1. 1 d 1 Impacts of an Industrialized Food System on Maternal and Child Health

3. Where in the Food System do Concerns Exist? Production Pesticides, chemical fertilizers, antibiotic and hormone use in meat and dairy production, infectious agents, arsenic, environmental degradation Processing Increased reliance on imported, unregulated processed foods; melamine; residual mercury; food-borne illness Packaging / Transportation Bisphenol A (BPA), phthalates, perfluorochemicals, air quality, food miles, widespread use of plastics leading to large volumes of waste both in landfills and incinerated, environmental degradation Consumption Fast food, sugar-sweetened beverages, high fructose corn syrup, marketing, obesogens, nutritionally deplete foods

4. Chemicals in the Food System  Mercury  Pesticides  Bisphenol A  Flame retardants  Phthalates  PCBs (polychlorinated biphenyls)

5. Our Chemical Environment  Over 85,000 synthetic chemicals in production  3,800 high production volume; used in quantities > 1 million lbs/yr  ~900 active pesticide ingredients (EPA)  ~ 3,000 in food processing (FDA)  Toxic Substances Control Act of 1976 (TSCA)  Health data exists for < 10% of chemicals on the market  62,000 ‘grandfathered’ in  Potential for endocrine disruption is not assessed  Cumulative exposures matter  Risk assessment and safety standards use a 1-chemical-at-a-time approach

6. Widespread exposure to chemicals with reproductive/developmental toxicity Based on analysis of representative sample of U.S. population by NHANES 2003-2004. Note, not all women were tested for all chemicals

7. Critical and Sensitive Windows of Development PericonceptionPrenatalPostnatal BlastocystEmbryo Fetus Infant Child Adolescent Environmental Exposures Immediate & Long Term Consequences Louis GMB, Cooney MA, Lynch CD, et al. Fertility and Sterility 2008 Childhood

8. 17 Body Burden www.ewg.org/reports/bodyburden Umbilical Cord Blood 10 infants tested showed an average of 200 industrial compounds and pollutants, including 21 out of 28 pesticides tested (2004). Pesticides Detected in human urine, semen, breast milk, ovarian fluid, cord blood, and amniotic fluid

9.  Toxicity Vulnerable periods of development  Bioconcentration  Persistence Persistent Bioaccumulative Toxicants (PBT’s)

10. Neurodevelopmental Toxicants  Metals  lead, mercury, manganese, arsenic  Solvents  PCBs  Dioxins  PBDEs (Polybrominated Diphenyl Ethers)  Pesticides

11. National Pesticide Use

12. 12 Carcinogenic Pesticides Used Annually in CA CA Department of Pesticide Regulation Pesticide Use Reports, 2008. Mapped by CA Environmental Health Investigations Branch.

13. Pesticides and Cancer Occupational exposure and cancer  Organophosphate Pesticides – NHL, Leukemia  Arsenical Pesticides – Lung, Skin cancer  Triazine herbicides – Ovary Epidemiologic studies associate pesticide exposure with cancer in children  Leukemia, neuroblastoma, Wilms' tumor, soft-tissue sarcoma, Ewing's sarcoma, non-Hodgkin's lymphoma, and cancers of the brain, colorectum, and testes Zahm et al. EHP 1998; Infante-Rivard et al. J Tox Environ Health B Crit Rev. 2007

14. OP Exposure in Children and ADHD: A Cross Sectional Study 1139 children ages 8 – 15 (NHANES) Examined Urinary OP metabolites Diagnosis of ADHD by DISC-IV or Med use  10-fold ↑ in urinary DMAP associated with an adjusted OR of 1.55 (1.14 – 2.10) for ADHD  Children with dimethyl thiophosphate > median had OR of 1.93 (1.23 - 3.02) for ADHD compared with children with ND levels Bouchard et al. Pediatrics, 125(6), 2010

15. Non-Cancer Adverse Health Effects Prenatal Exposure to Organophosphate Pesticides  Decreased Bayley MDI and PDI scores at 36 months (Rauh et al Pediatrics 2006)  Greater likelihood of behavioral issues on CBCL (Rauh et al Pediatrics 2006)  Abnormal primitive newborn reflexes (Brazelton NBAS) (Engel et al. Am J of Epid 2007)  Decreased birth weight and length (Whyatt et al. EHP 2004)  Smaller Head Circumference (Berkowitz et al. EHP 2004)  Decreased Bayley MDI at 24 mo. (Eskanazi et al, EHP 2007)

16. Atrazine in surface water and birth defects in the United States 16 Winchester et al. Acta Paediatr. 2009 April; 98(4): 664–669

17. 15 Effects of Postnatal Female Pesticide Exposure Women  Age at puberty and menarche  Menstrual and ovarian function  Fertility and fecundity  Menopause  Breast cancer Mendola P, Messer LC, Rappazzo K.. Fertility and Sterility. 2008;

18. 16 Effects of Adult Male Pesticide Exposure Men  Sterility  Altered semen quality  Prostate cancer Hauser R. Seminars in ReproductiveMedicine. 2006; Swan SH. Seminars in Reproductive Medicine. 2006; Diamanti-Kandarakis E et al. Endo. Reviews 2009

19. Magnitude of Exposure  Prenatal OP exposure in a farm worker cohort assoc. with lower mental development index scores at 24 mo. Median Maternal Urinary MDA level 0.82 mcg/L (Eskenazi at al EHP 2007)  Child exposure through conventional produce diet Median Child Urinary MDA level 1.5 mcg/L (Lu et al EFP 2006) — ----------- — A bit of apples and oranges? — In the same ball park but different exposure windows

