Tag: heavy metals

Is it toxic? Another look at scary ingredient warning videos
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“Too much of anything is bad for you.”

That’s what my mom would say when I asked to eat an entire watermelon for dinner. “But fruit is healthy,” I would beg.

At that moment, my mom was passing on age-old wisdom — that it doesn’t just matter if something is “good for you” or “bad for you,” the amount you consume matters, too.

A candy bar with lunch can be OK. Eating all my Halloween candy in one night: a haunting tummyache. A glass of wine with dinner? Fun! A whole bottle? Head-splitting.

The same principle often applies to the kinds of food additives that appear on product labels with tongue-twisting names that sound like they were pulled from chemistry textbooks or sci-fi movies. They can be perfectly safe to consume — in certain quantities.

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Take trisodium phosphate. Google it, and you’ll get ads for heavy-duty cleaning products used to prep walls before painting. Warning labels say that direct contact with trisodium phosphate powder can be irritating to eyes and skin and even poisonous if exposed in large amounts.

But it is also an ingredient in cereals and many other processed foods including cheeses, soda and baked goods. In small amounts, the U.S. Food and Drug Administration and the European Food Safety Authority say it’s fine in food. It controls pH levels and acts as a leavening agent to make food fluffier.

Initially, I was skeptical, too — could something that works as a heavy-duty cleaner really be OK in food, even in small amounts? But it turns out my mom was right: How much you consume makes a big difference.

“Many food-grade additives share names with industrial products, but concentration makes all the difference,” said Jessica Steier, a public health expert, podcaster and CEO of the science communication organization Unbiased Science. “The food-grade versions are highly purified, used in tiny amounts, and serve specific functions like pH regulation or preservation.”

As I reported on trisodium phosphate and other chemicals used in food, experts consistently said, “the dose makes the poison.” In other words, the toxicity of a substance in large amounts doesn’t necessarily translate to it being dangerous in small amounts.

Here’s another example: sodium bicarbonate. It can be used to clean ovens, unclog drains and extinguish fires. When consumed in large amounts, it can be poisonous.

Sounds like it might be bad to ingest, right? Well, sodium bicarbonate goes by another name: baking soda. Perfectly safe in chocolate chip cookies!

This applies to so many ingredients in our pantries. Table salt, or sodium chloride, is essential for the human body, but too much sodium can lead to health problems like cardiovascular issues and hypertension. Even too much water can be bad for you.

“The same chemical at different concentrations can be either beneficial or harmful (that’s toxicology in a nutshell)” Steier wrote in an email to PolitiFact.

The way you are exposed also makes a difference – something might be safe to put on your skin, but not good to eat. Or, something may be safe to eat, but not safe to inhale. “The route of exposure is very important when considering toxicity,” said Norbert Kaminski, toxicologist and director of the Center for Research on Ingredient Safety at Michigan State University.

But with so many ingredients to parse through, online influencers often point to scary warning labels that apply to chemicals in high doses. And they don’t mention that those warnings don’t apply to the way they usually appear in food: in very small quantities.

A few examples:
- Calcium disodium ethylene-diaminetetraacetate, or calcium disodium EDTA, is used in food to preserve the flavor, color and texture of foods like canned soda, canned beans and vegetables, dressings and sauces. The U.S. Food and Drug Administration and other global food authorities have deemed it safe for consumption in small amounts. It is also used in cosmetics, cleaning supplies, dental procedures, and to treat heavy metal poisoning. But online, warnings about side effects of medical calcium disodium EDTA, which is administered in higher doses, were used to raise concerns about the use of the additive in fast food sauces.
- Propylene glycol is an approved food additive in products such as Pop-Tarts, ice cream and cake mix. It is also an ingredient in anti-freeze. But the FDA considers it generally safe to consume in the small quantities in food.
- Some chemicals used to fluoridate water, like hydrofluorosilicic acid, can be corrosive in their pure form, but when a small amount is added to water at treatment plants, the acid breaks down its different parts and is safe to consume.
The FDA regulates safe levels of food additives. What is considered a “safe level” for a given ingredient is often “several magnitudes lower than what is typically found in animal studies,” to be safe, said Kaminski.

Sometimes online influencers raise concerns about other environmental contaminants that can end up in food, even if they’re not on the ingredients list.

Trace amounts of heavy metals such as arsenic, lead, cadmium and mercury can be detected in some foods — even Girl Scout cookies — because they are in the soil, water or air where foods are grown, raised or processed. This is true for organic food as well.

