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Food additives—protection or poison?
NUTRITION Food Additives-Protection or Poison? PEGGY KLOSTER YEN Must the elderly fear the food they eat? Mention food additives, and many of them immediately think cancer. The downbeat reports on everything from saccharin to ethylenedibromide led columnist Russell Baker to lament that the "only way to live forever, it seemed, was never to eat again.?" Many of today's 80- and 90-year olds grew up eating simple, fresh foods. All of them contained chemicals. Confusion about chemicals in food arises from the use of words like natural, synthetic, and imitation to describe foods. An egg is a natural food by any definition. Yet it contains lecithin, butyric acid, zeaxanthin, phosphates, and a host of other substances that are all chemicals. Frozen and packaged convenience foods, on the other hand, are a relatively new innovation. It is primarily these foods that require additives. Although all foods contain chemicals, all foods do not necessarily contain additives and are not necessarily dangerous. What precautions are necessary in choosing foods? A reasonable approach to judging food additives is to consider risk versus benefit. What does the additive contribute? What are its known or potential ill effects? Take food colors, for instance. They contribute no nutritional value to food, and although color is an important esthetic property of food, it is not necessary for good health. The color of food does give a clue about its taste. Red foods might be strawberry, cherry or ·Baker, Russell. "Eating Is Like Picking Your Way Through A Mine Field." Baltimore Sun, October IS, 1982, p. A 17.
Peegy Kloster Yen, RD, MPH, is a consultant and writer on the management of nutrition in health and in chronic disease.
COMMON FOOD ADD ITIVES Additive
Function
Pres rvat ives
Retard foo d spo ilag by microo r ani ms Example: prop ionates in baked g ood s.
Antiox ida nts
Prevent undesirab le chan es from o xy n, such as rancidity in fats and oils. Butylat ed hydro xyanisole (BH A) is a common antioxidant.
Emuls ifiers Th ickeners
Produce homogeneous mixtures from items that do not naturally combine , such as oil sn d vinegar in salad dressing . Give body to food . fo r exampl , the pectin in jam.
pH contro llers
Con tro l acid ity and al alinity , for tartn ss of fruit drin s.
Nutrients
Vitam ins and minerals fortily foods or r pla c nutrients lo st in processing. for ex ampl , iron to enrich flour .
Flavors Colors:
Add natural or synthetic color and fla vor. Examples: naturally occurring caret ne to mar arin and synthetic orange dye to oran es .
Leavening ag nts
Yeast , ba k ing po wd r, and other agents Ii hten be ed foods.
M isce llan ous agents
Serve many funct ions . BI ach ing a nts re used in mill ing flour . Glycerine, a humectant, IS added to coconut to p it moi l. Foaming 8 ents ligh t n w hip ped toppings . Nonnutritiv sw t ners, such as saccharin. dd flavor. Anticaking ag nts p granular and po wdored foods from form ing lumps .
tomato flavored but probably not chocolate or lemon flavored. Some food colors used for many years are now banned, such as Food, Drug, and Cosmetic red dye #2 and #4 and orange #2. These were related to organ damage or cancer in animal studies. Some food colors are natural, such as carotene, which is added to margarine. Many other food dyes require further safety test-
xe mpl , the
ing. Coloring agents are one category of additive where the risk outweighs the benefit. Avoiding them is probably wise. If the use of synthetic food colors is ever banned entirely, however, be prepared for white margarine and gray hotdogs! Other categories of food additives include flavorings, leavening agents, sequestrants, humectants, sweeteners, antioxidants, emulsifiers, stabiGeriatric Nursing November/December 1984385
ELASE· (fibrinolysin and desoxyrlboouclease. combined (bovine]) ELASE OiNtMENT (fibrinolysin and desoxyrlboouclease. combined [bovine]. ointment)
NUTRITION
Belen pracriblng. pIuu _ full pqscrlblng Inlormatlon. A Bn.f Summary Iollo'n:
IHDlCATIONS. Elase is indi caled lor topical use as a de bridi ng age nt in 3 variety of inflamma!ory and infect ed
