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Food additives
COMMON CONCERN Food Additives Their benefits far outweigh their risks, this expert argues. G I L B E R T A. L E V E I L L E In 1920, farms in the United States provided food for just over 100 million Americans. Today we must feed twice that many using less Jand than was under cultivation 62 years ago. And we have become a ~vorld supplier of food, exporting 60 percent of our wheat, 35 percent of our soy beans, and 30 percent of our corn (1). To serve the expanding world population, food additives will become an essential resource as we move into the next century. I realize that this answer to the growing food supply problems goes against the popular trend in recent years toward natural and organic foods. The notion that we should rely even more on additives in the future also appears to run counter to concerns that additives m a y be linked to a variety of illnesses, ranging from allergies to cancer. The health concerns over additives should not be minimized and I will discuss them. But first, what are additives and why are they so important? Additives can be defined broadly Gilbert A. Leveille, PhD, is director of nutrition and health sciences for General Foods Corp. Formerly professor and chairman, Dept. of Food Sciences and Human Nutrition, Michigan State University, East Lansing, and a past chairman of the Food and Nutrition Board, National Academy of Sciences, he has written and lectured extensively on nutrition. This article is adapted from his speech at the 1981 American Public Health Association Convention in Los Angeles, Calif.
as chemical substances put into four broad categories: preservafoods to enhance their longevity, tives, added nutrients, colors and taste, color, or consistency and tex- flavors, and food processing aids. PRESERVATIVES simply keep food ture. M a n y additives such as sugar, salt, or citric acid are found in na- from spoiling. T h e r e are two types. ture, while others are synthesized Antimicrobial preservatives inhibit the growth of bacteria, fungi, in laboratories. Man has flavored, spiced, pre- molds, and yeast. Sodium propioserved, and otherwise treated food n a t e , for example, a chemical prowith a d d i t i v e s - f o r thousands of duced naturally in Swiss cheese, is years. T h e ancient Egyptians ad- used in bread and cakes to retard ded colorings to enhance the appeal mold. Sodium nitrite is used in of their food. Kerosene was used by cured meats to prevent growth of the ancient Chinese to ripen bana- botulin, a highly active neurotoxnas and peas. Marco Polo traveled in. Antioxidant preservatives help to the Orient to bring back exotic spices. Cortez discovered the vanil- prevent enzyme browning in fruits la bean in the New World, and it and vegetables, and rancidity in became a popular additive in 16th foods containing unstable oils. century Europe. With the excep- Among the antioxidants now in use tion of kerosene, all of those addi- are ascorbic acid, citric acid, butyltives are part of our current food ated hydroxyan~sole ( B H A ) , and butylated hydroxytoluene ( B H T ) . supply. NUTRIENTS are added either to Sugar and salt, the most common food additives, are used to improve restore what is lost in food processflavor and for their preservative ef- ing or to increase its nutrional valfect. The foods most vulnerable to ue. Riboflavin, thiamin, and niaspoilage are those with a high mois- c i n - t h e B vitamins--belong to ture content. Bacterial growth in this category, as do vitamins A, C, food depends on water activity. D, and E, and such minerals as When sugar and salt are added, the iron, iodine, potassium, and zinc. COLORS AND FLAVORS enhance water is less active, and this in turn appearance and taste. Food, Drug inhibits the growth of bacteria. Salt and sugar now account for and Cosmetic red #3 and #40, yel93 percent, by weight, of all addi- low//5, blue #1, carotene, caramel, tives consumed. Another 6 percent and beet powder are the color addiconsist of 32 common substances tives used most often. Most food additives are flavoring such as yeast, baking soda, vegetable colors, citric acid, mustard, and ingredients. Some are derived from pepper. The remaining 2,200 com- 9foods such as lemons, oranges, and monly used food additives, most of vanilla beans. Others are herbs and which impart flavor, total only 1.0 spices. Still others are synthetic percent of those consumed. This substances. In all, more than 1,700 averages out to 0.07 ounces for natural a n d - s y n t h e t i c flavors are each additive, per person, per used in virtually every processed food. year. The fourth category, FOOD PROAdditives can be classified into
Differing perspectives on a problem that nurses share with other caregivers.
is pretty much a catch-all group. Emulsifiers, lecithin and the glycerides, for instance, are used to disperse particles, especially fat, that form when certain ingredients are mixed in salad dressings, margarine, and ice cream. Lecithin is present in milk and egg yolks; the glycerides are derived from vegetables and animal fats. Stabilizers and thickeners are added .to absorb water. They keep ice crystals from forming in frozen CESS1NG AIDS,
ago, for example, pellagra was the t o freezing and drying. Ascorbic leading cause of death in eight acid, citric acid, and sulfites, for insouthwestern states. Each spring stance, help extend the range and virtually every available bed in flexibility of preservation processes southern hospitals and mental in- by protecting color, flavor, and nustitutions was occupied by a patient tritive value. with pellagra(2). Within two years Botulism, the most dangerous after southern legislators mandated form of food poisoning, is now rare the fortification of corn meal with in this country. The Centers for niacin, pellagra had all but disap- Disease Control reported 8 cases of peared. botulism in 1979 and no deaths; 12 Vitamin and mineral additives cases and 2 deaths in the first 9 have produced other dramatic months of 1980(3). All of these health benefits. The addition of po- cases were t r a c e d to improper
1
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Ancient Egyptians added colorings to enhance the appeal of food. Marco Polo brought exotic spieces from the Orient.,Cortez discovered the vanilla bean in the New World, and it became a popular food additive in 16th century Europe.
foods, and help control evaporation and deterioration during storage. The most frequently used stabilizers and thickeners are tragacanth, gum arabic, pe6tin, carrageenan, cellulose gum, and guar gum. Other food processing aids include leavening, maturing, and bleaching agents; humectants; and agents to control hydrogen ion concentration, or pH.
