Families should reduce exposure to synthetic chemicals found in food colorings, preservatives, and packaging materials as a growing body of research show they may harm children's health, according to a policy statement and technical report from the American Academy of Pediatrics released online today.
The statement also suggests improvements to the food additives regulatory system including updating the scientific foundation of the U.S. Food and Drug Administration's safety assessment program and retesting all previously approved chemicals.
We asked Leonardo Trasande, MD, MPP, FAAP, an AAP Council on Environmental Health member and lead author of the policy statement, to tell us more about these concerns. He is also an Associate Professor of Pediatrics, Environmental Medicine & Population Health at NYU School of Medicine.
What are the growing number of studies showing us?
Over the past two decades, an accumulating body of science suggests some food additives can interfere with a child's hormones, growth, and development. In 2015, the Endocrine Society released a scientific statement about endocrine-disrupting chemicals which reviewed over 1,300 studies. The statement raised concerns that these chemicals disrupt hormones and cause disease.
Potentially harmful effects of food additives are of special concern for children because they are more sensitive to chemical exposures because they eat and drink more, relative to body weight, than adults do, and are still growing and developing. An early injury to their organ systems can have lifelong and permanent consequences.
What additives does the statement highlight?
Some additives are put directly in foods, while "indirect" additives may include chemicals from plastic, glues, dyes, paper, cardboard, and different types of coatings used for processing and packaging. The additives of most concern, based on rising research evidence cited in the report, include:
Bisphenols, such as BPA, used to harden plastic containers and line metal cans, can act like estrogen in the body and potentially change the timing of puberty, decrease fertility, increase body fat, and affect the nervous and immune systems. BPA is now banned in baby bottles and sippy cups.
Phthalates, which makes plastic and vinyl tubes used in industrial food production flexible, may affect male genital development, increase childhood obesity, and contribute to cardiovascular disease. In 2017, the Consumer Product Safety Commission banned the use of some phthalates in child-care products such as teething rings.
Perfluoroalkyl chemicals, used in grease-proof paper and cardboard food packaging, may reduce immunity, birth weight, and fertility. Research also shows PFCs may affect the thyroid system, key to metabolism, digestion, muscle control, brain development, and bone strength.
Perchlorate, added to some dry food packaging to control static electricity, is known to disrupt thyroid function, early life brain development and growth.
Artificial food colors, common in children's food products, may be associated with worsened attention-deficit/hyperactivity disorder symptoms. Studies cited in the report found a significant number of children who cut synthetic food colorings from their diets showed decreased ADHD symptoms.
Nitrates/nitrites are used to preserve food and enhance color, especially in cured and processed meats. These chemicals can interfere with thyroid hormone production and the blood's ability to deliver oxygen in the body. Nitrates and nitrites also have been linked with gastrointestinal and nervous system cancers.
Why are some additives like artificial colors banned in some countries, but not in the U.S.?
In regards to chemicals found in our food, the laws originally put in place were thought to be enough to protect our health. Since then, science has suggested that the current framework does not work to protect us adequately. The U.S. allows the use of more than 10,000 additives to preserve, package, or modify the taste, appearance, texture, or nutrients in foods. Many were grandfathered in for approval during the 1950s, and roughly 1,000 additives are used under a "Generally Recognized as Safe" designation process that doesn't require FDA approval. In the report, we urge a number of steps that can be taken such as more regulation on the side of the FDA. Some would require changes to the laws, while others can be done by the FDA.
In meantime, what does the AAP recommend?
There are safe and simple steps that families can take to reduce exposure. Studies show a substantial decrease in exposure can make a difference. These steps include:
Buying and serving more fresh or frozen fruits and vegetables, and fewer processed meats—especially during pregnancy.
Since heat can cause plastics to leak BPA and phthalates into food, avoid microwaving food or beverages, including infant formula and pumped human milk, in plastic when possible. Also try to avoid putting plastics in the dishwasher.
Use alternatives to plastic, such as glass or stainless steel, when possible.
Avoid plastics with recycling codes 3 (phthalates), 6 (styrene), and 7 (bisphenols) unless they are labeled as "biobased" or "greenware."
Washing hands thoroughly before and after touching food and clean all fruits and vegetables that cannot be peeled.
Families can also show their concern by not buying certain products and asking manufacturers to make changes. Often, we hear from industry about the costs of safer alternatives, but the benefits of prevention may be even greater, as we recognized in a study back in 2014 examining the tradeoffs of removing BPA from aluminum cans.