tes-oos. These inc lude (1) gene ral sur gocalwoun ds: (2) uJceratrve leSlo." ,\s-trophlC.decubit us. stasis. arterioscteronc; (3) seccoc -and th"d·degree bu rns; (4 ) circumcrsrooand ep is'otomy Elase 'S used mtravag inally in (1) cervicms-«ben,gn. postpartum, and postcoruzanco. and (2) vagi n'll s Elase (fib rino lys in and desos ynbon uctease , combmed [bovine]l solut,on is used as an ""gal ,ng age nl in (1) inlected wou nds- abscesses. fistulae. and smus trac ts: (2) ot orhirola ryngologic wound s; (3) supe r. focial hemalomas (e xcept wh en the he matoma 'Sad,a· cent to or wi1hin adipose tissue) CONTflAlHDICATlON. Erase is not recommended lor parenteral usc bec ause the bo vine fIbrinol ysin may b e anl igen ic . PRECAUTIONS. The usual precaut.oes ag a:nst a!lerg ic reactions shoul d be ob serv ed . part icu larly in p erson s w ilh a h i ~t ory of sensitivi ty to materials 01bo vine origin or to merc ury compound s. To be ma'
more aher reconstltuhon. ADVERSE REACTlONS. Side cnects attnbutable to the enzym es have not boen a problem at the dose and for the lnejlcatlons recommended herein. WIth higher concentr ation s. sid e eff ects have been minimal. consi stmq of loc al hyp oromia Ch ills and fever attnb utab te to anl ,genrc act ion of p rof.brioolysin ac nvarors of b act erial or ig in arc not a pr oblem wllh Elase. PREPARATION OF ELASE SOLUTION. The c ontents 01 each vial may be rcconshtutcd With to ml of isotonic sodlUI n chl oflde solution . Higher or Sower con cen trat ions c an be prepa red old esired by vary,ng the amounl onne di lu ent. DOSAGE AND ADUlNlSTRAnOH. Because the cononoos lor ....h 'c h Ela se is h elp ful vary c on side rably III sevenly. oosace must be adjuste d 10 lhe ind ividual ca se; however. t ~ e 'o~ow .n;1 gencral rccommcndatlons c an b e mad e Successf ul usc of enzyme d cb"d emcnl d ep ends on several tactors (1) dense. dry escha r. ,f prese nt , shou ld be removed surgically be fore enzy mat ic d cb nd ernent is a ttempt ed : (2) rho enzyme must be m con stant c ontacl with the substrate: (3) ac cumulated necronc oebns most be period 'ca lly remo ved . (4) tho enz yme mus t be rep lenished a t teast once da,ly; and (5) secon da ry cl osure o r ski n 9'a!l iflCJ must be emplo yed as soon a s possibtc after OPhmal deb nd cment has been anained . It is lu rlher essential tnat wound·dr es slng teChnique s be p erlarm ed ca relully und er aseptic cone-tons and mat aopropoate syst emic ally acting anllb iotlc s be ad mlnisl ercd conc om Ita ntly If. In the op inion 01the phYSICian . they are IndlC3ted . Genenll Topical U...: seiecnooof the product form and the dur allon of treatm eot must 10a great extent be lell to Ihe d ,scr et,on of tne pny sicran. Local appllcal ,on of the appropnate product should be repealed anoterva ts for as long as enzyme ac tion is desired. Elase solution may be apphcd 10p ic a~ly as a "Quid. spray. Of wei cressing Appl'cahon of a g entle spray of tne solution can be accomplished by USIng a conventional atomizer . After appllcanoo . Erase. es pec ially in sotutoo. become s rap id~y and prog ressive!)' less act ive and is pmbab~y exha usted for pr act ic al purposes at Ihe end of 24 hours . The dry mal cn al for so'unon and the oenment are stable a t room tem p era ture lhrough the exp.ranoo d ale punt ed on tho packa ao . lntraY8ginal Use: In rmtd 10moderate vag ,n'hs and c ervicms. 5 mJ01Etase Oinl menl should be d eposued dee p in the vag iM onc e nigh tly at bcdhmc lor approxlrnately 'Ive apphC()lIon S. 01 un nlthe entne con rents of one 3O-g tube ol Ela sehas be en used The pat 'ent should be cncex eo by her ph ysician /0 deterrmne po ssrb te need for furt her therapy In more severe c ervic ms and vag in.tls. som e physic ians p refer IOl lall,. to insltl l l 0 ml of the [lase (flbflnoly sin and d esoxyribon uclcJ5C. c om bined [ bovine]) sc lunoo inlravag,nalty. walt cne or two minutes tor the enzyme to o.spe rse. and then insert a ca lico tampon in the vag inal c anal. The tampon should be removed tne ned d ay. touowcd by as ma ny ap pbc ations of Elase Ointm ent as neces sary
.....pywma CIIv1t1n. IIm_. sinus _ .0< subcutaneous he
De spite the traind lcat ion aga in st p arent eral use. Etase has been us ed in irrigating these spec ihc cooo.noos. The [lase soJuhOrl~ould be d rained and replaced at intervals of SIX 10 l e n hours 10 rcdu::c tne amount of by .product
accumctat.oo a:-:dminrruze Sass 01enzymc a: I:v::y Traces 01blood ,n me dl scha l ge usueilfy indl ca1c active idling 1001the c avity Zf'
