Feds Reject Petition To Ban BPA In Food

I recently stumbled onto this article regarding bisphenol A (BPA) regulation (or lack of) while exploring the National Center for Toxicological Research (NCTR) website (http://www.npr.org/blogs/thesalt/2012/03/30/149683556/feds-to-decide-on-banning-bpa-from-food-and-other-products). The article was was posted in March 2012, but the findings have had a lasting impact on bisphenol A and other endocrine disrupting chemicals (EDC) regulation. Since learning about EDCs, I have been in favor of increasing funds for EDC research and regulation since the chemicals are associated with diabetes, immune dysfunction, subfertility, obesity, and neurobehavioral disorders in humans. A basic understanding of the endocrine system is crucial in understanding how chemicals disrupt it (skip the next two paragraphs if you want to just read about the NPR article).

The endocrine system is composed of the thyroid, pancreas, and approximately 28 other glands that use trace amount of chemical messengers, or hormones, to communicate with and regulate our bodies. The endocrine system regulates a number of bodily processes that range from female reproduction to neurological development. An endocrine disruption occurs whenever a chemical mimics, blocks, or interferes with these hormones, thereby altering bodily regulation. The three most daunting features of these chemicals are their hormonal interferences at low dosage levels, their persistence due to long half-lives, and their associated deleterious bodily and mental afflictions as wide and varied as the processes controlled by the human endocrine system.

Perhaps the most well-known EDC is dichlorodiphenyltrichloroethane, or DDT. Studies in the 1950s linked DDT exposure to harmful physiological effects in lab animals, and yet it took critical examination by Rachel Carson in Silent Spring to finally halt production of this pesticide in 1972. The most well-known EDC today is bisphenol A, which is present in the urine of 92.6% Americans and has been linked to obesity, cancer, and cardiovascular disease in laboratory animals. BPA is used in polycarbonate and epoxy production and is found in a variety of products, but predominately food and drink packaging. Some of these effects have been known since 1930, yet the Food and Drug Administration (FDA) considers BPA safe because of scientific uncertainty regarding their adverse effects. The uncertainty argument is appropriate from the skeptical perspective of science; however, scientific certainty is sufficient but not necessary for taking public policy action. In 2010, the FDA did ban BPA containing baby products, but only after retailers like Wal-Mart began removing the products from their shelves.

The NPR article discusses the refusal of the FDA to ban BPA primarily on the basis of two recent studies that were funded by the FDA. One experiment lead by Teeguarden at Pacific Northwest National Laboratory studied the amount of bioactive BPA that 20 men and women had in their urine after having a diet supposedly loaded with BPA from canned foods and juice in plastic containers (Abstract and article can be found here: http://www.ncbi.nlm.nih.gov/pubmed/21705716). The overall finding was that there were minimal BPA levels in the blood of the participants. One flaw that I immediately noticed in this study was that the initial BPA contained in the food was unknown and thus the BPA urine concentration wasn’t normalized to anything. In biochemical research, absolute values must be normalized to a control or the data doesn’t tell you much. It’s possible that the participants consumed different amounts of BPA containing food or that the measurement techniques processed the sample differently. The limited population size also limits the scope of the study. In fact Frederick S. vom Saal et al. published a critique of Teeguarden work and stated that it “contains numerous flawed assumptions, omissions, and misrepresentations of the published literature on bisphenol A (BPA) that demand our rebuttal.” I highly recommend reading it (http://toxsci.oxfordjournals.org/content/125/1/318.long#ref-19).  An article in Mother Jones labels Teeguarden as a “researcher who has collaborated with and been funded by the chemical industry, and works for an organization that also has worked with to the chemical industry.”

A second study by Dan Doerge at NCTR found that unlike mice and rat newborns who are more susceptible to BPA, newborn monkeys had no trouble inactivating the compound and only had greater BPA metabolism capabilities (Abstract and article can be found here: http://www.ncbi.nlm.nih.gov/pubmed/21983029). Other peer review studies contradict this work as well.

BPA and endocrine disruptors remain highly debated in the scientific community for numerous reasons. The primary cause of the discrepancy is that it is difficult to determine nanonmolar concentrations of EDCs and that there is no sure means to translate the impact of EDCs on experimental animals to humans. The ultimate question is how much proof do we need from the scientific community to instate regulatory policies? Data driven public health measures are the logical thing to do, but what happens when the data is ambiguous or nonexistent? A similar problem seems to be happening in Mayflower, where the Arkansas Department of Health wasn’t able to measure many toxic compounds immediately after the oil spill. According to “science” the town was not affected, but the respiratory problems and other health issues of Mayflower residents seem to tell a different story.

From a public health viewpoint, it’s likely that all populations are affected, but some are more affected than others. One would expect that low income individuals may more likely to turn to packaged foods that contain BPA and that they may be unable to receive proper medical care. It’s also possible the price of a BPA replacement in food containers could cause food cost to rise and do more harm than good. Since little is known about EDCs, the potential harmful effects could be mislabeled as another disease or chronic condition. Even if BPA is banned someday, it’s likely that another class of chemicals will take its place. In today’s modern world, we are exposed to thousands of chemicals, for better or for worse. 

