Arsenic in our Food Do we have reason to worry?

1. Arsenic in our FoodDo we have reason to worry? Rachel J. H. Mathisen, Dietetic Intern

2. Arsenic is a poison and aknown carcinogen

3. Arsenic- The Perfect Poison • In the middle ages it was known as the “King of Poisons” or the “Poison of Kings”* • Odorless • Tasteless • Couldn’t be detected until the 19th century * Hughes, MF, et al

4. Arsenic- History* • Industrial uses in the 19th century: • Pigment (Paris Green)- used in wallpaper, fabric, toys and candles • No longer used as a pigment, but is still used in the manufacturing of glass & semiconductors • Insecticides • Paris Green was used for mosquito control (1867-1900) • Lead arsenate sprayed on cherry & apple orchards until 1960s, but was not officially banned until 1988. • Health problems in orchard workers including lung and skin cancers • Copper Smelting * Hughes, MF, et al

5. Arsenic – History*Arsenic as medicine? • Hippocrates may have treated ulcers and abscesses with a arsenic based ointment. • Fowler’s solution (1% potassium arsenite) in 18th century used to treat malaria, syphilis, eczema, asthma • Salvarsan (arsenic based) used in early 20th century to treat syphilis. It was considered the “magic bullet.” • Arsenic trioxide – in use today as an effective chemotherapy agent for treatment of promyelocytic leukemia * Hughes, MF, et al

6. Arsenic- Today • Despite banning the use of lead arsenate pesticides, the United States still uses more arsenic than any other country. • Pesticides containing organic arsenic (considered less carcinogenic) are still permitted (ie on cotton); EPA will stop use on golf courses, sod farms by 2013.* • Arsenic is permitted in animal feed to increase growth and to prevent disease** • Poultry excrement (high arsenic concentration) is still used to make fertilizers used on crops.** *Hughes, et al **Consumer Reports: Arsenic in your food.

7. Health effects of chronic arsenic exposure • Skin changes (hard patches on palms & soles) • Skin cancer • Cancers of lung, bladder & kidney – it is classified as a Group 1 carcinogen • Blood vessel diseases (severe form causes gangrene) • Diabetes (?) • Hypertension (?)

8. Arsenic • Forms of Arsenic • Arsenobetaine (organic arsenic cpd) in seafood is considered nontoxic • Dimethylarsenic (DMA) an organic form is less toxic than organic arsenic and is main form in US rice • Inorganic arsenic types III and V are very toxic and are health risks Jackson, et al. Pure ApplChem (2012). 84(2): 215-223.

9. Sources of Arsenic • Naturally occurring arsenic in soil, rocks, and water (relatively small amounts) • Past use of arsenic based insecticides inorganic (most toxic) forms and organic forms • Drinking water from water sources with ‘natural” sources of arsenic leached from soil. (well water) • Well water in some parts of the U. S. have significantly high levels • Health problems in India have resulted in legislation of arsenic levels in drinking water • 0.01 mg/L (10 μg/L) of water WHO and US EPA • Food – vegetables, fruits, and rice are the top three food sources

10. Arsenic in our food? Rice, rice products, and fruit/fruit juices have recently been implicated as significant sources of arsenic.* Is there reason to be concerned? Or is this just media hype? * Consumer Reports: Arsenic in your food. (2012).

11. Not All Rice(or arsenic) is Created Equal • Rice, unlike most grains, can readily take up arsenic via its root system (grown in water) • Amount absorbed depends upon • The cultivar of rice • The soil, water it is grown in • Forms of Arsenic • Arsenobetaine (organic arsenic cpd.) in seafood is nontoxic • Dimethylarsenic (DMA) an organic form is less toxic than organic arsenic and is main form in US rice • Inorganic arsenic types III and V are very toxic and are health risks Jackson, et al. Pure ApplChem 2012; 84(2): 215-223.

12. Arsenic in Rice* • U.S. rice usually has more of the less toxic form of arsenic (dimethylarsinic acid- organic) • Rice grown in South-central United States has a higher average total arsenic concentration than rice grown in California • Studies have shown that the percentage of inorganic Arsenic in rice samples varies considerably from a low of 27% to a high of 86% • Eating 0.56 cup of cooked rice  predicted urinary total arsenic excretion comparable to drinking 1L of water at EPA max level. *Gilbert-Diamond, D., et al (2011).

13. Arsenic in Rice: What about our Infants and Toddlers? 2009 European Food Safety Authority (EFSA) report: Young children and infants are exposed to approx. 2 to 3 times as much inorganic arsenic as adults.