PARKE-DAVIS
Div of Warner·Lamberl Co Morris Plains, NJ 07950 USA PD·21 ·JA·0285·P·l (6- 81)
388 Geriatric: Nursinl November/December 1984
lizers, and nutrient supplements (see box). Two of the most common additives are sugar and salt, ingredients most of us don't even consider to be additives. Excessive salt consumption (actually sodium) is linked to the development of high blood pressure in susceptible individuals and, therefore, to stroke and heart attack. Eating sticky, sugar-containing foods causes tooth decay and usually provides only empty calories. Sugar and salt in food do serve an important function, for example, as preservatives. The high concentration of sugar in jam helps precipitate pectin to form a gel and also prevents mold growth. Salt has long been used as a preservative in curing meats and pickling. Large amounts of salt and sugar tie up the water in food so that it is not available for microbial growth. Many of the same foods could be frozen or canned using much less salt and sugar, so preserving with great quantities of salt and sugar is not really necessary for protecting public health. However, the public is far less anxious to avoid salt and sugar than to ban certain other food additives. The pervasive fear of cancer deepens the perception that danger from chemicals is greater than the danger from "normal," or familiar, foods. If we are to have a varied food supply, readily available when needed, then food additives are necessary. A very small percentage of Americans produce all the food for the rest of us. Additives keep that food fresh, tasty, and free from contamination until we buy it and use it. Without them, we would need to shop daily for groceries, as many elders can remember doing. Some foods wouldn't be available at certain times of year and others would be more expensive. But this does not mean that we have to accept the hazard associated with some food additives. Tbe Delaney Clause The 1938 Food, Drug, and Cos rnetic Act, as amended, is the basis for the protection of the food supply. A 1958 amendment included the Delaney clause, named after its author, New York Congressman James De-
laney. This paragraph specifies that no additives can be used in food if they are found to cause cancer in animals or humans. At the time of this amendment, certain food additives were exempted from testing requirements and placed on a list called Generally Recognized As Safe, or GRAS. Since then, any item added to food that is not on the GRAS list has been tested for safety. Disagreements about the safety of food additives center on the GRAS list, on the type of testing, and on the fact that only animal experiments are done. Salt, nitrates, caffeine, monoso dium glutamate (Accent), and sodium benzoate are some of the items on the GRAS list. Saccharin, removed from the list in 1972, can be added to food if it carries a warning label. Public pressure has made the Food and Drug Administration strengthen food additive policies in recent years. But it was also public pressure that forced Congress to make the FDA remove the ban on saccharin, in spite of the Delaney clause. When it comes to food-additive safety, Americans sometimes give contradictory signals. . The FDA began a review of the GRAS list in 1971. It was completed in 1980. Most additives were again found to be safe. About 25 percent were found to need further testing. Some of these face restrictions in use until proven safe. What to AYoid
There are very few additives that older adults need to avoid completely. Sugar and salt are okay in moderate amounts. Saccharin, nitrates, nitrites, and artificial food colors are the only common additives that the elderly may want to avoid because of their potential for causing cancer. The types of foods most likely to contain these additives-low-calorie foods, cured meats, desserts, and snack foods-should not be major components of the older person's diet. The inferior nutritional value of many of these foods also limits their usefulness. Elders who have asthma will want to avoid the sulfiting agents used to preserve the fresh appearance o( raw fruit and vegetables
8ee n co ns ide ring a cha nge ? A re yo lo ok in g for ro e .... cna tle g e and the ch anc e to ex pand yo ur ro r si n g ed ucat ion? Seel{ ing a tra ns format io n In yo ur li fes t yl e? Th en co ns i er aos weu Mem orial, no w !
