Health Impacts of the Industrialized Food System

Food Matters: A Clinical Education and Advocacy Program

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Food Matters: A Healthcare Education and Advocacy

Program

To inspire clinicians to:

Provide anticipatory guidance to patients and families about the importance of healthy foods and a healthy food system.

Work within health care facilities to create a healthy food service model that is recognized as integral to a preventive health agenda.

Work within the community at a local, regional and national level to promote policies that support the development of a healthy, accessible, and fair food system.

Clinical advisory group

Clinical curriculum development and • trainings

Nationwide clinical network

Maternal/Child health calendar

Video for waiting rooms, clinics, exam • rooms, community meetings

Healthy Food in Health Care campaign for healthier, more sustainable foodservice

Components of the Food Matters Program

Guiding Rationale An Ecological Health FrameworkThe individual in the context of family, community, society and ecosystem

Guiding Rationale A Food Systems Approach

Healthy food comes from a food system that is

ecologically soundeconomically viable, and

socially responsible.

Guiding Rationale A Food Systems Approach

Interconnections Between Nutrition and Environment

Barilla Centre for Food and Nutritionwww.barillacfn.com

Hospitals and healthcare professionals can be leaders and advocates for a food system that promotes public and environmental health.

Healthcare professionals have credibility, influence, and expertise.

Anti-smoking campaigns can be good models.

Guiding Rationale Healthcare Advocacy

Focus on inputs / outputs Specialization Resource intensiveness Large-scale

Farm as Factory

“The economic reductionism of modern industrial agriculture subjects the farm to the simplification, standardization and abstraction of a factory.”

- James Scott, 1998

HEALTH

SOCIETY

ENVIRONMENT

Chronic diseases (cancer, diabetes, obesity)

Antibiotic resistance & food-borne pathogens

Pesticide exposure (cancer, reproductive, neuro-developmental, and endocrine impacts)

Asthma and respiratory illness

Food injustice (hunger, food deserts)

Local economic decline

Labor issues

Water and air quality

Energy use and GHG emissions

Loss of crop and biological diversity

Soil erosion

Externalities of the Industrialized Food System

Where in the Food System do Health Concerns Exist?

ProductionPesticides, chemical fertilizers, antibiotic and hormone use in meat and dairy production, infectious agents, arsenic, environmental degradation

Processing Increased reliance on imported, unregulated processed foods; melamine; residual mercury; food-borne illness

Packaging / Transportation

Bisphenol A (BPA), phthalates, perfluorochemicals, air quality, food miles, widespread use of plastics leading to large volumes of waste both in landfills and incinerated, environmental degradation

Consumption Fast food, sugar-sweetened beverages, high fructose corn syrup, marketing, obesogens, nutritionally deplete foods

Toxics in the Food System

Pesticides Bisphenol A Phthalates Dioxins

PCBs Metals

lead, mercury, cadmium, manganese

PBDE flame retardants

Critical and Sensitive Windows of Development

Childhood →Periconception Prenatal Postnatal

Blastocyst EmbryoFetus

Infant ChildAdolescent

Environmental ExposuresImmediate & Long Term

Consequences

Based on analysis of representative sample of U.S. population by NHANES 2003-2004. Note, not all women were tested for all

chemicals

Widespread exposure to chemicals with reproductive/developmental toxicity

Body Burden: Pesticide Pollution in Children

www.ewg.org/reports/bodyburden

Pesticide exposure is ubiquitous among pregnant women. Pesticides have been detected in human urine, semen, breast milk, ovarian fluid, cord blood, and amniotic fluid.

Blood from the umbilical cords of 10 infants born in U.S. hospitals in 2004 showed an average of 200 industrial compounds, pollutants, pesticides and other chemicals, including 21 out of the 28 pesticides tested.

