Co-Director, Western States Pediatric Environmental Health Specialty Unit University of California San Francisco*

Director, CA EPA Children’s Environmental Health Center(Comments do not represent state of California)

Director COTC,Center for Integrative Research on Childhood Leukemia and the Environment

UC Berkeley

Arsenic in Food

*Funded by Agency for Toxic Substances Disease Registry and US EPA through ACMT

Mark Miller MD, MPHECHO April 2018

No disclosuresThis material was supported by the American College of Medical Toxicology (ACMT) and funded (in part) by the

cooperative agreement FAIN: U61TS000238-04 from the Agency for Toxic Substances and Disease Registry (ATSDR).

Acknowledgement: The U.S. Environmental Protection Agency (EPA) supports the PEHSU by providing partial

funding to ATSDR under Inter-Agency Agreement numberDW-75-95877701-4. Neither EPA nor ATSDR endorse the

purchase of any commercial products or services mentioned in PEHSU publications

Thank you - Pui Lai, Craig Steinmaus, Margaret Karagas, Keeve Nachman

As in water still an issue in the US

Toxicologic Profile ArsenicATSDR 2007

iAs metabolized to MMA and DMA

arsenobetaine

Rice is unique in ability to incorporateinorganic As

By "Oryza sativa of Kadavoor" © 2009 Jee & Rani Nature Photography is used here under a Creative Commons Attribution-ShareAlike 4.0 International License, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=30677472

Butte County CA

J Patrick Fisher Wikipedia Creative Commons Share Alike 2.0

Part of the image collection of the International Rice Research Inst. Creative Commons

Origin Mean total inorganic As Min/Max total inorganic Asppb μgm/serving ppb μgm/serving

California* 43.1 1.9 27-56 1.2-2.5India/Pakistan* 52.9 2.4 21-144 1.0-6.5Arkansas/Texa

s79.3 3.6 40-107 1.8-4.8

U.S. 94.3 4.2 77-112 3.5-5.1

*Values significantly different from others

Analysis of Arsenic in Rice and other Grains, Food Safety and Sustainability CenterConsumers Reports 2014

Rice Arsenic Varies by Location of Productionand varies significantly within regions

Adapted from table 4.2 - Arsenic in Rice and Rice Products Risk Assessment Report, FDA 2016

Type N Inorganic As(mean-ppb)

Inorganic As (range ppb)

Brown Basmati 13 122.7 66-200

Brown Jasmine 2 132.5 114-151

Brown Long/Short 98 160.5 34-249

White Basmati 40 61.8 20-144

White Jasmine 11 78.4 34-110

White Long 148 103.3 23-196

Concentration of inorganic As in Ricemeasured by FDA

Alternative grains - 1/10th the As

Arsenic in Rice and Rice Products Risk Assessment Report, FDA 2016

Rice containing foods (iAs per serving)

Average levels of inorganic arsenic

Brief summary of rice grain and rice products sampled by the FDA and the corresponding amount of inorganic arsenic per serving, based on data published in 2013 (FDA and Consumers Reports).

Product Inorganic arsenic (mcg/serving)

Bakery mixes and pudding

4.1

Beverages (incl. protein and rice drinks, beer)

2

Cereals 2.6Grain-based bars 1.8

Rice cakes 4.3White rice 4.2Brown rice 7.2

Basmati rice 3.5

Dewi Sri – Indonesian rice goddess

Tropenmuseum, part of the National Museum of World Cultures [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

Phosop – ThailandPo Ino Nogar – CambodiaNang Khosop - Laos

History of rice cultivation- interdependantculture

Wheat cultivation - independant

Adverse Health Effects from Arsenic Exposure

Sheet1

Organ SystemEffectsReferencesOrgan SystemEffects

SkinKeratosis, MelanosisArgos 2011, Haque 2003, Naujokas 2013SkinKeratosis, Melanosis

Skin CancerTseng 1977, Yu 2006Skin Cancer

Impaired intellectual functionHamadani 2011, Wasserman 2004, 2007Impaired intellectual function

NeuroImpaired motor functionParvez 2011NeuroImpaired motor function

Peripheral neuropathyVahidnia 2007Peripheral neuropathy

Pulmonary tuberculosisSmith 2011Pulmonary tuberculosis

BronchiectasisSmith 2006Bronchiectasis

RespiratoryLung cancerMarshall 2007, Smith 2009RespiratoryLung cancer

Lower Respiratory Tract Infections

Decreased lung functionDauphine 2011Decreased lung function

CardiovascularCoronary/ischemic heart diseaseChen 2011, Gong 2012CardiovascularCoronary/ischemic heart disease

