Food Additives Causing Harm, Reforms Urgently Needed, AAP Says

Norra MacReady

July 23, 2018

More information is urgently needed on the physiological and cognitive effects of additives in the American food supply, according to a new policy statement issued by the American Academy of Pediatrics (AAP) and published online today in Pediatrics.

The current regulatory framework for protecting the public has "serious flaws" because of "antiquated notions of safety" and is "in serious need of reform," the statement's lead author, Leonardo Trasande, MD, MPP, told Medscape Medical News. "These older tests were based on a more simplistic view of human health," he explained.

For example, the process through which additives are designated as Generally Recognized as Safe (GRAS) by the US Food and Drug Administration has been overused and is insufficient to protect against conflict of interest, Trasande and colleagues on the AAP Council On Environmental Health write in the policy statement.

"Because of the overuse of the GRAS process and other key failings within the food safety system, there are substantial gaps in data about potential health effects of food additives," they add in an accompanying technical report.

In fact, many of the chemicals currently in the food supply "have not been tested at all, while others have not been tested for endocrine disruption or their impact on brain development, and their effect on children's health is still unknown," Trasande, an associate professor of pediatrics at New York University School of Medicine in New York, said in a telephone interview.

As a result, data to support the use of these compounds often is either nonexistent or obsolete, and a growing body of evidence suggests that they may have serious health consequences. "Children may be particularly susceptible to the effects of these compounds because they have higher relative exposures compared with adults (because of greater dietary intake per pound), their metabolic (ie, detoxification) systems are still developing, and key organ systems are undergoing substantial changes and maturations that are vulnerable to disruptions," the authors write in the technical report.

Of particular concern are "food contact substances associated with the disruption of the endocrine system in early life, when the developmental programming of organ systems is susceptible to permanent and lifelong disruption," they add.

The technical report lists endocrine disruption, obesogenic activity, immunosuppression, cardiotoxicity, and decreased birth weight as among the most serious effects identified in some widely used classes of additives, which may include chemicals added to wrapping or packaging materials, as well as those added directly to food.

Clinicians should take the lead in pressing for change by advocating for new regulatory procedures and by educating their patients, particularly those from minority and lower-income families, who appear to be most affected, Trasande said. "We would like to see the removal of conflicts of interest from the testing and approval process, and the [US Food and Drug Administration] to take a stronger role in doing their own toxicology testing," instead of relying on industry-sponsored research.

In addition, consumers can start taking simple steps to limit their exposure to these compounds, such as choosing more fresh fruits and vegetables, limiting intake of heavily processed meats and other foods, and not microwaving foods or beverages in plastic containers whenever possible, because some additives can leach out into the food when heated. For that reason, putting plastic containers in the dishwasher is also not recommended.

Pediatricians can also recommend that their patients and families avoid certain types of plastics, because they contain particular additives. "Look at the recycling code on the bottom of products to find the plastic type, and avoid plastics with recycling codes 3 (phthalates), 6 (styrene), and 7 (bisphenols) unless plastics are labeled as 'biobased' or 'greenware,' indicating that they are made from corn and do not contain bisphenols," the authors write in the policy statement.

The Worst Offenders

The statement addresses 2 broad categories of additives: direct and indirect. Indirect additives refers to substances in "food contact materials," such as "adhesives, dyes, coatings, paper, paperboard, plastic, and other polymers," the authors of the policy statement explain. Direct food additives include chemicals such as colorings, flavorings, and preservatives added to food during processing.

Within those two categories the authors identified six types of additives of most concern, based on accumulating evidence summarized in the report and in an accompanying press release:

  • Bisphenols: Used to manufacture plastic containers and food and beverage cans, these compounds have been associated with endocrine and neurodevelopmental disruption and obesogenic activity, with alterations in the timing of puberty, reduced fertility, and impaired neurological and immunological development. One bisphenol, bisphenol A, has already been banned from baby bottles and sippy cups.

  • Phthalates: As components of plastic wrap and plastic tubing and containers, phthalates similarly have been implicated in endocrine disruption and obesogenic activity. "A robust literature" shows that these chemicals adversely affect male sexual development, may contribute to childhood obesity and insulin resistance, and may also contribute to cardiovascular disease.

  • Perfluoroalkyl chemicals: These chemicals are used in the manufacture of greaseproof paper and cardboard packaging. They have been associated with immunosuppression, endocrine disruption such as impaired thyroid function, and decreased birth weight.

  • Perchlorate: Often added to plastic packaging for dry foods to control static electricity, perchlorate has been shown to disrupt production of thyroid hormone, with implications for subsequent cognitive function. Of particular concern is exposure among pregnant women, "given that the developing fetus is entirely reliant on the maternal thyroid hormone during the first trimester of pregnancy," the authors write in the technical report. They suggest that perchlorate "may be contributing to the increase in neonatal hypothyroidism and other thyroid system perturbations that have been documented in the United States."

  • Nitrates and nitrites: As direct food additives, these compounds are used as preservatives and color enhancers in cured and processed meats, fish, and cheese. There has been "longstanding concern" over their use, the authors write, because of an association with cancers of the nervous and gastrointestinal systems, and methemoglobinemia in infants. They were classified as "probable human carcinogens" in 2006 by the International Agency for Research on Cancer.

  • Artificial food colors: Often added to products that appeal to children, such as juice drinks, artificial food colors have been associated in some studies with an increased risk for attention-deficit hyperactivity disorder. Although their mechanisms of action are not yet completely understood, and the research "should be interpreted with caution," the authors recommend "a thorough reassessment" of artificial food colors to ensure they are safe.

Some changes, such as revision of US Food and Drug Administration testing procedures, require Congressional action, Trasande concedes. However, "that is not the only opportunity for proactive action here," he told Medscape Medical News. The very fact that the AAP has issued this report "hopefully will raise the call for alarm."

The current political climate may be difficult, he said in the press release, but "there is an urgent need for decision makers to fix this issue, starting by rolling back the presumption of safety for chemicals added to foods."

The authors have disclosed no relevant financial relationships.

Pediatrics. Policy statement full text, Technical report full text

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