For the next several days, this blog is going to highlight articles that Ben Gold (one of my partners at GI Care for Kids) has recently sent me. For what it is worth, I am not sure that Ben Gold actually sleeps. He seems tireless. He shares articles with lots of individuals in our group on a wide range of subjects. In addition to his loaded clinic schedule, he is busy giving lectures, engaged in NASPGHAN committees, provides guidance for our research projects, participates in hospital meetings, and is active with family pursuits (super-proud Dad).
Ben is also in the running to be the next NASPGHAN president & I think he is very well-suited for this role. He has been a Division Chief with a distinguished career both at the CDC and Emory, and has been in a busy private practice. Between these roles, he has acquired practical knowledge with regard to negotiating with hospitals, universities, insurers and industry. This combined academic-private practice experience would benefit NASPGHAN and its members, particularly at a time when the roles of physicians and hospitals are changing so rapidly.
A recent AAP policy statement and technical report (Trasande L, Shaffer RM, Sathyanarayana; Pediatrics 2018; 142 (2): e20181408 & technical report: Pediatrics 2018; 142 (2): e20181410) highlights child health concerns and food additives.
Food additives include the following:
- Direct additives: colorings, flavorings, and chemicals added during processing. This policy statement notes that there are 10,000 direct food additives which are allowed in the U.S.
- Indirect additives: food contact materials including adhesives, plastics, paper which can contaminate food as part of packaging and distribution
- Other contaminants like pesticides are not addressed in this policy statement
- Regulation and oversight of many food additives is inadequate. This is due to key problems with the Federal Food, Drug, and Cosmetic Act. Current requirements allow for a “generally recognized as safe” (GRAS) designation. The GRAS process was intended to used in limited situations, but “has become the process by which virtually all new food additives enter the market.”
- Yet the FDA does not have adequate authority to acquire data on chemicals and data about health effects of food additives on infants and children are limited or absent.
- Furthermore, FDA regulation does not regularly consider issues of cumulative dosing and synergistic effects of food additives.
- Bisphenols, which are used in the lining of metal cans, could result in disruption of endocrine pathways
- Phthalates, which are used in adhesives, lubricants, and plasticizers during the manufacturing process, can also in disruption of endocrine pathways
- Perfluoroalkyl chemicals (PFCs), which are used in grease-proof paper and packaging, may result in obsesogenic activity, decreased birth weight, and disruption of endocrine pathways
- Nitrates and nitrites, which are added as preservatives and color enhancer especially with meats, may contribute to carcinogenicity and thyroid hormone disruption
- Artificial food colors may be associated with exacerbation of attention-deficit/hyperactivity disorder symptoms
Conflict of interest with GRAS evaluations:
- Among GRAS evaluations, 22.4% were made by an employee of manufacturer, 13.3% were made by a consulting firm selected by manufacturer, and 64.3% were made by an expert panel selected by manufacturer or manufacturer’s consulting firm
Given the potential safety concerns of numerous additives, the policy statement makes the following recommendations for pediatricians:
- Prioritize consumption of fresh or frozen fruits and vegetables
- Avoid processed meats, especially during pregnancy
- Avoid microwaving food or beverages
- Avoid placing plastics in dishwasher
- Recycling labeling often offers clues to the type of plastic with concern for the following codes: 3 often indicating phthalates, 6 for styrene, and 7 for bisphenols –unless labeled as “biobased” or “greenware.”
The policy statement encourages further regulatory steps for government/FDA as well.
My take: These articles sound the alarm that food additives may be making us sick. This area is ripe for further investigations.