“Total elimination isn’t possible; these elements are part of the earth’s crust, and attempting zero tolerance could eliminate nutritious foods from our diet without meaningful health benefit,” Steier said. That’s where the FDA’s regulations come in.

So, Thin Mints are safe to eat despite small traces of these metals (but the whole box might give you a tummy ache).

Trace amounts of the herbicide glyphosate can sometimes be detected in food because it is used so widely in agriculture. The Environmental Protection Agency and the FDA monitor these levels and consider small amounts safe to consume.

In many cases, simply running water over fruits and vegetables will help reduce pesticide residues.

So, wash your produce. Eat the things you love as part of a balanced eating plan. And don’t believe every scary ingredient video you see in your social media feed. First ask: How much is there?
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August 20, 2025
What Is “Pine Mouth Syndrome”? | NutritionFacts.org

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Why do some pine nuts cause a bad taste in your mouth that can last for weeks?

The reason I make pesto with walnuts instead of the more traditional pine nuts isn’t only because walnuts are probably healthier with 20 times more polyphenols, but also because of a mysterious phenomenon known as PMS. Not that PMS. Pine mouth syndrome is characterized by what has become my favorite word of the week: cacogeusia, meaning a bad taste in your mouth. You can get cacogeusia from heavy metal toxicity, seafood toxins, certain nutritional and neurologic disorders, or the wrong kind of pine nuts. “Termed ‘Pine Mouth’ by the public, cases present in a roughly similar fashion: a persistent metallic or bitter taste beginning 1–3 days following ingestion of pine nuts lasting for up to 2 weeks.”

As I discuss in my video Pine Mouth Syndrome: Prolonged Bitter Taste from Certain Pine Nuts, thousands of cases have been reported, and it doesn’t seem to matter if the pine nuts are raw or cooked. Could the cause be an unidentified toxin present in some varieties of non-edible pine nuts? Indeed, “out of more than 100 species of the Pinus genus, [only] 30 are considered to be edible by the Food and Agriculture Organisation of the United Nations.”

Researchers analyzed pine nut samples from consumers who had fallen ill and found that, indeed, they all contained nuts from Chinese white pine, which is not reported to be edible. That tree is typically used only for lumber. You can see photos of inedible and edible pine nuts below and at 1:36 in my video.

More photos can be seen here and at 1:40.

We don’t know it’s the Chinese white pine nuts, though, until we put it to the test. Researchers gave study participants six to eight Chinese white pine nuts. Most hadn’t ever heard of pine mouth syndrome, and they all developed symptoms. We still don’t know exactly what it is in those nuts that causes such a bizarre reaction. We know to stay away from those kinds of pine nuts.

So, what kinds of pine nuts are on shelves in the United States? All kinds, apparently, “including those associated with pine mouth.” You can see more examples below and at 2:19 in my video.

Unsurprisingly, hundreds of cases of PMS have been reported in the United States. Most of the implicated nuts “were predominantly reported to be labeled from or originating from Asia, and in most cases China,” as seen here and at 2:30 in my video.

The European Union demanded that China stop sending them toxic nuts, which they did beginning in 2011. “This export restriction likely resulted in a global export restriction of these species to the US as well,” given the decline in cases going into 2012, as shown below and at 2:47.

Rare cases still occur, though, as evidenced by an active Facebook group entitled “Damn you, Pine Nuts.” The primary reason I made this video is to allay fears should this ever happen to you. “There are no proven therapies for PMS. The only treatment is to cease ingesting implicated nuts and to wait for symptoms to abate.” Thankfully, pine mouth syndrome appears to be benign and goes away on its own.

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Michael Greger M.D. FACLM

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August 19, 2025
Chemical Safety, Cultivated Meat, and Our Health | NutritionFacts.org

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More than 95 percent of human exposure to industrial pollutants like dioxins and PCBs comes from fish, other meat, and dairy.

By cultivating muscle meat directly, without associated organs like intestines, the incidence of foodborne diseases “could be significantly reduced,” as could exposure to antibiotics, “pesticides, arsenic, dioxins, and hormones associated with conventional meat.” Currently, the U.S. Food and Drug Administration has approved seven hormone drugs to bulk up the production of milk and meat. “In the European Union, there exists a total ban on such use,” however. Even without injected hormones, though, animal products naturally have hormones because they come from animals. “Eggs, example given, contribute more to the dietary intake of estradiol [estrogens] than beef, whether the animal is legally treated with hormones or not.” After all, eggs come straight from a hen’s ovaries, so, of course, they’re swimming with hormones. But if you’re directly growing just muscle meat or egg white protein, you don’t need to include reproductive organs, adrenal glands, or any of the associated hormones.