Why Are Additives Important? Food additives clearly serve a variety of specific functions, with added nutrients providing the most direct health benefits. Once, nutrient-deficiency diseases were one of our foremost public health problems. Fifty years
tassium iodide to table salt, in 1924, brought goiter under control. Rickets, a common childhood disease before 1940, the year "eitamin D was added to milk, is now rare in this country. Preservatives also clearly benefit health by inhibiting the growth of "the disease-causing microorganisms that formerly posed public health problems just as serious as deficiency disease. The incidence of food poisoning and gastrointestinal illness in the U.S. has dropped dramatically over the last 30 years, due largely to improved refrigeration and hygienic practices. Additives have also contributed, either by retarding the growth of pathogens or as adjuncts
home processing. A principal reason for the low incidence of botulism is the use of sodium nitrite, which inhibits the growth of the deadly Clostridium botulinum. I believe it is safe to say that our modern system of food production and distribution would be impossible without additives. We can gain some idea of the economic importance of preservatives from the estimate by the U.S. Department of Agriculture that one-third of our entire oil seed crop is preserved with antioxidants(4). Without preservatives, that portion of the supply would become rancid. Other additives also confer economic benefits. In 1973, Arthur D.
COMMON CONCERN Little Laboratories calculated the economic 9 of producing bread without using preservatives, leavening agents, yeast foods, and dough conditioners(5). It is possible to make bread without these additives, Of course, but it would take longer and the bread would have to be distributed faster. As a result, 9 the Little study estimated a net increase of four to five cents per loaf of bread, or a total annual cost nationwide of $1.1 billion. These esti-. mates would be even higher toda~r On~ should be wary of such economic projections because they depend on many variables and are not ,precise. However, economic studies do-i'ndicate consistently that without additives the price of food would rise significantly (6,7). The Future of Additives
As we look to the future, the worldwide supply of food assumes critical importance. In our country we are blessed with a food supply unparalleled in human history. Elsewhere, however, the struggle for food continues. The United N a tion's Food and Agricultural Organization has estimated that 500 million 9 p e o p l e - - o r 25 percent of the population of developing count r i e s - s u f f e r from acute malnutrition(8). This figure is disputed by some authorities. The U S D A puts the number of seriously malnourished at close to 100 million(9). But whether it is half a billion or I00 million, the point is clear: a substantial number of the human race a r e hungry. This problem is likely to become more severe if population growth outdistances agricultural productivity. In the past 20 years, world food production has increased by. 40 percent, but world population has doubled. By 2000, world population is likely to double again, to almost 7 billion. Can agricultural productivity, which now appears to be leveling off, keep pace'?.
self-protection against injurious pests 9 Pesticide residues such as chlordane and heptachlor e Food additives(12). 9 Few aspects of our physical environment are more closely watched, tested, and regulated than food additives. T h e first Pure Food and Drug Act was passed in 1906 because the nation was shocked at the conditions in meat packing houses portrayed in Upton Sinclair's The Jungle, and at the practices of merchants who used substances like copper s u l p h a t e , borax, and formaldehyde to make spoiled food appear fresh. A stronger law, passed in r1938 and amended in 1958, required 9 to demonstrate the safety of any new additive before it could be used. T h e 1958 Food Additive Amendment included the famous Delaney Clause, which prohibited the use o f any additive "found to induce cancer when ingested by man or aniHealth Concerns Over Additives mal." All the benefits of additives a r e O u r present food safety laws set irrelevant if they cause serious ad- different standards for innumeraverse health effects. T h e scientific ble c a t e g o r i e s - - n a t u r a l l y occurring evidence on additives shows, I be- substances, flavor additives, color lieve, that their risks are out- additives, previously sanctioned weighed by their benefits. In sur- substances, pesticide residues, and veys, more than 30 percent of the substances " G e n e r a l l y Regarded general public express a high de- As Safe." gree of concern about additives. Even substances in use for centuExperts on food safety, however, ries such as sugar, salt, and corn generally rank additives very low as starch, and belonging to the categoa potential public health risk(11). ry " G e n e r a l l y Regarded As Safe," The Food and Drug Administraare periodically reviewed and tested. tion lists six hazards associated Before approving new food addiwith food, in o r d e r of decreasing tive, the F D A reviews the evidence public health impact: from three types of animal studies. 9 Food-borne diseases of micro- In acute toxicity tests, groups of bial origin, such as Salmonella poi- animals are fed a wide range of sinsoning or botulism gle doses of the chemical to deter9 Malnutrition resulting from mine the level at which toxic effects the absence of essential nutrients appear. Subacute toxicity tests 9 Environmental contaminants, measure the toxic effect of daily insuch as polychlorinated biphenyls gestion for days or weeks. Chronic (PCBs) or mercury tests are conducted over periods 9 N a t u r a l l y occurring toxicants ranging from several months to a in food, such.as aflatoxin in field lifetime. crops, or some chemicals that In each Case, large doses are emplants manufacture as a form o f " p l o y e d to determine the " m a x i m u m We
