Environmental Risks: How Do We Protect Kids?

Interviewer: Laurie Scudder, PNP, DNP; Interviewee: Jennifer A. Lowry, MD


September 26, 2018

Concerns about chemicals in food, water, and air, and their impact on children's health, have been a near constant drumbeat throughout 2018. The American Academy of Pediatrics (AAP) and its Council on Environmental Health have been busy examining issues ranging from food additives to lead in water and pollution from coal-burning power plants.

Jennifer A. Lowry, MD

Medscape spoke with Jennifer A. Lowry, MD, medical director of clinical pharmacology, toxicology, and therapeutic innovations at Children's Mercy hospital in Kansas City and chair of the AAP Council, about the environmental issues that keep her up at night.

Medscape: The AAP recently released a policy statement and technical report on food additives. The report noted that the food safety system has not kept up with the times. Data on the safety of many chemicals in the food supply are either nonexistent or obsolete. And children may be particularly vulnerable. What are some of the adverse effects that are of particular concern for children?

Lowry: The concerns about additives in our food are twofold: concerns about those that are put there on purpose, and those put there because of either the packaging or how we make it. There is a widespread misconception that all foods have been assessed by the US Food and Drug Administration (FDA) before they show up on grocery store shelves and therefore everything ought to be okay. Unfortunately, that's not always the case. Substances designated as "generally recognized as safe" (GRAS) are not tested. They are misused, and overused, by industry in foods. We don't necessarily know what harm can occur because of their presence.

Also, we know that food additives can lead to some of the health effects that we currently see in both children and adults. These include plastics, from the phthalates to bisphenols, that are part of packaging, fragrances, and flavorings.

Medscape: Can you review the history of the designation of substances as GRAS?

Lowry: The list of GRAS substances was initially much smaller than it is today. This rule has been in place for decades. It exempts industry from a requirement to test the safety of substances designated as GRAS. Industry can intentionally add a substance to food without approval if it is recognized, among qualified experts, as safe when used as it was intended. The FDA has the authority to request testing of GRAS products but generally does not. No testing has been done for many products labeled as GRAS. At best, the true safety of many of these products is unknown, and some are probably harmful.

Medscape: Plastics in packaging have been particularly implicated in concerns about endocrine disruption. Yet plastic is ubiquitous. Avoiding plastic completely is probably not possible for any families. What do you tell your own patients about safe use?

Lowry: I agree that there is no way to get around using these products. In jest, I challenge my students and trainees to try and go a day without plastic. It is clearly impossible. So I tell families that because they cannot get away from plastic, use it in the way that it was intended to be used.

First, don't use it if you don't need to use it. Be smart about when you purchase it. Do you really need this item to be plastic, or can you use something biodegradable or reusable?

Second, think about what you are going to do with plastic. You should not put plastic in dishwashers, microwaves, or boiling water, because it is a synthetic chemical and heating can disrupt the integrity of that product, destroying some of those molecules so that they are released into the food or liquid. That is how you ingest it.

The US Centers for Disease Control and Prevention's (CDC) National Report on Human Exposure to Environmental Chemicals compiles data examining a range of chemicals used in growing, preparing, and packaging our foods. These include phthalates and the alphabet soup of bisphenols (bisphenol A, which is no longer used commercially; bisphenol S; and bisphenol M). This report confirms that these substances found in plastics are now present in almost all of us.

Medscape: Are racial and ethnic disparities a factor? Are minority children most at risk from food additives?

Lowry: I don't know that these children are at more risk from the effects of food additives. I think that they are at risk of ingesting more of them, which then puts them at higher risk. Any child of any color or ethnicity exposed to the same amount of additives will probably experience the same effects, although there's probably some genetic predisposition that probably is associated with some variance. But more African American kids grow up in poverty, in lower-socioeconomic neighborhoods that rely on corner stores with less availability of fresh, unpackaged foods. So these children have higher exposure to foods packaged in plastic and loaded with preservatives. They are not healthy foods.


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