o
r355 bed ho sp ita l i s s it ate d in Sun Cit y , a no r thwest ern S bu rn o f Phoenix , and i s de sig ned to m eet the need s of 0 r g row ing comm u nit y. And , o r sun ny year 'ro nd ou td o or lif esty le and rich c /t ural res o urces w ,II ens re that " aft er ho u rs" are as sat is f Yin g as y o r ho rs at wo r . 80s we ll i s preparing f or the f ut u re. /Ve ant tc toare a need f o r ex pe rien c ed Reg istered . urs es in earl y 198 5 to prov id e pati ent care serv ices in th e areas o f :
" Chec k Nlt h Us " to rece ive f urt her de ta il s concern ing these pro fess io na l opportun it ies r Ass is ta nt Dir ec t o r o f at 8 0 swe ll. Please call urs i ng fo r Rec ru itm en t! Rete t i on at (602) 876-5376 , o r fill in t e c o pon oe low .
, Thund erb ird BI·Jd .
Sun Ci t y, AZ 85351
Eq al Op po rtun it y Em p lo yer M I F I H
_ _ _ _ _ _ _ _ _ _ _ __ _ _ _ State
Phone ( Zip
Circle No. 12 on Reader Service Card
1
Circle No. 11 on Reader Service Card Geriatric Nursing No vember/December 1984389
NUTRITION
n caring for pati t at ri r ur s r w hat h ' pp en
betu/ en turns? On ,rant Peripheral Circulatory A . i ( P \ ) Pad
Ti ue
On weig h t dis tributing de ices t
a te Removed
(fleece , foam , , gels, water mattress ' , and o ther .raric d vices)
Ti ue '\ as te: Accumulate
through peripheral v ins, lyrnphati " and othcr : mall ir ularory p assagl~ .
in tens of millions of v in , lyrnphat i s and other . mall ircu lato ry pas ag within ri ucs,
Rc ult : 0.0% I cw Pre.. ure ore - Ex cpt in ca e lik riti al
Result: The TIssue Trauma Resea r h .enrer e rimared over 600,000 presu r ore patient in th nited late.
nutritional d ficiency (2-3% o f di 'abled per, o n, ). As cffe live again t pressure sore: as . alk accine again r Polio .
in 19 3 (30,000 in Illinois nur ing homes alone [ .hi ago un TImes, j une 9 19 3].).
For fur ther information o n Peripheral 'ir ulatory A i r ( P \ )n " Inquire: Washing ton Blvd. ' tamfo rd, Ct. 01>901
1010
!oo J j!. 7-21 50
Circle No. 13 on R 390 Geriatric Nursing November/December 1984
Soo 24 3-5237
at salad bars. They may not be labeled, so it's wise to question the management. Protecting the food supply is a formidable task. Recently, the National Research Council reported that there were enough data on only five percent of additives in use to allow a complete health-hazard appraisal. This is perhaps the greatest problem with food additives. In many cases, we just don't know for sure what harm they can cause and in what amounts. Most additives were permitted long before rigorous testing was required, and most people assume that familiar foods that have been in use for hundreds of years are free from harmful substances. A look at some common foods proves otherwise. Arsenic, a powerful poison, is found in oysters, shrimp, and virtually every other food we eat. Potatoes contain solanine, a toxin. Cabbage and kale contain goitrogens, which affect thyroid function. None of these foods is thought to cause significant disease. But the presence of such chemicals in everyday foods illustrates the problems the FDA faces in protecting the food supply.. What level of a toxin is acceptable in a food? How many people are susceptible to low levels of an additive? Even if an additive can't kill, what about individual, allergic response? How much are we willing to sacrifice in convenience, availabilty, and nutritional value in order to rid the food supply of any additive that contributes to any health problem? No one has satisfactory answers to these questions. Until we do, government agencies will ban substances like ethylenedibromide and citizens will protest the introduction of new processing methods such as food irradiation. Politics, consumerism, and science will wage the battle over additives until a conclusion acceptable to the majority is reached. There is probably no absolutely safeIevel of food additives, just as there is no absolute safety in breathing the air around us or in driving a car. All we can expect is rigorous testing and responsible judgment about what goes in our food.