“Chemical safety is another concern for meat produced under current production systems.” There are chemical toxicants and industrial pollutants that build up in the food chain, such as pesticides, PCBs, heavy metals, and ﬂame retardants, but there is no food chain with cultivated meat. We could produce all the tuna we wanted, with zero mercury.

When the World Health Organization determined that processed meat was a known human carcinogen and unprocessed meat a probable human carcinogen, it wasn’t even talking about the carcinogenic environmental pollutants. When researchers tested retail meat for the presence of “33 chemicals with calculated carcinogenic potential,” like polycyclic aromatic hydrocarbons (PAHs), organochlorine pesticides like DDT, and dioxin-like PCBs, they concluded that, in order to reduce the risk of cancer, we should limit beef, pork, or chicken consumption to a maximum of five servings a month.

Why cultivate meat at all when you can just buy organic? Surprisingly, “consumption of organic meat does not diminish the carcinogenic potential associated with the intake of persistent organic pollutants (POPs).” A number of studies have recently compared the presence of environmental contaminants in organic meat versus conventional meat, and the researchers found, surprisingly, that organic meat was sometimes more contaminated. Not only organic beef either. Higher levels were also found in pork and poultry.

If you look at the micropollutants and chemical residues in both organic and conventional meat, several environmental contaminants, including dioxins, PCBs, lead, and arsenic, were measured at signiﬁcantly higher levels in the organic samples. As you can see below and at 2:56 in my video, The Human Health Effects of Cultivated Meat: Chemical Safety, the green is organic meat, and the blue is conventional.

Cooking helps to draw off some of the fat where the PCBs are concentrated, as shown here and at 3:01.

Seafood seems to be an exception. Steaming, for example, generally increases contaminant levels, increasing contaminant exposure and concentrating mercury levels as much as 47 percent, as you can see here and at 3:15 in my video. Better not to have toxic buildup in the first place.

More than 95 percent of human exposure to industrial pollutants like dioxins and PCBs comes from foods like meat, including fatty fish, and dairy, but the pollutants don’t appear magically. The only way the chicken, fish, and other meat lead to human exposure is because the animals themselves built up a lifetime of exposure in our polluted world, from incinerators, power plants, sewer sludge, and on and on, as you can see here and at 3:40 in my video.

Unlike conventional meat production, a slaughter-free harvest would not only mean no more infected animals, but no more contaminated animals either. In terms of pollutants, it would be like taking a time machine back before the Industrial Revolution.

Doctor’s Note:

Cultivated meat means less contamination with fecal residues, toxic pollutants, antibiotics, and hormones; up to 99 percent less environmental impact; and zero pandemic risk. Cultivated meat allows people to have their meat and eat it, too, without affecting the rest of us.

This is the final video in this cultivated meat series. If you missed the first two, check out the videos on Food Safety and Antibiotic Resistance.

I previously did a video series on plant-based meats; see the related posts below.

All videos in the plant-based meat series are also available in a digital download from a webinar I did. SeeThe Human Health Implications of Plant-Based and Cultivated Meat for Pandemic Prevention and Climate Mitigation.

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Michael Greger M.D. FACLM

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June 5, 2025
Is Stainless Steel or Cast Iron Cookware Best? Is Teflon Safe? | NutritionFacts.org

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What is the best type of pots and pans to use?

In my last video, I expressed concerns about the use of aluminum cookware. So, what’s the best type of pots and pans to use? As I discuss in my video Stainless Steel or Cast Iron: Which Cookware Is Best? Is Teflon Safe?, stainless steel is an excellent option. It’s the metal chosen for use “in applications where safety and hygiene are considered to be of the utmost importance, such as kitchenware.” But what about studies showing that the nickel and chromium in stainless steel, which keeps the iron in stainless unstained by rust, can leach into foods during cooking? The leaching only seems to occur when the cookware is brand new. “Metal leaching decreases with sequential cooking cycles and stabilizes after the sixth cooking cycle,” after the sixth time you cook with it. Under more common day-to-day conditions, the use of stainless steel pots is considered to be safe even for most people who are acutely sensitive to those metals.