have some untapped reunderused farmlands in developing countries, promising new crops like the- winged bean and the a m a r a n t h grain, the systematic farming of marine life (aquaculture). However, our productive res o u r c e s are likely to remain finite. Today we must not merely produce more food but make better use of it. According to the U S D A approximately one-fourth of the world grain crop is lost through spoilage (10). This loss can be r e d u c e d sharply through the careful use of preservatives. Better processing, packaging, storage, and transportation systems a r e required in many parts of the globe. The estimated loss of grains and beans in India, for example, ranges between 30 and 40 percent of total harvest. Improvements in these systems will depend on increased use of antimicrobials and antioxidants to prevent spoilage. sources:
no-effect level" on animals. This m a x i m u m no-effect level is generally divided by a safety factor of 100 to determine the acceptable daily intake for humans. T h e net result of extensive testing is that additives pose almost no risk of acute toxicity for the general population. I wish I could say additives posed no short-term risk f o r anyone, but no such statement is possible when it comes to health and the environment. Additives and Allergy Some additives can pose shortterm risks, in the form of allergic reacl~ions, for a small percentage of the population. M a n y recent stud- The U.S. food supply is unparalleled in human history, but in many parts of the globe ies have examined the possible rela- better processing, packaging, storage, and transport are needed to supply enough food. " tionship of food additives to allerof cancer. gies. This body of evidence has not cylates or not), it is known as an Fortunately, however, there is no established a link between additives additive-free diet. convincing evidence that any addiFeingold's published results are a n d allergic reactions except for tive now in use is carcinogenic in tartrazine ( F D & C yellow #5), so- based on case reports in which the humans. W e Can make this statedium benzoate, and sulphur diox- evaluation of behavior change was ment with some assurance because subjective, and in which there were ide(13). our food safety laws set strict stanSeveral studies indicate that no controls for expectations (known those compounds m a y pose a prob- as the placebo effect) on the part of dards for assessing the cancercausing potential of food addilem for some individuals who have the child and parents. tives. At least eight major controlled asthma or other respiratory ailT h e Food, Drug & Cosmetic Act ments(14)~ Within the small per- studies have tested the Feingold prohibits the use of any amount of centage of the affected population, theory(16). After reviewing these any additive that " m a y render" however, allergic reactions to addi- studies, the National Advisory food injurious to health. A naturaltives do not appear to be nearly as Committee on Hyperkinesis and ly occurring substance is permitted w i d e s p r e a d as those caused by Food Additives concluded that "no if it does not "ordinarily render" milk, eggs, corn, fish, shellfish, and instances of consistent, dramatic food injurious to health. Potentially deterioration in behavior [were obpeas. harmful pesticides and environAdditives also have been asso- served] in hyperactive children mental contaminants are permitted ciated with hyperkinesis, the condi- challenged under double-blind conin food up to certain m a x i m u m toltion among children characterized ditions with artificial food colorings erance levels. following treatment with the diet by hyperactivity. During the 1970s, The Delaney Clause specifically Benjamin Feingold, MD, advanced that removes the substance"(17). prohibits the use of any additive the theory that about 50 percent of in other words, this committee upon finding that it causes cancer hyperkinetic children can be .found no evidence in these studies in animals--regardless of dosage or treated effectively by eliminating that color additives caused hyperkispecies. This is a standard of zero most salicylate compounds from nesis. risk. their diet(l 5). Additives and Cancer As a result of these strict stanSalicylates, aspirin-like subThe prime public concern with dards, a number of additives (instances that occur naturally in cluding red #2 and 4, orange B, oranges, grapes, cucumbers, and the long-term effects of food addicarbon black, violet 1, T C E , and tomatoes, are present in many fla- tives is cancer. Cancer is now the vor and color additives. Because the second leading cause of death in cyclamates) have been prohibited or voluntarily withdrawn. SacchaFeingold diet excludes all processed the U.S., and evidence mounts that foods containing added color and various substances in the envi/-on- rin escaped prohibition when Congress created a special exemption flavors (whether they contain sail- ment are major contributing causes
Geriat'ric Nursing September/October 1982 327
COMMON CONCERN from the food additive law. N o n e of these substances were proven to cause cancer in humans. Because o f the inherent limitations in h u m a n epidemio|ogy studies, conclusive proof is rarely available. However, animal studies produced evidence that these additives might pose a cancer risk for humans(18). Our strict laws on additives reflect the general consensus that we should do whatever we can to limit h u m a n exposure to potential carcinogens. In the past several years, however, there has been increasing concern in industry and medicine that the food additive laws m a y be too strict. This concern arose largely as a "result o f the experiences with saccharin and nitrite. In each case, the absolutist nature of the additives law ran head-on into competing social n e e d s - - t h e need of s o m e segments o f society for low caloric sug ar substitutes, and the need of society at large to prevent botulism. Congress is now considering changes in our food safety laws. Scientific Inquiry and Present Law Most evidence on the health effects of additives c o m e from animal studies. The validity of animal studies as a basis for estimating hum a n cancer risks rests on two assumptions: 9 Test animals, usually rats or mice, have metabolisms similar to humans', and therefore the effects observed in test animals will be manifested in humans. 9 If high dosage of a substance causes a measurable incidence of cancer in test animals, a lower dose will produce, a significant but lower incidence o f cancer in humans. There is nothing wrong with making these ~issumptions as long as we realize that the conclusions drawn about h u m a n cancer risk cannot be absolute. W e must rely on animal tests, however, because reliable epidemiological evidence is l a c k i n g for most substances, and