Peegy Kloster Yen, RD, MPH, is a consultant and writer on the management of nutrition in health and in chronic disease.
COMMON FOOD ADD ITIVES Additive
Function
Pres rvat ives
Retard foo d spo ilag by microo r ani ms Example: prop ionates in baked g ood s.
Antiox ida nts
Prevent undesirab le chan es from o xy n, such as rancidity in fats and oils. Butylat ed hydro xyanisole (BH A) is a common antioxidant.
Emuls ifiers Th ickeners
Produce homogeneous mixtures from items that do not naturally combine , such as oil sn d vinegar in salad dressing . Give body to food . fo r exampl , the pectin in jam.
pH contro llers
Con tro l acid ity and al alinity , for tartn ss of fruit drin s.
Nutrients
Vitam ins and minerals fortily foods or r pla c nutrients lo st in processing. for ex ampl , iron to enrich flour .
Flavors Colors:
Add natural or synthetic color and fla vor. Examples: naturally occurring caret ne to mar arin and synthetic orange dye to oran es .
Leavening ag nts
Yeast , ba k ing po wd r, and other agents Ii hten be ed foods.
M isce llan ous agents
Serve many funct ions . BI ach ing a nts re used in mill ing flour . Glycerine, a humectant, IS added to coconut to p it moi l. Foaming 8 ents ligh t n w hip ped toppings . Nonnutritiv sw t ners, such as saccharin. dd flavor. Anticaking ag nts p granular and po wdored foods from form ing lumps .
tomato flavored but probably not chocolate or lemon flavored. Some food colors used for many years are now banned, such as Food, Drug, and Cosmetic red dye #2 and #4 and orange #2. These were related to organ damage or cancer in animal studies. Some food colors are natural, such as carotene, which is added to margarine. Many other food dyes require further safety test-
xe mpl , the
ing. Coloring agents are one category of additive where the risk outweighs the benefit. Avoiding them is probably wise. If the use of synthetic food colors is ever banned entirely, however, be prepared for white margarine and gray hotdogs! Other categories of food additives include flavorings, leavening agents, sequestrants, humectants, sweeteners, antioxidants, emulsifiers, stabiGeriatric Nursing November/December 1984385
ELASE· (fibrinolysin and desoxyrlboouclease. combined (bovine]) ELASE OiNtMENT (fibrinolysin and desoxyrlboouclease. combined [bovine]. ointment)
NUTRITION
Belen pracriblng. pIuu _ full pqscrlblng Inlormatlon. A Bn.f Summary Iollo'n:
IHDlCATIONS. Elase is indi caled lor topical use as a de bridi ng age nt in 3 variety of inflamma!ory and infect ed
tes-oos. These inc lude (1) gene ral sur gocalwoun ds: (2) uJceratrve leSlo." ,\s-trophlC.decubit us. stasis. arterioscteronc; (3) seccoc -and th"d·degree bu rns; (4 ) circumcrsrooand ep is'otomy Elase 'S used mtravag inally in (1) cervicms-«ben,gn. postpartum, and postcoruzanco. and (2) vagi n'll s Elase (fib rino lys in and desos ynbon uctease , combmed [bovine]l solut,on is used as an ""gal ,ng age nl in (1) inlected wou nds- abscesses. fistulae. and smus trac ts: (2) ot orhirola ryngologic wound s; (3) supe r. focial hemalomas (e xcept wh en the he matoma 'Sad,a· cent to or wi1hin adipose tissue) CONTflAlHDICATlON. Erase is not recommended lor parenteral usc bec ause the bo vine fIbrinol ysin may b e anl igen ic . PRECAUTIONS. The usual precaut.oes ag a:nst a!lerg ic reactions shoul d be ob serv ed . part icu larly in p erson s w ilh a h i ~t ory of sensitivi ty to materials 01bo vine origin or to merc ury compound s. To be ma'