Our Chemical Environment

Over 85,000 synthetic chemicals in production 3,800 high production volume; used in quantities

> 1 million lbs/yr ~900 active pesticide ingredients (EPA) ~ 3,000 in food processing (FDA)

Toxic Substances Control Act of 1976 (TSCA) Health data exists for < 10% of chemicals on the

market 62,000 ‘grandfathered’ in Potential for endocrine disruption is not

assessed

Cumulative exposures matter Risk assessment and safety standards

use a 1-chemical-at-a-time approach

Toxicity / vulnerable periods of development

Bioconcentration

Persistence

Persistent Bioaccumulative Toxicants (PBT’s)

MercuryPBDEsDioxins

PCBsPesticides

DDT Heptachlor Dieldrin Chlordane

National Pesticide Use

Cumulative Exposures Add Up

~ 40% of US children may have OP pesticide levels greater than benchmarks for neurological impacts

Payne-Sturges D, Cohen J, Castorina R, et al. Evaluating cumulative organophosphorus pesticide body burden of children: a national case study. Environ Sci Technol. 2009 Oct 15;43(20):7924-30.

Carcinogenic Pesticide Use in California

CA Department of Pesticide Regulation Pesticide Use Reports, 2008. Mapped by CA Environmental Health Investigations Branch.

Pesticides and Cancer

Occupational exposure and cancer Organophosphate Pesticides – NHL, Leukemia Arsenical Pesticides – Lung, Skin cancer Triazine herbicides – Ovary

Epidemiologic studies associate pesticide exposure with cancer in children

Leukemia, neuroblastoma, Wilms' tumor, soft-tissue sarcoma, Ewing's sarcoma, non-Hodgkin's lymphoma, and cancers of the brain, colorectum, and testes

Non-Cancer Adverse Health Effects Prenatal Exposure to Organophosphate Pesticides

Decreased Bayley MDI and PDI scores at 36 months

(Rauh et al Pediatrics 2006)

Greater likelihood of behavioral issues on CBCL (Rauh et al Pediatrics 2006)

Abnormal primitive newborn reflexes (Brazelton NBAS) (Engel et al. Am J of Epid 2007)

Decreased birth weight and length (Whyatt et al. EHP 2004)

Smaller Head Circumference (Berkowitz et al. EHP 2004)

Decreased Bayley MDI at 24 mo. (Eskanazi et al, EHP 2007)

Effects of Preconception and Prenatal Exposure

Eskenazi B et al. Basic Clin. Pharmacol. Toxicol. 2008.

more…

OP Exposure in Children and ADHD

1139 children ages 8 – 15 (NHANES)Examined Urinary OP metabolites

Diagnosis of ADHD by DISC-IV or Med use

10-fold ↑ in urinary DMAP associated with an adjusted OR of 1.55 (1.14 – 2.10) for ADHD

Children with dimethyl thiophosphate > median had OR of 1.93 (1.23 - 3.02) for ADHD compared with children with ND levels

Bouchard et al. Pediatrics, 125(6), 2010

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Agri-chemicals in surface water and birth defects in the United States

Winchester et al. Acta Paediatr. 2009 April; 98(4): 664–669

Effects of Adult Male Pesticide Exposure

Sterility Altered semen quality Prostate cancer

Women

Hauser R. Semin Reprod Med. 2006; Swan SH. Semin Reprod Med. 2006;Diamanti-Kandarakis E et al. Endo Rev 20099

Effects of Postnatal Female Pesticide Exposure

Men WomenMen Age at puberty and menarche

Menstrual and ovarian function

Fertility and fecundity

Menopause Breast cancer

Mendola P, Messer LC, Rappazzo K.. Fertil Steril. 2008;Diamanti-Kandarakis E et al. Endo Rev 2009

Farm Workers and Pesticides

↑ rates of many cancers & respiratory illness

Mills and Kwong 2001, Linaker and Smedley 2002, Zahm 1997

↑ rates of birth defects & childhood leukemia

Wigle et al. 2009, Van Maele-Fabry et al. 2010.

10,000–20,000 acute poisonings per year in the U.S.