because it would be u n e t h i c a l to conduct experiments on h u m a n subjects. I wish I c o u l d propose a new standard that would provide the high degree o f protection we have grown to expect, allow for the limitations in scientific methodology, and reflect social decisions on what constitutes acceptable risk and how risks should be weighed against benefits. However, those decisions are best m a d e in the political arena. T h e problem now before Congress as it considers changes in our food safety laws is to devise a framework that will permit the continued, safe use of additives as we m o v e into the 21st century. References 1. U.S. Agriculture Department. World Agricultural Supply and Demand Estimates. (Approved by World Agricultural Outlook Board, ERS/FAS) Washington, D.C., The Department, 1982. 2. National Academy of Sciences' Forum. How Safe is Safe? The Design of Policy on Drugs and Food Additives. Washington, D.C., The Academy, 1974. 3. U.S. Centers for Disease Control. Foodborne Disease Outbreaks. Annual Summary 1979. Atlanta, Ga., The Centers, April 1981. 4. Another checkup for additives9 Chemical Week Oct. 22, 1980, p. 37. 5. Angeline, and Leonardos. Food additives: some economic considerations. Food Technology 27(4): 40, 1973. 6. Melnick, D. Economics in food and nutrition issues. IN Food Science and Nutrition; Current Issues and Art~wers, ed. by F. Clydesdale9 Englewood Cliffs. N.J., Prentice Hall, 1979, pp. 178-216. 7. Ibid. 8. Crittenden, Ann. Food and hunger statistics questioned. N Y Times Oct. 5, 1981, p. I. 9. Ibid. 10. The USDA estimates are projections based on countries, such as the Soviet Union, where actual losses are known (up to 10 per cent in the USSR, for example). The U.N.'s Food and Agriculture Organization places losses anywhere from 15 percent to 34 percent depending on the type of crop. Based on conversations with agency officials. I I. Schmidt, A9 Address given at the symposium, Food Safety--A Centenary of Progress, celebrating the hundredth anniversary of the Food and Drug Act, London, Oct. 20, 1975. 12..Ibid. 13. Freedman, B.J. A diet free from additives in the management of allergic disease. Clin.AIlergy 7:417-421, Sept. 1977. 9 Asthma induced by sulphur dioxide, benzoate and tartrazine contained in orange drinks. Clin.Allergy 7:407-415, Sept. 1977. Kreind/er, J.J., and others. The effect of food
colors and sodium benzoate on rat peritoneal mast cells. Ann.Allergy 44:76-81, Feb. 1980. Levantine, A., and Almeyda, J. Cutaneous reactions to food and drug additives. Br.J.Dermatol. 91:359-362, Sept. 1974. Ros, A.M., and others. A follow-up study of patients with recurrent urticaria and hypersensitivityto aspirin,benzoates and azo dyes. Br.J.Dermatol. 95:19-24, July 1976. Rosenhall, L. Asthmatic patients with hypersensitivity to aspirin, benzoic acid and tartrazinc. Scdnd.J.Resp.Dis. (Denmark) 55(Suppl 60):88, 1974. 14. Ibid. 15. Feingold, B.F. Why Your Child's Hyperactive. N.Y., Random House, 1974, p. 71. 16. Conners, C.K., and others. Food additives and hyperkinesis: a controlled double-blind experiment. Pediatrics 58:154-166, Aug. 1976. Levy, F., and others. Hypcrkinesis and diet: a double-blind crossover trial with a tartrazine challenge. Med.J.Aust. 1:61-64, Jan. 1978. Williams, J.l., and others. Relative effects of drugs and diet on hyperactive behaviors: an experimental study. Pediatrics 61:811-817, June 1978. Goyette, C.H., and others. Effects of artificial colors on hypcrkinetic children: a doubleblind challenge study (proceedings). PsychopharmacoI.BulL 14:39-40, Apr. 1978. Harley, J.P., and others. Hyperkinesis and food additives: testing the Feingold hypothesis. Pediatrics 61:818-828, June 1978. 9 Synthetic food colors and hyperactivity in children: a double-blind challenge" experiment. Pediatrics 62:975-983, Dec. 1978. Mathes, J., and Gittclman-Klein. R.A. Crossover study of artificial food colorings in a hyperkinctic child. Am.J.Psychiatry 135:987988, Aug. 1978. Levy, F., and Hobbes, G. Hyperkinesis and diet: a replication study9 Am.J.Psychiatry 135:1559-1560, Dec. 1978. Conners, C.K. Disruptive bchavi~ and artificial colors in the diet: current status of res e a r c h . IN The Treatment of Hyperactive and Learning Disorders, ed. by R.M. Knights and D.J. Bakkcr. Baltimore, Md., University Park Press, 1979. Weiss, B,, and others. Behavioral responses to artifical food colors9 Science 207:1487-1489, Mar. 28, 1980. Mathers, J., and Gittelman-Klein, R. Effects of Artificial Food Colorings in Children with Hyperactive Symptomatology. Glen Oaks, NY, Long Island Jewish-ltillside Medical Center, June 1980. (Unpub. manuscript) 17. National Advisory Committee on Hypcrkinesis and Food Additives. Final Report to the Nutrition Foundation. New York, The Nutrition Foundation, October 1980. 18. U.S. Food and Drug Administration. FD&C Red No. 2. (Unpublished study) Davis, K.J., and others. Chronic toxicity of Ponceau SX rats, mice, and dogs. Toxic.AppL Pharmacol. 8:306-317, Mar. 1966. FD&C Violet No. 1. (Unpublished Japanese study) U.S. National Cancer Institute, Temporary Committee for the Review of Data on the Carcinogenicity of Cyclamates. Cyclamates. Bethesda, Md., The Institute, 1976. U.S. National Institutes of Health. Carcinogenesis Bioassay of Trichloroethylene. (Carcinogenesis Technical Rep. Ser. No. 2) (DHEW Publ. 1Q0. (NIH) 76-802) Washington, D.C., U.S. Government Printing Office.
