“Food Additives and Child Health” – Two Critically Important Statements From The American Academy Of Pediatrics

The two articles, Food Additives and Child Health: Policy Statement and Food Additives and Child Health: Technical Report [Links are to the Full Text PDFs], were published July 2018 by the American Academy of Pediatrics. These two articles are critical statements important to all citizens (including all parents and healthcare workers).

The article, Some food additives raise safety concerns for child health; AAP offers guidance, July 23, 2018 [Link is to the HTML from the AAP news] of the American Academy of Pediatrics, is a summary of the main articles above and is a very fast read.

What follows are excerpts from Food Additives and Child Health: Policy Statement, July 2018 (but healthcare workers should carefully read and review both of the above papers):


It is difficult to know how to
reduce exposures to many of these chemicals, but some
recommendations are cited here.‍74–76 Insofar as these modifications can pose additional costs, barriers may exist for low-income families to reduce their exposure to food
additives of concern. Pediatricians may wish to tailor guidance in the context of practicality, especially because food insecurity remains a substantial child health concern. Pediatricians also can advocate for modernization of the FFDCA, as described in the subsequent section, which is of unique importance for low-income populations who may not be as readily able to reduce exposure to food additives.

• Prioritize consumption of fresh or frozen fruits and vegetables when possible, and support that effort by developing a list of low cost sources for fresh fruits and

• Avoid processed meats, especially maternal consumption during pregnancy.

• Avoid microwaving food or beverages (including infant formula and pumped human milk) in plastic, if possible.

• Avoid placing plastics in the dishwasher.

• Use alternatives to plastic, such as glass or stainless steel, when possible.

• 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.

• Encourage hand-washing before handling foods and/or drinks, and wash all fruits and vegetables that cannot be peeled.

Our purposes with this policy statement and its accompanying technical report are to review and highlight emerging child health concerns related to the use of colorings, flavorings, and chemicals deliberately added to food during processing (direct food additives) as well as substances in food contact materials, including adhesives, dyes, coatings, paper, paperboard, plastic, and other polymers, which may contaminate food as part of packaging or manufacturing equipment (indirect food additives); to make reasonable recommendations that the pediatrician might be able to adopt into the guidance provided during pediatric visits; and to propose urgently needed reforms to the current regulatory process at the US Food and Drug Administration (FDA) for food additives. Concern regarding food additives has increased in the past 2 decades, in part because of studies in which authors document endocrine disruption and other adverse health effects. In some cases, exposure to these chemicals is disproportionate among minority and low-income populations. Regulation and oversight of
many food additives is inadequate because of several key problems in the Federal Food, Drug, and Cosmetic Act. . . .

Today, more than 10000 chemicals are allowed to be added to food and food contact materials in the United States, either directly or indirectly, under the 1958 Food Additives Amendment to the 1938 Federal Food, Drug, and Cosmetic Act (FFDCA) (public law number 85-929). Many of these were grandfathered in for use by the federal government before the 1958 amendment, and an estimated 1000 chemicals are used under a “generally recognized as safe” (GRAS) designation process without US Food and Drug Administration (FDA) approval.‍1 Yet, suggested in accumulating evidence from nonhuman laboratory and human epidemiological studies is that chemicals used in food and food contact materials may contribute to disease and disability, as described in the accompanying technical report and summarized in Table 1. Children may be particularly susceptible to the effects of these compounds [for a number of reasons detailed in the two articles].

The potential for endocrine system disruption is of great concern, especially in early life, when developmental programming of organ systems is susceptible to
permanent and lifelong disruption. The international medical andscientific communities have called attention to these issues in several recent landmark reports, . . . Chemicals of increasing concern include the following:

• bisphenols, which are used in the lining of metal cans to prevent corrosion‍45;

• phthalates, which are esters of diphthalic acid that are often used in adhesives, lubricants, and plasticizers during the manufacturing process‍17;

• nonpersistent pesticides, which have been addressed in a previous policy statement from the
American Academy of Pediatrics and, thus, will not be discussed in this statement‍46;

• perfluoroalkyl chemicals (PFCs), which are used in grease-proof paper and packaging‍47; and

• perchlorate, an antistatic agent used for plastic packaging in contact with dry foods with surfaces that
do not contain free fat or oil and also present as a degradation product of bleach used to clean food
manufacturing equipment.‍48

Additional compounds of concern discussed in the accompanying technical report include artificial food colors, nitrates, and nitrites.

Environmentally relevant doses (ie, low nanomolar concentrations that people are likely to encounter in daily life) of bisphenol A (BPA)‍4 trigger the conversion of cells to adipocytes,9 disrupt pancreatic β-cell function in vivo,49 and affect glucose transport in adipocytes.‍9–11

Phthalates are metabolized to chemicals that influence the
expression of master regulators of lipid and carbohydrate metabolism, the peroxisome proliferator-activated
receptors,21 with specific effects that produce insulin resistance in nonhuman laboratory studies. Some studies have documented similar metabolic effects in human
populations.‍22 Some phthalates are well known to be antiandrogenic and can affect fetal reproductive

Authors of recent studies have linked perfluoroalkyl
chemicals with reduced immune response to vaccine‍27,28 and thyroid hormone alterations,29,51,52 among other adverse health end points.

Perchlorate is known to disrupt thyroid hormone‍34 and,
along with exposures to other food contaminants, such as
polybrominated diphenyl ethers,53–55 may be contributing to the increase in neonatal hypothyroidism that has been documented in the United States.‍56

Artificial food colors may be associated with exacerbation
of attention-deficit/hyperactivity disorder symptoms.‍57

Nitrates and nitrites can interfere with thyroid hormone production‍40 and, under specific endogenous conditions, may
result in the increased production of carcinogenic N-nitroso compounds.‍37,38

The FDA’s food safety oversite and regulatory powers are, not surprisingly, grossly inadequate. See the two articles for details and for policy change advocacy.


Food Additives and Child Health: Policy Statement

Food Additives and Child Health: Technical Report

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