EPA 1992, Blondell 1997, Calvert 2008

Magnitude of Exposure

Prenatal OP exposure in a farm worker cohort associated with lower mental development index scores at 24 months

Median Maternal Urinary MDA level 0.82 mcg/L

(Eskenazi at al EHP 2007)

Child exposure through conventional produce diet

Median Child Urinary MDA level 1.5 mcg/L

(Lu et al EFP 2006)

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A bit of apples and oranges?In the same ball park but different exposure

windows

Pesticide Exposure Reduction

OP residues dramatically reduced (malathion, chlorpyrifos)

� in elementary school children with organic diets substituted for conventional diets for 5 days in a longitudinal designLu et al, EHP 2006

Choosing Produce to Reduce

Pesticide Exposure

www.ewg.org/foodnews

Recombinant Bovine Growth Hormone (rBGH)

Used to increase milk production in dairy cows

↑ udder infections, necessitating the use of antibiotics

↑ levels of insulin-like growth factor (IGF-1) found in milk

Banned inCanada, Australia, New Zealand,

Japan, all 25 countries of the European Union

Arsenic Use in Poultry Production

Arsenic is fed to ~70% of US broilers Chicken meat can carry arsenic residues

Chicken waste contains ¾ of arsenic dose 90% applied to cropland as fertilizer Fed as a protein source to beef cattle

Water Contamination 13 million Americans drink water contaminated

with arsenic beyond the safety standard of 10 ppb

Never approved for use inall 25 countries of the European

Union

Health Concerns Related to Arsenic Exposure

Cancer (even at low levels of exposure)

Neural tube defects

Neurodevelopmental effects

Diabetes

Heart disease

The Antibiotic Resistance Crisis

Without effective action, treatments for

common infections “will become

increasingly limited and expensive – and,

in some cases, nonexistent.”

Source: www.cdc.gov/ drugresistance/actionplan/

Source: Union of Concerned Scientists, "Hoggin' It" 2001

United States Antibiotic Use

0

5

10

15

20

25

30 NonRxAnimal

RxAnimal

HumanRx

Other(soaps,pets)

Millions of pounds

~80% is nontherapeutic use in livestock production

Antibiotics widely used in livestock production:ErythromycinTetracyclineBacitracinPenicillinSulfathiazoleSulfamethazineTylosin (macrolide)Virginiamycin (streptogramin)Fluroquinolones (withdrawn in 2000)

Agricultural Use of Antibiotics

There is consensus among

independent experts that

antibiotic use in agriculture

contributes to resistant

bacteria affecting humans.

Banned in Denmark and restricted in the European Union

HUMANS(General Populace)

Routes of human exposure to resistant bacteria

Antibiotics

Via WORKERSHandling of Feed, Manure; transfer to family, community

Via FOODSlaughter, Handling, Consumption (undercooked meat, cross-contamination)

Via ENVIRONMENTContamination of ground & surface water, spray fields by resistant bacteria AND undigested antibiotics from manure

Bacteria

Animals

David Wallinga, Institute for Agriculture and Trade Policy

Food Borne Illness in the U.S.

>47.8 million cases annually ~128,000 require hospital

care

~ 3,000 deaths annually 1/3 are from tainted meat

Multiple routes of exposure

20% of supermarket samples in Washington D.C. were contaminated with salmonella

84% of these isolates were resistant to at least one antibiotic

“The Isolation of Antibiotic-Resistant Salmonella from Retail Ground Meats”

Volume 345:1147-1154 October 18, 2001

Emerging Evidence

Bisphenol-A (BPA)

Widespread Human Exposure Over 90% of Americans have

residues in their urine (CDC) > 6 billions lbs produced / year

Health Concerns Endocrine disruption Neurodevelopmental impairment Developmental toxicity Cancers Cardiovascular disease &

diabetes Obesogen/Insulin Resistance

BPA and Phthalate Exposure: Findings from a Dietary Intervention

3 day “fresh foods” intervention

Urine levels of BPA and DEHP metabolites ↓ significantly

↓ of mean concentrations of BPA by 66% and DEHP by 53-56%

Rudel RA, et al. 2011. Environ Health Perspect. 119(7):914-920

Estradiol

Chemical Structure

Endocrine Disrupting Chemicals

Bisphenol A, PCBs, PBDEs, phthalates, organochlorine pesticides, atrazine

Chemical compounds with the capacity to interfere with development, behavior, fertility and maintenance of homeostasis