as chemical substances put into four broad categories: preservafoods to enhance their longevity, tives, added nutrients, colors and taste, color, or consistency and tex- flavors, and food processing aids. PRESERVATIVES simply keep food ture. M a n y additives such as sugar, salt, or citric acid are found in na- from spoiling. T h e r e are two types. ture, while others are synthesized Antimicrobial preservatives inhibit the growth of bacteria, fungi, in laboratories. Man has flavored, spiced, pre- molds, and yeast. Sodium propioserved, and otherwise treated food n a t e , for example, a chemical prowith a d d i t i v e s - f o r thousands of duced naturally in Swiss cheese, is years. T h e ancient Egyptians ad- used in bread and cakes to retard ded colorings to enhance the appeal mold. Sodium nitrite is used in of their food. Kerosene was used by cured meats to prevent growth of the ancient Chinese to ripen bana- botulin, a highly active neurotoxnas and peas. Marco Polo traveled in. Antioxidant preservatives help to the Orient to bring back exotic spices. Cortez discovered the vanil- prevent enzyme browning in fruits la bean in the New World, and it and vegetables, and rancidity in became a popular additive in 16th foods containing unstable oils. century Europe. With the excep- Among the antioxidants now in use tion of kerosene, all of those addi- are ascorbic acid, citric acid, butyltives are part of our current food ated hydroxyan~sole ( B H A ) , and butylated hydroxytoluene ( B H T ) . supply. NUTRIENTS are added either to Sugar and salt, the most common food additives, are used to improve restore what is lost in food processflavor and for their preservative ef- ing or to increase its nutrional valfect. The foods most vulnerable to ue. Riboflavin, thiamin, and niaspoilage are those with a high mois- c i n - t h e B vitamins--belong to ture content. Bacterial growth in this category, as do vitamins A, C, food depends on water activity. D, and E, and such minerals as When sugar and salt are added, the iron, iodine, potassium, and zinc. COLORS AND FLAVORS enhance water is less active, and this in turn appearance and taste. Food, Drug inhibits the growth of bacteria. Salt and sugar now account for and Cosmetic red #3 and #40, yel93 percent, by weight, of all addi- low//5, blue #1, carotene, caramel, tives consumed. Another 6 percent and beet powder are the color addiconsist of 32 common substances tives used most often. Most food additives are flavoring such as yeast, baking soda, vegetable colors, citric acid, mustard, and ingredients. Some are derived from pepper. The remaining 2,200 com- 9foods such as lemons, oranges, and monly used food additives, most of vanilla beans. Others are herbs and which impart flavor, total only 1.0 spices. Still others are synthetic percent of those consumed. This substances. In all, more than 1,700 averages out to 0.07 ounces for natural a n d - s y n t h e t i c flavors are each additive, per person, per used in virtually every processed food. year. The fourth category, FOOD PROAdditives can be classified into
Differing perspectives on a problem that nurses share with other caregivers.
is pretty much a catch-all group. Emulsifiers, lecithin and the glycerides, for instance, are used to disperse particles, especially fat, that form when certain ingredients are mixed in salad dressings, margarine, and ice cream. Lecithin is present in milk and egg yolks; the glycerides are derived from vegetables and animal fats. Stabilizers and thickeners are added .to absorb water. They keep ice crystals from forming in frozen CESS1NG AIDS,
ago, for example, pellagra was the t o freezing and drying. Ascorbic leading cause of death in eight acid, citric acid, and sulfites, for insouthwestern states. Each spring stance, help extend the range and virtually every available bed in flexibility of preservation processes southern hospitals and mental in- by protecting color, flavor, and nustitutions was occupied by a patient tritive value. with pellagra(2). Within two years Botulism, the most dangerous after southern legislators mandated form of food poisoning, is now rare the fortification of corn meal with in this country. The Centers for niacin, pellagra had all but disap- Disease Control reported 8 cases of peared. botulism in 1979 and no deaths; 12 Vitamin and mineral additives cases and 2 deaths in the first 9 have produced other dramatic months of 1980(3). All of these health benefits. The addition of po- cases were t r a c e d to improper
1
i
f
I~'=~'~)t%'~gt
Ancient Egyptians added colorings to enhance the appeal of food. Marco Polo brought exotic spieces from the Orient.,Cortez discovered the vanilla bean in the New World, and it became a popular food additive in 16th century Europe.
foods, and help control evaporation and deterioration during storage. The most frequently used stabilizers and thickeners are tragacanth, gum arabic, pe6tin, carrageenan, cellulose gum, and guar gum. Other food processing aids include leavening, maturing, and bleaching agents; humectants; and agents to control hydrogen ion concentration, or pH.