more aher reconstltuhon. ADVERSE REACTlONS. Side cnects attnbutable to the enzym es have not boen a problem at the dose and for the lnejlcatlons recommended herein. WIth higher concentr ation s. sid e eff ects have been minimal. consi stmq of loc al hyp oromia Ch ills and fever attnb utab te to anl ,genrc act ion of p rof.brioolysin ac nvarors of b act erial or ig in arc not a pr oblem wllh Elase. PREPARATION OF ELASE SOLUTION. The c ontents 01 each vial may be rcconshtutcd With to ml of isotonic sodlUI n chl oflde solution . Higher or Sower con cen trat ions c an be prepa red old esired by vary,ng the amounl onne di lu ent. DOSAGE AND ADUlNlSTRAnOH. Because the cononoos lor ....h 'c h Ela se is h elp ful vary c on side rably III sevenly. oosace must be adjuste d 10 lhe ind ividual ca se; however. t ~ e 'o~ow .n;1 gencral rccommcndatlons c an b e mad e Successf ul usc of enzyme d cb"d emcnl d ep ends on several tactors (1) dense. dry escha r. ,f prese nt , shou ld be removed surgically be fore enzy mat ic d cb nd ernent is a ttempt ed : (2) rho enzyme must be m con stant c ontacl with the substrate: (3) ac cumulated necronc oebns most be period 'ca lly remo ved . (4) tho enz yme mus t be rep lenished a t teast once da,ly; and (5) secon da ry cl osure o r ski n 9'a!l iflCJ must be emplo yed as soon a s possibtc after OPhmal deb nd cment has been anained . It is lu rlher essential tnat wound·dr es slng teChnique s be p erlarm ed ca relully und er aseptic cone-tons and mat aopropoate syst emic ally acting anllb iotlc s be ad mlnisl ercd conc om Ita ntly If. In the op inion 01the phYSICian . they are IndlC3ted . Genenll Topical U...: seiecnooof the product form and the dur allon of treatm eot must 10a great extent be lell to Ihe d ,scr et,on of tne pny sicran. Local appllcal ,on of the appropnate product should be repealed anoterva ts for as long as enzyme ac tion is desired. Elase solution may be apphcd 10p ic a~ly as a "Quid. spray. Of wei cressing Appl'cahon of a g entle spray of tne solution can be accomplished by USIng a conventional atomizer . After appllcanoo . Erase. es pec ially in sotutoo. become s rap id~y and prog ressive!)' less act ive and is pmbab~y exha usted for pr act ic al purposes at Ihe end of 24 hours . The dry mal cn al for so'unon and the oenment are stable a t room tem p era ture lhrough the exp.ranoo d ale punt ed on tho packa ao . lntraY8ginal Use: In rmtd 10moderate vag ,n'hs and c ervicms. 5 mJ01Etase Oinl menl should be d eposued dee p in the vag iM onc e nigh tly at bcdhmc lor approxlrnately 'Ive apphC()lIon S. 01 un nlthe entne con rents of one 3O-g tube ol Ela sehas be en used The pat 'ent should be cncex eo by her ph ysician /0 deterrmne po ssrb te need for furt her therapy In more severe c ervic ms and vag in.tls. som e physic ians p refer IOl lall,. to insltl l l 0 ml of the [lase (flbflnoly sin and d esoxyribon uclcJ5C. c om bined [ bovine]) sc lunoo inlravag,nalty. walt cne or two minutes tor the enzyme to o.spe rse. and then insert a ca lico tampon in the vag inal c anal. The tampon should be removed tne ned d ay. touowcd by as ma ny ap pbc ations of Elase Ointm ent as neces sary
.....pywma CIIv1t1n. IIm_. sinus _ .0< subcutaneous he
De spite the traind lcat ion aga in st p arent eral use. Etase has been us ed in irrigating these spec ihc cooo.noos. The [lase soJuhOrl~ould be d rained and replaced at intervals of SIX 10 l e n hours 10 rcdu::c tne amount of by .product
accumctat.oo a:-:dminrruze Sass 01enzymc a: I:v::y Traces 01blood ,n me dl scha l ge usueilfy indl ca1c active idling 1001the c avity Zf'
PARKE-DAVIS
Div of Warner·Lamberl Co Morris Plains, NJ 07950 USA PD·21 ·JA·0285·P·l (6- 81)
388 Geriatric: Nursinl November/December 1984