Food Stamp Cuts Create High Demand for Food Bank Supplies

The Supplemental Nutrition and Assistance Program (SNAP), more commonly known as the food stamp program, recently found itself without new funding from Congress. This resulted in approximately 47 million Americans having their food stamp benefits cut. In an interview with a family receiving food stamp assistance, a mother feels her monthly cut will affect the health of her family in a very negative way. This mother says her $53 monthly cut will prevent her from purchasing fresh fruits and vegetables. She plans on buying packaged fruits and freeze dried vegetables now in order to stay within her tighter budget.

I feel the interview with this mother paints a vivid picture of the social determinants of health, specifically income. This single mother has two children, and her main source of income is an $830 per month babysitting job. With SNAP, she is able to somewhat overcome her income barrier and provide healthy, fresh foods for her family. With the recent cuts to SNAP, her available funds are reduced, and those fresh, healthy foods that kept her family in good health can no longer be purchased. The article details that one in seven Americans receives benefits through SNAP, and a $40 billion program cut is currently being debated in Congress. If the program is cut, many Americans will find themselves living less healthy lives, because they simply cannot afford to do so. Seniors, children, veterans, and diabetics tend to rely on SNAP assistance the most, and these at-risk groups will become even more vulnerable. The cuts made to SNAP will become a public health issue because income will be a greater determinant of health than before, and the health of nearly 47 million Americans will suffer because of it.

The food stamp cuts are of great concern for food pantries and food banks across the nation. Many worry that demand will far exceed supply. Spokespersons for various food banks have agreed that this demand will require food lines to be cut once the maximum number of people has been served, and food bags will have to be reduced in quantity and quality in order to serve more people. Many are concerned that the lack of support through food organizations will cause a major stepping stone to independent living to be destroyed. This idea plays into the multi-faceted view of health. If one’s food and nutrition needs are not taken care of, then many other aspects of life, such as physical activity, caring for a family, and finding and maintaining a job, will suffer.

http://www.usatoday.com/story/news/nation/2013/11/02/food-stamps-cuts-food-banks/3356667/

Typhoon Haiyan

http://www.usatoday.com/story/news/2013/11/13/philippines-typhoon-haiyan-relief-aid-problems/3514709/

This article from USA Today is about the aftermath of the recent typhoon that hit the Philippines. Due to the destruction and chaos, communication has been an issue between many different attempts to bring aid. Similar articles from immediately after the storm estimated a total death toll of 1,200, but the current estimation has risen to 5,000 -10,000 possible deaths in just the city of Tacloban. The article describes that the central government is attempting to improve relief efforts by flying in teams of doctors and psychological health workers. However, many of the response teams’ supplies have been stuck at the airport. On the world news tonight I also saw that doctors were running low on medication, bandages, and sanitation supplies, while the flow of severely injured patients seems never-ending. An additional link found on this article (http://www.ksdk.com/story/weather/2013/11/12/philippines-typhoon-haiyan-relief-and-survivor-search/3504077/) further addresses public health concerns, including that the United Nations is asking for $301 million in aid. This article discusses the concern about power outages, and that some hospitals without power will lose all their vaccines. It is estimated that the city of Tacloban may not have power for three months. The shortage of medication and vaccines may increase future deaths due to infection and disease. These two articles show the many areas needed in a relief effort of this caliber. Food, water, medical care, and debris removal are just a few areas that need immediate attention in this crisis.

U.S. Adult Obesity Rate Levels Off

There is finally (semi) good news relating to U.S. obesity rates----obesity among adults seems to be leveling off. At a time when over a third of adults are obese, or more than 35 pounds above ideal body weight, any change is welcome. In 2012, 78 million adults were obese, and according to the National Center for Health Statistics, over 50 million were white. There has not been a significant change in the percentage of obese adults in the U.S. since 2004, when the adult obesity rate was 32%; in 2012, it was reported to be 34.9%. This new analysis is based on data from the National Health and Nutrition Examination Survey, which is a survey of people whose weight and height are actually measured rather than being self-reported, making it more reliable. Some other statistics of interest include that there was no significant change in obesity in men or women, and that the obesity rate among Asians was the lowest out of all the demographics. While it is promising to hear that the adult obesity rate is leveling off and not increasing as it has in past years, we should not be too quick to celebrate. Over one third of all adults are still obese, and obesity is a harmful epidemic that can cause a multitude of diseases such as type 2 diabetes and cardiovascular problems. We need to concentrate on publicizing the downfalls of an unhealthy lifestyle and promote healthy eating and physical activity. Additionally, the U.S. needs to consider lowering the costs of organic foods and specialty items and placing a tax on unhealthy food, just as Canada and countries in the United Kingdom have. This would definitely eliminate part of the problem. 

http://www.usatoday.com/story/news/nation/2013/10/17/obesity-rate-levels-off/2895759/

