform in the timeframe, and what they are finding is that when parents report that if they don't give these foods containing two red dye No. 3, that they see lessening of the symptoms. So that timeframe is over weeks to months, generally, but that definitely does vary. The other thing I will say in addition to other preservatives and other food colorings that are in some of these foods, there tends to be a lot of sugar that are in these foods. And so again, it's unclear whether it's the sugar, it's the dye, it's the preservatives, but certainly since this isn't providing any substantive health benefit, it's a very reasonable idea to consider taking away some of these dyes from our foods.

Contemporary Pediatrics®:

With that being said for pediatricians and parents alike, is it as simple as looking at a label on these food products? Or is it kind of embedded in any kind of way?

Alan:

That's a great question. It should be on the label for these food products. Now, I will tell you that it's usually listed as red dye No. 3, but they could also technically put the name erythrosine. And you want to look for other dyes as well. Red dye No. 40 has about four or five different names. The other thing you can do is I did go this morning to ewg.org. They have a very nice table of all the foods that do contain red dye No. 3. So if you have easy internet access, that's a very easy website to navigate.

Contemporary Pediatrics®:

You mentioned this red dye No. 40. How similar is that to red dye No. 3, it sounds like they kind of work in conjunction with each other. What other similar diet should pediatrician advise patients of? And are they in similar types of food groups as well?

Alan:

Yeah, so these dyes are in similar types of food groups that are added to make food look more appealing so that you will want to consume the food. The dyes that have the most literature around them are Red Dawn No. 40, red dye No. 3, and yellow dye No. 5, those have the best datasets. However, there's reason to believe that any of these food dyes could make this contribution. And again, it's really difficult to tease out the effect of the dye from the sugar or preservatives or other things that might be in that food.

Contemporary Pediatrics®:

Dr. Alan, thank you so much. Is there anything else you'd like to add? Or maybe perhaps health care providers pediatrician should know when advising parents when it comes to these cosmetic related food products?

Alan:

Yeah, that's a great question. One of the easy ways to avoid getting any of these food products with these dyes is to shop around the outside of your grocery store and avoid some of those processed foods. Now, that sounds simple. But in reality for many kids, that's very difficult. I think we have to remember that a lot of parents and children live in food deserts and their main source of food and their store that they get food from might be gas station. This is going to be very difficult for some parents and some patients to navigate. So I think it's very important to give this advice it may be completely appropriate, but of course also use your clinical judgment and your knowledge of your patients and your patient population that you're treating.