Health concerns include: reproductive problems, early puberty, brain and behavior problems, impaired immune functions, various cancers

Obesogens

Bisphenol A, phthalates, non-stick PFOAs,

and certain organophosphate pesticides Chemical compounds hypothesized

to disrupt normal development or homeostasis of metabolism of lipids, ultimately resulting in obesity

Interplay between genes and fetal and early postnatal exposures

National Academy of Sciences on Animal Data

Studies of comparison between developmental effects in

animals and humans find that “there is concordance of

developmental effects between animals and humans and that humans are as sensitive or

more sensitive than the most sensitive animal

species”.

A Precautionary Approach

An ounce of prevention is worth a pound of cure.

When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically.

-Wingspread Conference on the Precautionary Principle

HEALTH AND ENVIRONMENTAL COSTS

ARE NOT REFLECTED IN THE PRICE OF FOOD OR

ACCOUNTED FOR IN THE FOOD SYSTEM

Promoting health

Households

Institutions

Communities

Regionally

Nationally, Globally

David Wallinga, Institute for Agriculture and Trade Policy

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Making change

In your practice

Calendars available at www.HealthyFoodinHealthCare.

org

Increase procurement of healthy food for healthy bodies, farms, communities and environment

Make food a part of the healing process

Lead by example and educate patients, visitors, and the community about healthy, sustainable food

Pool purchasing power to move the marketplace

Making change

In Hospitals

www.HealthyFoodinHealthcare.org

Making change

In Hospitals

Over 380 Pledge signers

in 26 states

www.HealthyFoodinHealthcare.org

ProcurementCafeteria &Patient trays

Buying local, organic, fair trade, rBGH-free, antibiotic and hormone-free, grass-fed, cage-free

Reducing meat & sugar sweetened

beverages

↑ Contracting with local and regional

vendors, farmers, distributors and processors

On-site Farmers’ markets & hospital gardens Waste reduction - composting & reusable dishes

PolicyHealthy Food in Health Care Pledge Advocating for federal legislation, e.g. Preservation of Antibiotics for Medical Treatment Act

What Health Care Facilities Are Doing

4 Pilot Hospitals: Reduced meat by 28% in 12

months

Achieved $402,000 savings Used savings to purchase more

sustainably-produced meat

Saved the equivalent of over 1,000 tons/year reductions in greenhouse gas emissions

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Making change

In Hospitals

Balanced Menus Challenge

Making change

In Communities

Farm to School Farmtoschool.org

Sustainable Table Sustainabletable.org

Community Food Security Coalition Foodsecurity.org

Making change

Nationally

Sign the Charter atwww.HealthyFoodAction.org

Facebook - A Citizen’s Guide to a Better Food System

Literature: Wallinga D. Contribution of Agricultural Policy to Childhood Obesity. Health Affairs. March 2010

Imhoff. Food Fight: The Citizen’s Guide to a Food and Farm Bill

Webinars: www.HealthyFoodAction.org

The Farm Bill

Making change

Nationally

Healthy Food ActionMaking Health the Future of Food and Farmingwww.healthyfoodaction.org Safer Chemicals, Healthy FamiliesReform Toxic Substances Control Act (TSCA) to keep toxins out of

foodwww.saferchemicals.org

Preservation of Antibiotics for Medical Treatment Act Sign the Health Care Without Harm Petition www.protectantibiotics.org

Principles of a Healthy, Sustainable Food System

Uniting health professions in a common visionhttp://www.planning.org/nationalcenters/health/food.htm

Food Matters Clinical Advisory TeamJudy Focareta, RNJoel Forman, MD

Sarah Janssen, MDPreston Maring, MDJoanne Perron, MD

Naomi Stotland, MDDavid Wallinga, MD

Food Matters is made possible with generous support from:

Rose Foundation Stonyfield Organics Profits for the Planet Program The Cedar

Tree FoundationThe Orchard Foundation W.K. Kellogg Foundation