Why Are Additives Important? Food additives clearly serve a variety of specific functions, with added nutrients providing the most direct health benefits. Once, nutrient-deficiency diseases were one of our foremost public health problems. Fifty years
tassium iodide to table salt, in 1924, brought goiter under control. Rickets, a common childhood disease before 1940, the year "eitamin D was added to milk, is now rare in this country. Preservatives also clearly benefit health by inhibiting the growth of "the disease-causing microorganisms that formerly posed public health problems just as serious as deficiency disease. The incidence of food poisoning and gastrointestinal illness in the U.S. has dropped dramatically over the last 30 years, due largely to improved refrigeration and hygienic practices. Additives have also contributed, either by retarding the growth of pathogens or as adjuncts
home processing. A principal reason for the low incidence of botulism is the use of sodium nitrite, which inhibits the growth of the deadly Clostridium botulinum. I believe it is safe to say that our modern system of food production and distribution would be impossible without additives. We can gain some idea of the economic importance of preservatives from the estimate by the U.S. Department of Agriculture that one-third of our entire oil seed crop is preserved with antioxidants(4). Without preservatives, that portion of the supply would become rancid. Other additives also confer economic benefits. In 1973, Arthur D.
COMMON CONCERN Little Laboratories calculated the economic 9 of producing bread without using preservatives, leavening agents, yeast foods, and dough conditioners(5). It is possible to make bread without these additives, Of course, but it would take longer and the bread would have to be distributed faster. As a result, 9 the Little study estimated a net increase of four to five cents per loaf of bread, or a total annual cost nationwide of $1.1 billion. These esti-. mates would be even higher toda~r On~ should be wary of such economic projections because they depend on many variables and are not ,precise. However, economic studies do-i'ndicate consistently that without additives the price of food would rise significantly (6,7). The Future of Additives
As we look to the future, the worldwide supply of food assumes critical importance. In our country we are blessed with a food supply unparalleled in human history. Elsewhere, however, the struggle for food continues. The United N a tion's Food and Agricultural Organization has estimated that 500 million 9 p e o p l e - - o r 25 percent of the population of developing count r i e s - s u f f e r from acute malnutrition(8). This figure is disputed by some authorities. The U S D A puts the number of seriously malnourished at close to 100 million(9). But whether it is half a billion or I00 million, the point is clear: a substantial number of the human race a r e hungry. This problem is likely to become more severe if population growth outdistances agricultural productivity. In the past 20 years, world food production has increased by. 40 percent, but world population has doubled. By 2000, world population is likely to double again, to almost 7 billion. Can agricultural productivity, which now appears to be leveling off, keep pace'?.
self-protection against injurious pests 9 Pesticide residues such as chlordane and heptachlor e Food additives(12). 9 Few aspects of our physical environment are more closely watched, tested, and regulated than food additives. T h e first Pure Food and Drug Act was passed in 1906 because the nation was shocked at the conditions in meat packing houses portrayed in Upton Sinclair's The Jungle, and at the practices of merchants who used substances like copper s u l p h a t e , borax, and formaldehyde to make spoiled food appear fresh. A stronger law, passed in r1938 and amended in 1958, required 9 to demonstrate the safety of any new additive before it could be used. T h e 1958 Food Additive Amendment included the famous Delaney Clause, which prohibited the use o f any additive "found to induce cancer when ingested by man or aniHealth Concerns Over Additives mal." All the benefits of additives a r e O u r present food safety laws set irrelevant if they cause serious ad- different standards for innumeraverse health effects. T h e scientific ble c a t e g o r i e s - - n a t u r a l l y occurring evidence on additives shows, I be- substances, flavor additives, color lieve, that their risks are out- additives, previously sanctioned weighed by their benefits. In sur- substances, pesticide residues, and veys, more than 30 percent of the substances " G e n e r a l l y Regarded general public express a high de- As Safe." gree of concern about additives. Even substances in use for centuExperts on food safety, however, ries such as sugar, salt, and corn generally rank additives very low as starch, and belonging to the categoa potential public health risk(11). ry " G e n e r a l l y Regarded As Safe," The Food and Drug Administraare periodically reviewed and tested. tion lists six hazards associated Before approving new food addiwith food, in o r d e r of decreasing tive, the F D A reviews the evidence public health impact: from three types of animal studies. 9 Food-borne diseases of micro- In acute toxicity tests, groups of bial origin, such as Salmonella poi- animals are fed a wide range of sinsoning or botulism gle doses of the chemical to deter9 Malnutrition resulting from mine the level at which toxic effects the absence of essential nutrients appear. Subacute toxicity tests 9 Environmental contaminants, measure the toxic effect of daily insuch as polychlorinated biphenyls gestion for days or weeks. Chronic (PCBs) or mercury tests are conducted over periods 9 N a t u r a l l y occurring toxicants ranging from several months to a in food, such.as aflatoxin in field lifetime. crops, or some chemicals that In each Case, large doses are emplants manufacture as a form o f " p l o y e d to determine the " m a x i m u m We