lizers, and nutrient supplements (see box). Two of the most common additives are sugar and salt, ingredients most of us don't even consider to be additives. Excessive salt consumption (actually sodium) is linked to the development of high blood pressure in susceptible individuals and, therefore, to stroke and heart attack. Eating sticky, sugar-containing foods causes tooth decay and usually provides only empty calories. Sugar and salt in food do serve an important function, for example, as preservatives. The high concentration of sugar in jam helps precipitate pectin to form a gel and also prevents mold growth. Salt has long been used as a preservative in curing meats and pickling. Large amounts of salt and sugar tie up the water in food so that it is not available for microbial growth. Many of the same foods could be frozen or canned using much less salt and sugar, so preserving with great quantities of salt and sugar is not really necessary for protecting public health. However, the public is far less anxious to avoid salt and sugar than to ban certain other food additives. The pervasive fear of cancer deepens the perception that danger from chemicals is greater than the danger from "normal," or familiar, foods. If we are to have a varied food supply, readily available when needed, then food additives are necessary. A very small percentage of Americans produce all the food for the rest of us. Additives keep that food fresh, tasty, and free from contamination until we buy it and use it. Without them, we would need to shop daily for groceries, as many elders can remember doing. Some foods wouldn't be available at certain times of year and others would be more expensive. But this does not mean that we have to accept the hazard associated with some food additives. Tbe Delaney Clause The 1938 Food, Drug, and Cos rnetic Act, as amended, is the basis for the protection of the food supply. A 1958 amendment included the Delaney clause, named after its author, New York Congressman James De-
laney. This paragraph specifies that no additives can be used in food if they are found to cause cancer in animals or humans. At the time of this amendment, certain food additives were exempted from testing requirements and placed on a list called Generally Recognized As Safe, or GRAS. Since then, any item added to food that is not on the GRAS list has been tested for safety. Disagreements about the safety of food additives center on the GRAS list, on the type of testing, and on the fact that only animal experiments are done. Salt, nitrates, caffeine, monoso dium glutamate (Accent), and sodium benzoate are some of the items on the GRAS list. Saccharin, removed from the list in 1972, can be added to food if it carries a warning label. Public pressure has made the Food and Drug Administration strengthen food additive policies in recent years. But it was also public pressure that forced Congress to make the FDA remove the ban on saccharin, in spite of the Delaney clause. When it comes to food-additive safety, Americans sometimes give contradictory signals. . The FDA began a review of the GRAS list in 1971. It was completed in 1980. Most additives were again found to be safe. About 25 percent were found to need further testing. Some of these face restrictions in use until proven safe. What to AYoid
There are very few additives that older adults need to avoid completely. Sugar and salt are okay in moderate amounts. Saccharin, nitrates, nitrites, and artificial food colors are the only common additives that the elderly may want to avoid because of their potential for causing cancer. The types of foods most likely to contain these additives-low-calorie foods, cured meats, desserts, and snack foods-should not be major components of the older person's diet. The inferior nutritional value of many of these foods also limits their usefulness. Elders who have asthma will want to avoid the sulfiting agents used to preserve the fresh appearance o( raw fruit and vegetables
8ee n co ns ide ring a cha nge ? A re yo lo ok in g for ro e .... cna tle g e and the ch anc e to ex pand yo ur ro r si n g ed ucat ion? Seel{ ing a tra ns format io n In yo ur li fes t yl e? Th en co ns i er aos weu Mem orial, no w !
