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August 3, 2017

Is your mac and cheese really 'toxic'? Probably not.

Daily Briefing

A paper recently published online suggests fans of boxed macaroni and cheese should be worried about potentially harmful chemicals called phthalates in the processed food products—but critics say the concerns are unwarranted. 

What are phthalates?

Phthalates "are industrial chemicals used to soften plastics and are used as solvents, in adhesives and in ink on packaging," the New York Times' "Well" reports. While phthalates are not intentionally added to food, they can work their way in through food processing equipment, such as plastic tubing and conveyor belts, or food packaging materials, such as adhesives and food label ink. The chemicals bind with fats, meaning they tend to accumulate in fatty foods such as cheeses, meats, and fast food, according to "Well."

What providers can do now to address food insecurity

In some circumstances, exposure to certain quantities of phthalates might be dangerous, the New York Magazine's "Science of Us" reports. For instance, they can disrupt male hormones and have been tied to genital birth defects in infant boys as well as behavioral problems in older children, according to "Well."  

About a decade ago, regulators barred the chemicals from children's teething rings and rubber duck toys, "Well" reports. FDA does not, however, bar the presence of phthalates in food—though Europe prohibits them from use in plastics that contact fatty foods, according to "Well."

Paper reveals phthalates in mac and cheese

For the new paper, a group of environmental advocacy organizations asked an independent laboratory to investigate the presence and prevalence of 13 phthalates in 30 cheese products, including 10 varieties of mac and cheese. The findings were posted on the website; they have not been published in a peer-reviewed journal.

The researchers found that 29 of the products contained phthalates and that boxed mac and cheese products had the highest concentrations of the chemicals. Among all tested food products, the researchers found 11 of the 13 phthalates for which they tested—and some products had up to six distinct phthalates. In terms of quantity, among all the tested products, the average levels of phthalates ranged from 0.6 parts per billion (ppb) to 295 ppb, "Science of Us" reports.

According to Mike Belliveau—executive director of the Environmental Health Strategy Center, one of four advocacy groups that funded the report—"The phthalate concentrations in powder from mac and cheese mixes were more than four times higher than in block cheese and other natural cheeses like shredded cheese, string cheese, and cottage cheese." He added, "Our belief is that it's in every mac 'n' cheese product—you can't shop your way out of the problem."

The paper concluded, "Further research is needed on the phthalate levels in food and further action should be taken to eliminate phthalates in any food products." Specifically, the coalition in an open letter to Kraft Heinz Company—one of the mac and cheese brands assessed in the report—called on the company to remove the "toxic industrial chemicals" from their products. 

Critics aren't convinced

But the advocacy groups' suggestions—and initial media coverage of the paper—have drawn criticism from health researchers as well as other media outlets.

As "Science of Us" points out, the study identified the amount of different phthalates present in the various products, but it didn't demonstrate that the phthalates in those quantities posed a health risk. For instance, the most common phthalate, di(2-ethylhexyl) phthalate (DEHP), was observed at an average concentration of 295 ppb. The next most common, diethyl phthalate, was observed at 64 ppb. While there's no established threshold for what quantity of phthalates poses a health risk, "Science of Us" reports that the concentrations found in the study are so low that they "might not matter at all."

Joe Schwarcz, a chemist at McGill University who leads its Office for Science and Society, said, "We can detect these things in infinitesimal quantities, but the presence of a chemical does not necessarily equate to the presence of risk." In fact, citing the overall nutritional profile of mac and cheese, Schwarcz added, "If you want to scare [people] about the mac 'n' cheese you can scare them about the amount of fat and salt it contains. ... That's much more meaningful than the phthalates."

And physician James Hamblin, writing in The Atlantic, added that while "phthalates are probably a problem in our food system, ... macaroni and cheese is not a unique problem, and if it's one of the few highly processed foods that you eat, risk of phthalate toxicity is as close to zero as possible."

Citing the group behind the study and its lack of peer review, Hamblin in The Atlantic writes, "An analysis conducted with the express purpose of justifying a cause means bias, which is evident in the reporting of the results, which omit practical analysis of the levels of phthalates in the cheeses." Hamblin contends that the analysis "was a scare-based publicity move undertaken with apparently noble intentions, to raise awareness for what the advocacy group deems to be a dire cause. It worked. It also caused undue concern and regret."

That said, the criticisms about the study's conclusion and its coverage in the media don't necessarily mean that the comparatively low concentration of phthalates isn't harmful, "Science of Us" reports. But we currently lack reliable data on the topic.

Moreover, "many experts agree that phthalates are a problem in the food system as a whole," Hamblin writes. For instance, according to Heather Patisaul, a professor of biological sciences at the Center for Human Health and the Environment at North Carolina State University, "If you asked most scientists about the top 10 or 20 endocrine-disrupting chemicals they worry about, phthalates would be on that list."

Ultimately, "Science of Us" reports, the argument about phthalates' potential risk in mac and cheese isn't one that shouldn't be made—but it is one that "needs to be made carefully" (Rabin, "Well," New York Times, 7/12; Samuelson, Time, 7/14; Singal, "Science of Us," New York Magazine, 7/18; Matthews, Slate, 7/14; Report,, accessed 7/19; Hamblin, The Atlantic, 7/31). 

What providers can do now to address food insecurity

Nearly 15% of individuals in the U.S. live in food insecure households. Given the prevalence of the problem and the clear link between hunger, food insecurity, obesity, and other poor health outcomes, providers are uniquely positioned to provide targeted support to patients to address these challenges.

This presentation provides actionable insights for hospitals and clinics seeking ways to identify patients in need of supplemental food assistance and provide services as part of the traditional patient care plan.

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