have some untapped reunderused farmlands in developing countries, promising new crops like the- winged bean and the a m a r a n t h grain, the systematic farming of marine life (aquaculture). However, our productive res o u r c e s are likely to remain finite. Today we must not merely produce more food but make better use of it. According to the U S D A approximately one-fourth of the world grain crop is lost through spoilage (10). This loss can be r e d u c e d sharply through the careful use of preservatives. Better processing, packaging, storage, and transportation systems a r e required in many parts of the globe. The estimated loss of grains and beans in India, for example, ranges between 30 and 40 percent of total harvest. Improvements in these systems will depend on increased use of antimicrobials and antioxidants to prevent spoilage. sources:
no-effect level" on animals. This m a x i m u m no-effect level is generally divided by a safety factor of 100 to determine the acceptable daily intake for humans. T h e net result of extensive testing is that additives pose almost no risk of acute toxicity for the general population. I wish I could say additives posed no short-term risk f o r anyone, but no such statement is possible when it comes to health and the environment. Additives and Allergy Some additives can pose shortterm risks, in the form of allergic reacl~ions, for a small percentage of the population. M a n y recent stud- The U.S. food supply is unparalleled in human history, but in many parts of the globe ies have examined the possible rela- better processing, packaging, storage, and transport are needed to supply enough food. " tionship of food additives to allerof cancer. gies. This body of evidence has not cylates or not), it is known as an Fortunately, however, there is no established a link between additives additive-free diet. convincing evidence that any addiFeingold's published results are a n d allergic reactions except for tive now in use is carcinogenic in tartrazine ( F D & C yellow #5), so- based on case reports in which the humans. W e Can make this statedium benzoate, and sulphur diox- evaluation of behavior change was ment with some assurance because subjective, and in which there were ide(13). our food safety laws set strict stanSeveral studies indicate that no controls for expectations (known those compounds m a y pose a prob- as the placebo effect) on the part of dards for assessing the cancercausing potential of food addilem for some individuals who have the child and parents. tives. At least eight major controlled asthma or other respiratory ailT h e Food, Drug & Cosmetic Act ments(14)~ Within the small per- studies have tested the Feingold prohibits the use of any amount of centage of the affected population, theory(16). After reviewing these any additive that " m a y render" however, allergic reactions to addi- studies, the National Advisory food injurious to health. A naturaltives do not appear to be nearly as Committee on Hyperkinesis and ly occurring substance is permitted w i d e s p r e a d as those caused by Food Additives concluded that "no if it does not "ordinarily render" milk, eggs, corn, fish, shellfish, and instances of consistent, dramatic food injurious to health. Potentially deterioration in behavior [were obpeas. harmful pesticides and environAdditives also have been asso- served] in hyperactive children mental contaminants are permitted ciated with hyperkinesis, the condi- challenged under double-blind conin food up to certain m a x i m u m toltion among children characterized ditions with artificial food colorings erance levels. following treatment with the diet by hyperactivity. During the 1970s, The Delaney Clause specifically Benjamin Feingold, MD, advanced that removes the substance"(17). prohibits the use of any additive the theory that about 50 percent of in other words, this committee upon finding that it causes cancer hyperkinetic children can be .found no evidence in these studies in animals--regardless of dosage or treated effectively by eliminating that color additives caused hyperkispecies. This is a standard of zero most salicylate compounds from nesis. risk. their diet(l 5). Additives and Cancer As a result of these strict stanSalicylates, aspirin-like subThe prime public concern with dards, a number of additives (instances that occur naturally in cluding red #2 and 4, orange B, oranges, grapes, cucumbers, and the long-term effects of food addicarbon black, violet 1, T C E , and tomatoes, are present in many fla- tives is cancer. Cancer is now the vor and color additives. Because the second leading cause of death in cyclamates) have been prohibited or voluntarily withdrawn. SacchaFeingold diet excludes all processed the U.S., and evidence mounts that foods containing added color and various substances in the envi/-on- rin escaped prohibition when Congress created a special exemption flavors (whether they contain sail- ment are major contributing causes
Geriat'ric Nursing September/October 1982 327
COMMON CONCERN from the food additive law. N o n e of these substances were proven to cause cancer in humans. Because o f the inherent limitations in h u m a n epidemio|ogy studies, conclusive proof is rarely available. However, animal studies produced evidence that these additives might pose a cancer risk for humans(18). Our strict laws on additives reflect the general consensus that we should do whatever we can to limit h u m a n exposure to potential carcinogens. In the past several years, however, there has been increasing concern in industry and medicine that the food additive laws m a y be too strict. This concern arose largely as a "result o f the experiences with saccharin and nitrite. In each case, the absolutist nature of the additives law ran head-on into competing social n e e d s - - t h e need of s o m e segments o f society for low caloric sug ar substitutes, and the need of society at large to prevent botulism. Congress is now considering changes in our food safety laws. Scientific Inquiry and Present Law Most evidence on the health effects of additives c o m e from animal studies. The validity of animal studies as a basis for estimating hum a n cancer risks rests on two assumptions: 9 Test animals, usually rats or mice, have metabolisms similar to humans', and therefore the effects observed in test animals will be manifested in humans. 9 If high dosage of a substance causes a measurable incidence of cancer in test animals, a lower dose will produce, a significant but lower incidence o f cancer in humans. There is nothing wrong with making these ~issumptions as long as we realize that the conclusions drawn about h u m a n cancer risk cannot be absolute. W e must rely on animal tests, however, because reliable epidemiological evidence is l a c k i n g for most substances, and