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r355 bed ho sp ita l i s s it ate d in Sun Cit y , a no r thwest ern S bu rn o f Phoenix , and i s de sig ned to m eet the need s of 0 r g row ing comm u nit y. And , o r sun ny year 'ro nd ou td o or lif esty le and rich c /t ural res o urces w ,II ens re that " aft er ho u rs" are as sat is f Yin g as y o r ho rs at wo r . 80s we ll i s preparing f or the f ut u re. /Ve ant tc toare a need f o r ex pe rien c ed Reg istered . urs es in earl y 198 5 to prov id e pati ent care serv ices in th e areas o f :
" Chec k Nlt h Us " to rece ive f urt her de ta il s concern ing these pro fess io na l opportun it ies r Ass is ta nt Dir ec t o r o f at 8 0 swe ll. Please call urs i ng fo r Rec ru itm en t! Rete t i on at (602) 876-5376 , o r fill in t e c o pon oe low .
, Thund erb ird BI·Jd .
Sun Ci t y, AZ 85351
Eq al Op po rtun it y Em p lo yer M I F I H
_ _ _ _ _ _ _ _ _ _ _ __ _ _ _ State
Phone ( Zip
Circle No. 12 on Reader Service Card
1
Circle No. 11 on Reader Service Card Geriatric Nursing No vember/December 1984389
NUTRITION
n caring for pati t at ri r ur s r w hat h ' pp en
betu/ en turns? On ,rant Peripheral Circulatory A . i ( P \ ) Pad
Ti ue
On weig h t dis tributing de ices t
a te Removed
(fleece , foam , , gels, water mattress ' , and o ther .raric d vices)
Ti ue '\ as te: Accumulate
through peripheral v ins, lyrnphati " and othcr : mall ir ularory p assagl~ .
in tens of millions of v in , lyrnphat i s and other . mall ircu lato ry pas ag within ri ucs,
Rc ult : 0.0% I cw Pre.. ure ore - Ex cpt in ca e lik riti al
Result: The TIssue Trauma Resea r h .enrer e rimared over 600,000 presu r ore patient in th nited late.
nutritional d ficiency (2-3% o f di 'abled per, o n, ). As cffe live again t pressure sore: as . alk accine again r Polio .
in 19 3 (30,000 in Illinois nur ing homes alone [ .hi ago un TImes, j une 9 19 3].).
For fur ther information o n Peripheral 'ir ulatory A i r ( P \ )n " Inquire: Washing ton Blvd. ' tamfo rd, Ct. 01>901
1010
!oo J j!. 7-21 50
Circle No. 13 on R 390 Geriatric Nursing November/December 1984
Soo 24 3-5237
at salad bars. They may not be labeled, so it's wise to question the management. Protecting the food supply is a formidable task. Recently, the National Research Council reported that there were enough data on only five percent of additives in use to allow a complete health-hazard appraisal. This is perhaps the greatest problem with food additives. In many cases, we just don't know for sure what harm they can cause and in what amounts. Most additives were permitted long before rigorous testing was required, and most people assume that familiar foods that have been in use for hundreds of years are free from harmful substances. A look at some common foods proves otherwise. Arsenic, a powerful poison, is found in oysters, shrimp, and virtually every other food we eat. Potatoes contain solanine, a toxin. Cabbage and kale contain goitrogens, which affect thyroid function. None of these foods is thought to cause significant disease. But the presence of such chemicals in everyday foods illustrates the problems the FDA faces in protecting the food supply.. What level of a toxin is acceptable in a food? How many people are susceptible to low levels of an additive? Even if an additive can't kill, what about individual, allergic response? How much are we willing to sacrifice in convenience, availabilty, and nutritional value in order to rid the food supply of any additive that contributes to any health problem? No one has satisfactory answers to these questions. Until we do, government agencies will ban substances like ethylenedibromide and citizens will protest the introduction of new processing methods such as food irradiation. Politics, consumerism, and science will wage the battle over additives until a conclusion acceptable to the majority is reached. There is probably no absolutely safeIevel of food additives, just as there is no absolute safety in breathing the air around us or in driving a car. All we can expect is rigorous testing and responsible judgment about what goes in our food.