14. Arsenic in Baby Rice Cereal • Rice-based cereals are a significant source of arsenic. • Meharg, et al concluded that a 20 lb 1yo baby eating a single 20g serving of rice cereal would ingest 0.21 μg kg-1d-1 of arsenic, which is more than an adult drinking water with 10 ppb arsenic (0.17 μg kg-1 d-1)

15. Arsenic Intake in Infancy • Mennella et al (2006) found in a survey of infant and feeding practices (FITS study) found that > 90% of American infants were consuming grain products between the ages of 6 and 11 months and about 74% consumed infant cereals on any given day. • Infant rice cereal is usually the first cereal recommended by health professionals • Infants with GE reflux may have formula thickened with rice cereal within the first few weeks of life.

16. Arsenic in Infant Rice Cereals* * From table published in : Arsenic in your food: A Consumer Reports investigation. http://www.consumerreports.org/cro/magazine/2012/11/arsenic-in-your-food/index.htm#chart

17. Arsenic in Baby Foods • Rice-fortified baby foods were determined in a New Hampshire study to have significantly higher total arsenic concentrations than non-rice based baby foods. • A 10 kg infant eating 3 jars of the rice-fortified Stage 2/3 baby foods tested, would “be exposed to 0.39 μgarsenic per kg body mass per day, more than twice the 0.17 μg kg-1d-1 safe adult arsenic exposure level.” Jackson, et al (2012a) • Most of the arsenic is in the inorganic form Jackson, et al (2012a).

18. Arsenic in Baby Foods • Infant fruit and vegetable purees are also a source of arsenic. • Total arsenic concentration per serving for 3 brands of purees ranged from 0.03 to 2.3 μg which is relatively low, but most of the arsenic is in the inorganic form • 7 month old eating 1.5 jars/day would “be exposed to ≈0.05 μg arsenic per kg body mass, or < 1/3 of the ‘safe’ adult level derived from drinking water.” Jackson, et al (2012a).

19. Arsenic in Juice • Consumer Reports tested several brands of apple juices and grape juices for arsenic: • 5 samples of apple juice & 4 samples of grape juice exceeded federal standards for arsenic in drinking water Consumer Reports (2012). Arsenic in your juice.

20. Arsenic in Infant Formula • In a study by Jackson, et al • Milk-based formulas had much lower arsenic concentrations (P=0.003) compared to nondairy formulas. • Arsenic speciation was almost entirely inorganic in infant formula. • Thus a 6.2 kg infant (3mo old) consuming 360 ml/day of formula would receive 0.036 to 0.21 ug arsenic/kg body mass/day. (An adult drinking 1 L of water at the EPA limit would take in 0.17 ug/d). Jackson, et al (2012a). Pure ApplChem 2012; 84 (2): 215-224.

21. Jackson, et al (2012b) • Tested products containing Organic Brown Rice Syrup (OBRS) • Many contained considerable amounts of both inorganic and organic arsenic • An “organic” toddler formula with OBRS as its first ingredient had total arsenic concentrations up to 6 times the EPA’s limit in drinking water.

22. Jackson, et al (2012b) • Organic Brown Rice Syrup (OBRS) • 3 OBRS brands- 4 samples total • Total arsenic ranged from 90 to 400 ng/g with inorganic arsenic comprising between 50% to 90% of the total arsenic • If added to products in the dried form, arsenic concentrations increase (1.15 times).

23. Arsenic in Toddler Formulas • Two “organic” toddler formulas containing OBRS were analyzed • Dairy based formula (reconstituted) • 8-9 μg/L inorganic arsenic • Soy based formula • ˷ 15-25 μg/L inorganic arsenic • US Standard for drinking water • 10 μg/L Jackson, et al (2012b)

24. Potential Impact of Arsenic in baby foods • The exposure to arsenic is high especially when compared to the small body size of infants and toddlers • “Children under 3 years are the most exposed to inorganic arsenic.” EFSA (2009) • Arsenic may: • Negatively impact neurological development • Long-term (whole life) exposure to arsenic is associated with: • Increased cancer risks, increased risk of neurological problems

25. Arsenic and Infants • Inorganic arsenic is almost completely absorbed in the human GI tract and > 70% of organic arsenic can be absorbed • Absorbed arsenic is transported to most organs and tissues • It readily crosses the placenta • High maternal levels associated with • Decreased birth weights • Developmental delays EFSA (2009)

26. Gluten Free Diets • Rice-based products are a mainstay for those people on gluten free diets; thus, arsenic exposure in this population is likely to be high.