South Asian Cholera Strain Spreading

A South Asian strain of Cholera was discovered in Haiti and the Domincan Republic three years ago, now it is not isolated in the Caribbean Islands. It was discovered in Mexico on September 9th. Cholera, once present in the water - especially in areas with poor sanitation, is very hard get rid of. Haiti and the Domincan Republic's case of this strain of Cholera was most likely from UN peacekeeping troops from Nepal, who were positioned long term, in a camp, which had very poor sanitary facilities/untreated water. 
Mexico has been the fourth country in the Western Hemisphere to experience this outbreak. Mexico's case was first found in through normal surveillance of hospital cases of severe diarrhea. Since September, there has been 171 reported cases found in Mexico, and one person who has died.
 It was not that long ago either since the last major cholera epidemic. 22 years ago, a cholera outbreak spread all the way up the South American continent, until stopping at the US- Mexico border, because of the US modern sanitation facilities. It sickened more than 1 million people and killing around 10,000. Officials are extremely worried a similar situation could play out with this South Asian Cholera strain. It took Mexico more than 10 years to bring the last cholera epidemic under control.
The World health Organization has a stockpile of oral cholera vaccines, costing $ 1.85 and requires two doses, however Mexico is not considering using them right now. The vaccine is mainly to use for epidemics (which this could turn into). But Mexico authorities are focused on monitoring the population and fast treatment of affected people.

If this turns into an epidemic, the public health implications would be huge. It won't just a regional impact, but a global health impact. Infectious diseases have away of bringing developing nations backward in time. It's not just having people sick - it's having people unable to go to work, to school, unable to live their lives. Public health officials agree that the only real solution is to have clean water and better sewage treatment to communities. In the article is states that Cholera is one of the few diseases that makes people listen. So hopefully this strain of Cholera will make people take action (as in provide funding to bring clean water and sewage treatment).
 In class we learned about the leading causes of death has changed (in the US), from infectious diseases and things that are from crowded spaces, poor water treatment, etc in the early 20th century, to chronic diseases in the 21st century. Thus the things public health has been focused on and targets has changed. I think this contributes to the idea that, for Americans, their is a view that Cholera was something that happened in the past, and it won't affect us now. Clean water and sewage treatment is such a basic human need, that it's hard to imagine not having that available - and that this is still a problem, and it's not just in far away places, it's in a place that the US share's a border with.



http://www.npr.org/blogs/health/2013/10/23/239803890/haitian-cholera-strain-spreads-to-mainland-with-mexico-outbreak

No Time for Toxins, Just Sleep.

According to BBC, Recent research suggests that lack of sleep could lead to deteriorative mental health issues later in life. For many years, evolutionary biologists have wondered why, in a predator-prey food chain environment, animals maintain sleep above other functions when it so clearly exposes them to harm. Now there is evidence that it is due to the restorative processes occurring during sleep. These studies are centered on the function of the glymphatic system of mice while they sleep, including the shrinking of the glial cells, which enables the interstitial space to open and fluid to wash away toxic chemicals that build up during the day.

This has led the way for studies to track the mental health of those running daily on little to no sleep. Included in this sleep-deprived population are students ranging from middle school through college-aged, whose ration of homework each night keeps them from getting the sleep they require. This has serious implications for those in secondary education, during the critical formative years for brain and neuronal development, who are staying up until the early hours doing homework and playing video games. The grade-driven and technologically consumed culture has become over-bearing and stressful for younger generations and in several decades, could lead to an older population plagued with neurodegenerative disorders.

The article did not clarify the interstitial fluid composition nor did it qualify what toxins were building up in the brain, so I would be curious to know the biochemical pathways associated with this process.  If cleaning mechanisms or lipid metabolics are influenced/inhibited by these toxins, then the possibility for causation of neurodegenerative disorders is more than likely true. And if that is the case, then there most definitely needs to be a stronger campaign for youth to spend less time stressing about schoolwork, and more time resting, meaning classes and teachers may have to reevaluate their techniques to maximize time in the classroom to reduce time spent outside the classroom. Schools should spend more time teaching students how to study and work, rather than piling on lectures and expecting the students to process the information on their own.  It has always been said that sleep is critical to good mental health, but now those words may be truer than ever.

http://www.bbc.co.uk/news/health-24567412 

Chronic Kidney Disease

According to this article, kidney disease in America is actually the cause for more deaths (90,000) than breast cancer and prostate cancer combined annually. Obviously, great strides have been made in cancer research but to almost abandon funding and research for kidney disease and prevention presents a huge public health issue. Kidney disease is very preventable and with the correct diet and treatment can be very manageable.  Limiting the soft drink, red meat and fast food consumption could have a very large effect on the number of deaths resulting each year from kidney disease. If people can take such proactive measures to do research for cancer and make an effort to limit the contributing factors to the disease, then  why can't they focus on doing the same for kidney diseases? Because this is such a preventable disease it just makes sense to stop it before it's too late as opposed to waiting until you already have it. By that time, type 1 or 2 diabetes could have set in leaving you to pay for treatment that most of the time exceeds the average Medicare pay out by nearly 5 times for patients 65 and older.

http://well.blogs.nytimes.com/2013/07/15/kidney-disease-an-underestimated-killer/?_r=0