because it would be u n e t h i c a l to conduct experiments on h u m a n subjects. I wish I c o u l d propose a new standard that would provide the high degree o f protection we have grown to expect, allow for the limitations in scientific methodology, and reflect social decisions on what constitutes acceptable risk and how risks should be weighed against benefits. However, those decisions are best m a d e in the political arena. T h e problem now before Congress as it considers changes in our food safety laws is to devise a framework that will permit the continued, safe use of additives as we m o v e into the 21st century. References 1. U.S. Agriculture Department. World Agricultural Supply and Demand Estimates. (Approved by World Agricultural Outlook Board, ERS/FAS) Washington, D.C., The Department, 1982. 2. National Academy of Sciences' Forum. How Safe is Safe? The Design of Policy on Drugs and Food Additives. Washington, D.C., The Academy, 1974. 3. U.S. Centers for Disease Control. Foodborne Disease Outbreaks. Annual Summary 1979. Atlanta, Ga., The Centers, April 1981. 4. Another checkup for additives9 Chemical Week Oct. 22, 1980, p. 37. 5. Angeline, and Leonardos. Food additives: some economic considerations. Food Technology 27(4): 40, 1973. 6. Melnick, D. Economics in food and nutrition issues. IN Food Science and Nutrition; Current Issues and Art~wers, ed. by F. Clydesdale9 Englewood Cliffs. N.J., Prentice Hall, 1979, pp. 178-216. 7. Ibid. 8. Crittenden, Ann. Food and hunger statistics questioned. N Y Times Oct. 5, 1981, p. I. 9. Ibid. 10. The USDA estimates are projections based on countries, such as the Soviet Union, where actual losses are known (up to 10 per cent in the USSR, for example). The U.N.'s Food and Agriculture Organization places losses anywhere from 15 percent to 34 percent depending on the type of crop. Based on conversations with agency officials. I I. Schmidt, A9 Address given at the symposium, Food Safety--A Centenary of Progress, celebrating the hundredth anniversary of the Food and Drug Act, London, Oct. 20, 1975. 12..Ibid. 13. Freedman, B.J. A diet free from additives in the management of allergic disease. Clin.AIlergy 7:417-421, Sept. 1977. 9 Asthma induced by sulphur dioxide, benzoate and tartrazine contained in orange drinks. Clin.Allergy 7:407-415, Sept. 1977. Kreind/er, J.J., and others. The effect of food
colors and sodium benzoate on rat peritoneal mast cells. Ann.Allergy 44:76-81, Feb. 1980. Levantine, A., and Almeyda, J. Cutaneous reactions to food and drug additives. Br.J.Dermatol. 91:359-362, Sept. 1974. Ros, A.M., and others. A follow-up study of patients with recurrent urticaria and hypersensitivityto aspirin,benzoates and azo dyes. Br.J.Dermatol. 95:19-24, July 1976. Rosenhall, L. Asthmatic patients with hypersensitivity to aspirin, benzoic acid and tartrazinc. Scdnd.J.Resp.Dis. (Denmark) 55(Suppl 60):88, 1974. 14. Ibid. 15. Feingold, B.F. Why Your Child's Hyperactive. N.Y., Random House, 1974, p. 71. 16. Conners, C.K., and others. Food additives and hyperkinesis: a controlled double-blind experiment. Pediatrics 58:154-166, Aug. 1976. Levy, F., and others. Hypcrkinesis and diet: a double-blind crossover trial with a tartrazine challenge. Med.J.Aust. 1:61-64, Jan. 1978. Williams, J.l., and others. Relative effects of drugs and diet on hyperactive behaviors: an experimental study. Pediatrics 61:811-817, June 1978. Goyette, C.H., and others. Effects of artificial colors on hypcrkinetic children: a doubleblind challenge study (proceedings). PsychopharmacoI.BulL 14:39-40, Apr. 1978. Harley, J.P., and others. Hyperkinesis and food additives: testing the Feingold hypothesis. Pediatrics 61:818-828, June 1978. 9 Synthetic food colors and hyperactivity in children: a double-blind challenge" experiment. Pediatrics 62:975-983, Dec. 1978. Mathes, J., and Gittclman-Klein. R.A. Crossover study of artificial food colorings in a hyperkinctic child. Am.J.Psychiatry 135:987988, Aug. 1978. Levy, F., and Hobbes, G. Hyperkinesis and diet: a replication study9 Am.J.Psychiatry 135:1559-1560, Dec. 1978. Conners, C.K. Disruptive bchavi~ and artificial colors in the diet: current status of res e a r c h . IN The Treatment of Hyperactive and Learning Disorders, ed. by R.M. Knights and D.J. Bakkcr. Baltimore, Md., University Park Press, 1979. Weiss, B,, and others. Behavioral responses to artifical food colors9 Science 207:1487-1489, Mar. 28, 1980. Mathers, J., and Gittelman-Klein, R. Effects of Artificial Food Colorings in Children with Hyperactive Symptomatology. Glen Oaks, NY, Long Island Jewish-ltillside Medical Center, June 1980. (Unpub. manuscript) 17. National Advisory Committee on Hypcrkinesis and Food Additives. Final Report to the Nutrition Foundation. New York, The Nutrition Foundation, October 1980. 18. U.S. Food and Drug Administration. FD&C Red No. 2. (Unpublished study) Davis, K.J., and others. Chronic toxicity of Ponceau SX rats, mice, and dogs. Toxic.AppL Pharmacol. 8:306-317, Mar. 1966. FD&C Violet No. 1. (Unpublished Japanese study) U.S. National Cancer Institute, Temporary Committee for the Review of Data on the Carcinogenicity of Cyclamates. Cyclamates. Bethesda, Md., The Institute, 1976. U.S. National Institutes of Health. Carcinogenesis Bioassay of Trichloroethylene. (Carcinogenesis Technical Rep. Ser. No. 2) (DHEW Publ. 1Q0. (NIH) 76-802) Washington, D.C., U.S. Government Printing Office.