27. Arsenic in Our Food In a study of data from NHANES, Xue, et al concluded that the American population was exposed to more total and inorganic arsenic from certain foods than from drinking water YET the U.S. currently has no standards for arsenic levels in food.

28. Arsenic in Our Food China has laws regulating the maximum amount of arsenic in food. Should we? Should we be concerned?

29. Arsenic in Rice Products Based on info from Consumer Reports members of Congress are planning to introduce legislation limiting arsenic levels in rice and rice based foods. “R.I.C.E. Act” http://news.consumerreports.org/health/2012/09/members-of-congress-introducing-bill-to-limit-arsenic-in-rice-products.html

30. What we can do • Push for legislation • Cook rice in large volumes of water (as per pasta). • Recommend that clients drinking well water have it tested for arsenic • Recommend a varied grain diet especially in infants and young children • Consider increasing oat , barley, and wheat based cereals for infants and toddlers and decreasing reliance on rice based products.

31. References • Consumer Reports (2012). Arsenic in your food. http://www.consumerreports.org/cro/magazine/2012/11/arsenic-in-your-food/index.htm • Consumer Reports (2012). Arsenic in your juice. http://www.consumerreports.org/cro/consumer-reports-magazine-january-2012/arsenic-in- • Consumer Reports (2012). Members of congress introducing bill to limit arsenic in rice products. http://news.consumerreports.org/health/2012/09/members-of-congress-introducing-bill-to-l • Davis M A, Mackenzie TA, Cottingham KL, Gilbert-Diamond D, Punshon T, Karagas MR (2012). Rice consumption and urinary arsenic concentrations in U.S . children. Environ Health Perspect 120(10): 1418-1424. • European Food Safety Authority. (2009). EFSA panal on contaminants in the food chain (CONTAM): Scientific opinion on arsenic in food. ESFA J 7(10):60-71. Available: http://www.efsa.europa.eu/en/efsajournal/pub/1351.htm • Gilbert-Diamond, D, Cottingham, KL, Gruber, JF, Punshon, T, Savarath, V, Gandofi, AJ, Baker ER, Jackon BP (2011). Rice consumption contributes to arsenic exposure in US women. Proc NatlAcadSci USA 108(51):20656-60. • Gruber JF, Karagas MR, Gilbert-Diamond D, Bagley PJ, Zens MS, Sayarath V, Punshon T, Morris JS, Cottingham KL (2012). Associations between toenail arsenic concentration and dietary factors in a New Hampshire population. Nutrition Journal 11:45. http://www.nutritionj.com/content/11/1/45

32. References Hughes MF, Beck BD, Chen Y, Lewis AS, Thomas DJ. (2011). Arsenic exposure and toxicology: a historical perspective. ToxicolSci 123 (2): 305-332. doi: 10.1093/toxsci/kfr184 Jackson, BP, Taylor, VF, Punshon, T, Cottingham, KL (2012a). Arsenic concentration and speciation in infant formulas and first foods. Pure ApplChem 84(2):215-223. Jackson, RP, Taylor, VF, Karagas, MR, Punshon, T, Cottingham, KL (2012b). Arsenic, organic foods, and brown rice syrup. Environ Health Perspect 120(5):623-6. Meharg AA, Sun G, Williams PN, Adomako E, Deacon C, Zhu Y-G, Feldman J, Raab A. (2008). Inorganic arsenic levels in baby rice are of concern Xue J, Zartarian V, Wang S-W, Liu SV, Georgopoulos P (2010). Probabilistic modeling of dietary arsenic exposure and dose evaluation with 2003-2004 NHANES data. Environ Health Perspect 118 (3): 345-350.

33. Thank you! • Rachel Mathisen • rmathise@montevallo.edu

34. Additional Info

35. OBRS • Other products that may be sweetened with OBRS • Energy Bars • Cereals • Cereal Bars • High Energy Athletic Performance products

36. Energy Shot Blocks (gels) • Jackson, et al (2012b) tested energy shot blocks containing OBRS • 1st product • 84 + 3 ng/g (n=3) total Arsenic and 100% of arsenic was inorganic. • 2nd & 3rd products were comparable to each other • 171 + 3.6 ng/g (n=6) with 53% as inorganic arsenic

37. High Energy Shot Blocks At manufacturer’s recommended intake levels (2 servings/hour during exercise) an athlete in a two hour high intensity workout would consume about 10 μg inorganic arsenic/day from this source alone* * Jackson, et al (2012b)