Acute myocardial infarctionYuan 2007Acute myocardial infarction

HypertensionAbhyankar 2012, Abir 2012Hypertension

GastrointestinalLiver cancerChen 2004, Chiu 2004GastrointestinalLiver cancer

RenalKidney cancerBates 2004RenalKidney cancer

GenitourinaryBladder cancerMarshall 2007GenitourinaryBladder cancer

ReproductiveLow birth weight

ImmuneDecreased immune functionRaqib 2009, Ahmed 2011ImmuneDecreased immune function (T cell ratios, IL2 levels, expression immune response genes

EndocrineDiabetesRahman 1998EndocrineDiabetes, impaired glucose tolerance in pregnant women

Sheet2

Sheet3

Low dose exposure studies are proliferatingFetal immune function (in utero exposure)

• Changes in CD4+/CD8+ ratios in cord blood• IL1β levels positively related to As

IQ - >5 vs.

Early life exposure: greater lung and bladder cancer risk

Lung cancer

Bladder cancer

Craig SteinmausFrom Lai et. al. J Peds 2015

Courtesy Craig Steinmaus, OEHHA, CA EPALai et. al., J Peds 2015

Rice predominates as dietary source for high end childhood As consumers

21

20

27

514

18

percent dietary contribution (mean

intake)

Juice/fruit

Based on data from Yost et. al. Human and Ecologic Risk Ass. 2004

20

50

12

39

8

percent dietary contribution

juice/fruitrice/rice productother grainsvegetablesdairyother

95 % intake

based on USDA food consumption dataand modeling

Who are at risk?

Children / Infants High rice consumers

• Asian American and others with tradition of rice based diet

• Poor• Celiac disease / Gluten Free Diets• Food allergies• Macrobiotic Diet

I

Maintain infant rice cereal below As 100 ppb• Proposed regulatory limit• EU standard for rice destined for use in products for

infants and young children 0.1 mcg/kg

Same dietary guidance as previous• Rice cereal should not be sole source of supplementation

for infants• Everyone should eat a varied dietFurther study

FDA announces draft guidance on arsenic in riceApril 2016

Commission Regulation (EU) 2015/1006 of 25 June 2015 amending Regulation (EC) No 1881/2006 as regards maximum levels of inorganic arsenic in foodstuffs

Arsenic in Rice and Rice Products Risk Assessment Report, FDA 2016

Arsenic in Rice and Rice Products Risk Assessment Report, FDA 2016

Arsenic in Rice and Rice Products Risk Assessment Report, FDA 2016

Consumer Reports 2014 – point system

http://www.consumerreports.org/cro/magazine/2015/01/how-much-arsenic-is-in-your-rice/index.htm

Arsenic readily crosses placenta

Low birth weightStill birthInfant mortality

BUT• Limited amount in breast

milk even in areas with As in water As by predominant feedingWater As 2 ppb

Carignan et. al. EHP 2015

Choose varieties of rice lower in iAs• White over brown (nutrition tradeoffs) • Basmati, California/India/ Pakistan (caveats)

Cooking method• Rinse and cook in excess water

• 40-60% reduction, 70% reduction thiamine, Fe, folate, etc. (enriched rice)

Limit number of servings• Consumers Reports point scale

What can I do?

Minimize use of infant rice cereal • Use alternative grains

Rare use of rice beverages, rice pasta, and hot rice cereals in children• Gluten free, allergic

Avoid products with rice syrup sweeteners Encourage breast feeding

Special messages for children

Target High Consumers?

High rice consumers• Asian American and others with tradition of rice

based diet• Poor• Celiac disease / Gluten Free Diets• Food allergies• Macrobiotic Diet

Does not fit traditional “Health Based” regulatory scheme

Establish mandatory or voluntary limits• “Best Methods” limits (beyond infant cereal) that

over time could decrease?• Labeling requirements, monitoring “targets” met

Programs to improve food production for foods not meeting minimum standards

Risk communication – reliable info on sources and dietary alternatives

Regulatory actions

Questions?

Arsenic in Food�Slide Number 2Slide Number 3iAs metabolized to MMA and DMASlide Number 5Slide Number 6Slide Number 7Slide Number 8Slide Number 9Rice containing foods (iAs per serving)Slide Number 11Adverse Health Effects from Arsenic Exposure Slide Number 13Early life exposure: �greater lung and bladder cancer riskSlide Number 15Slide Number 16Who are at risk?Slide Number 18Slide Number 19Slide Number 20Slide Number 21Consumer Reports 2014 – point system�Slide Number 23Slide Number 24Slide Number 25Slide Number 26Slide Number 27Slide Number 28