20. Pesticide Exposure Reduction OP residues dramatically reduced (malathion, chorpyrifos) — in elementary school children with organic diets substituted for conventional diets for 5 days in a longitudinal design Lu et al, EHP 2006

21. Choosing Produce to Reduce Pesticide Exposure www.ewg.org/foodnews

22. Recombinant Bovine Growth Hormone (rBGH) in Milk Production Animal Welfare and Human Health Concerns  Average increase in milk production 11%-16%  Increases rates of udder infections in cows (25% increase), necessitating the use of antibiotics  Possible increases levels of insulin-like growth factor (IGF- 1) found in milk, raising concerns about cancer risks rBGH is banned in: Canada, Australia, New Zealand, Japan, and all 25 nations of the European Union

23. 22 Arsenic Use in Poultry Production  Arsenic is fed to ~70% of US broilers For growth promotion, feed efficiency and improved pigmentation  Chicken meat can carry arsenic residues  Chicken waste contains ¾ of arsenic dose  90% applied to cropland as fertilizer  Fed as a protein source to beef cattle  Water Contamination  13 million Americans drink water contaminated with arsenic beyond the safety standard of 10 ppb

24. Health Concerns Related to Arsenic Exposure  Cancer (even at low levels of exposure)  Neural tube defects  Neurodevelopmental effects  Diabetes  Heart disease. Arsenic in poultry feed is banned in all 25 countries of the European Union.

25. The Antibiotic Resistance Crisis: Infections with No Treatment “Without effective action, treatments for common infections will become increasingly limited and expensive – and, in some cases, nonexistent.” CDC, 2001 A Public Health Action Plan to Combat Antimicrobial Resistance

26. Livestock Production and Antibiotics: Use or Misuse? 80% of antibiotics in the US are used in livestock production  Of those, more than 50% are medically-important to humans  Livestock use is non-therapeutic; for growth promotion  Contributes to increasing levels of antibiotic resistant bacteria  Resistant bacteria transmitted to humans via food

27. 26 Courtesy of David Wallinga, MD IATP / KeepAntibioticsWorking.org Antibiotic Use in the United States Millions of pounds Antibiotics widely used in livestock production:  Erythromycin  Tetracycline  Bacitracin  Penicillin  Sulfathiazole  Sulfamethazine  Tylosin (macrolide)  Virginiamycin (streptogramin)  Fluroquinolones (withdrawn in 2000)

28. Courtesy of David Wallinga, MD IATP / KeepAntibioticsWorking.org HUMANS (General Populace) Routes of Human Exposure to Antibiotic Resistant Bacteria ANTIBIOTICS via WORKERS Handling of Feed, Manure; transfer to family, community via FOOD Slaughter, Handling, Consumption (undercooked meat, cross-contamination) via ENVIRONMENT Contamination of ground & surface water; spraying of fields by resistant bacteria and undigested antibiotics from manure. BACTERIA ANIMALS

29. Food Borne Illness in the United States  Over 75 million cases annually  1/3 from tainted meat  325,000 require hospital care  5,000 deaths annually

30. “The Isolation of Antibiotic-Resistant Salmonella from Retail Ground Meats”  20% of supermarket samples in Washington D.C. were contaminated with salmonella  84% of these isolates were resistant to at least one antibiotic Volume 345:1147-1154 October 18, 2001 Food Borne Illness - Salmonella

31. a Emerging Evidence

32. Bisphenol A (BPA) Widespread Human Exposure  Over 90% of Americans have residues in their urine (CDC)  young adults > older adults  NHB > Caucasian, Hispanic  Breast milk, amniotic fluid, cord blood Routes of Exposure  Most likely oral, although dermal and inhalation also possible  FDA estimates major exposure is from food  Infants > Adults

33. Bisphenol A (BPA)  Over 6 billion pounds produced each year  Developed as estrogenic drug in the 1930s

34.  Exposure in fetuses and young children up to 2-3 yrs can affect brain development.  PCB exposure has been associated with low birth weight, hypoactivity and smaller head circumference at birth.  Alterations in thyroid hormone function linked with lower IQ, lower reading comprehension, and behavioral abnormalities in children Endocrine Disruption – Interference with thyroid hormone action

35. Studies of comparison between developmental effects in animals and humans find that “there is concordance of developmental effects between animals and humans and that humans are as sensitive or more sensitive than the most sensitive animal species”. s National Academy of Science on Animal Data

36. BPA Animal Studies  Carcinogen  Prostate hyperplasia/cancer  Mammary cancer  Developmental toxin  Altered onset of puberty  Chromosomal abnormalities  Neurological toxin  Obesogen/Insulin Resistance

37. 37 Food Packaging 3 day “fresh foods” intervention  Urine levels of BPA and DEHP metabolites ↓ significantly  ↓ of mean concentrations of BPA by 66% and DEHP by 53-56% Bisphenol A and Phthalate Exposure: Findings from a Dietary Intervention Rudel et al, EHP 2011

38. Obesogens BPA, phthalates, fructose, and certain organophosphate pesticides  Chemical compounds hypothesized to disrupt normal development or homeostasis of metabolism of lipids, ultimately resulting in obesity  Interplay between genes and fetal and early postnatal exposure

39. What we have reviewed today  Widespread exposures throughout various points in the food system  Critical and sensitive windows of vulnerability  Health effects and exposures:  Pesticides  rBGH  Arsenic  Antibiotics  Emerging threats (BPA)

40. Health care costs are not reflected in food prices

41. Acknowledgments Thank you to the many people who contributed slides, information, and ideas for this presentation including: Sean Palfrey, Michelle Gottlieb, Jamie Harvie, Sarah Janssen, Kendra Klein, Lucia Sayre, Patrice Sutton,, David Wallinga, Tracey Woodruff