A little leaching metal can even be a good thing in the case of straight iron, like a cast iron skillet, which can have the “beneficial effect” of helping to improve iron status and potentially reduce the incidence of iron deficiency anemia among children and women of reproductive age. The only caveat is that you don’t want to fry in cast iron. Frying isn’t healthy regardless of cookware type, but, at hot temperatures, vegetable oil can react with the iron to create trans fats.

What about using nonstick pans? Teflon, also known as polytetrafluoroethylene (PTFE), “is used as an inner coating material in nonstick cookware.” Teflon’s dark history was the subject of a 2019 movie called Dark Waters, starring Mark Ruffalo and Anne Hathaway. Employees in DuPont’s Teflon division started giving birth to babies with deformities before “DuPont removed all female staff” from the unit. Of course, the corporation buried it all, hiding it from regulators and the public. “Despite this significant history of industry knowledge” about how toxic some of the chemicals used to make Teflon were, it was able to keep it hidden until, eventually, it was forced to settle for more than half a billion dollars after one of the chemicals was linked to “kidney and testicular cancers, pregnancy-induced hypertension, ulcerative colitis, and high cholesterol.”

“At normal cooking temperatures, PTFE-coated cookware releases various gases and chemicals that present mild to severe toxicity.” As you can see below and at 2:38 in my video, different gases are released at different temperatures, and their toxic effects have been documented.

You’ve heard of “canaries in the coal mine”? This is more like “canaries in the kitchen, as cooking with Teflon cookware is well known to kill pet birds,” and Teflon-coated heat lamp bulbs can wipe out half a flock of chickens.

“Apart from the gases released during heating the cooking pans, the coating itself starts damaging after a certain period. It is normally advised to use slow heating when cooking in Teflon-coated pans,” but you can imagine how consumers might ignore that. And, if you aren’t careful, some of the Teflon can start chipping off and make its way into the food, though the effects of ingestion are unknown.

I could find only one study that looks at the potential human health effects of cooking with nonstick pots and pans. Researchers found that the use of nonstick cookware was associated with about a 50 percent increased risk of colorectal cancer, but that may be because of what they were cooking. “Non-stick cookware is used in hazardous cooking methods (i.e. broiling, frying, grilling or barbecuing) at high temperatures mainly for meat, poultry or fish,” in which carcinogenic heterocyclic amines (HCA) are formed from the animal protein. Then, the animal fat can produce another class of carcinogens called polycyclic aromatic hydrocarbons (PAH). Though it’s possible it was the Teflon itself, which contains suspected carcinogens like that C8 compound from the movie Dark Waters, also known as PFOA, perfluorooctanoic acid.

“Due to toxicity concerns, PFOA has been replaced with other chemicals such as GenX, but these new alternatives are also suspected to have similar toxicity.” We’ve already so contaminated the Earth with it, though, that we can get it prepackaged in food before it’s even cooked, particularly in dairy products, fish, and other meat; now, “meat is the main source of human exposure” to these toxic pollutants. Of those, seafood is the worst. In a study of diets from around the world, fish and other seafood were “major contributors” of the perfluoroalkyl substances, as expected, given that everything eventually flows into the sea. Though the aquatic food chain is the “primary transfer mechanism” for these toxins into the human diet, “food stored or prepared in greaseproof packaging materials,” like microwave popcorn, may also be a source.

In 2019, Oral-B Glide dental floss was tested. Six out of 18 dental floss products researchers tested showed evidence of Teflon-type compounds. Did those who used those kinds of floss end up with higher levels in their bloodstream? Yes, apparently so. Higher levels of perfluorohexanesulfonic acid were found in Oral-B Glide flossers, as you can see below and at 5:28 in my video.

There are a lot of environmental exposures in the modern world we can’t avoid, but we shouldn’t make things worse by adding them to consumer products. At least we have some power to “lower [our] personal exposure to these harmful chemicals.”

This is the second in a three-video series on cookware. The first was Are Aluminum Pots, Bottles, and Foil Safe?, and the next is Are Melamine Dishes and Polyamide Plastic Utensils Safe?.

What about pressure cooking? I covered that in Does Pressure Cooking Preserve Nutrients?.

So, what is the safest way to prepare meat? See Carcinogens in Meat.

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Michael Greger M.D. FACLM

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September 24, 2024
Can We Safely Use Aluminum Foil, Bottles, and Pots? | NutritionFacts.org

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DNA damage is assessed in users of aluminum cookware.

“Over the last decades, the toxicity of aluminum for humans has been heavily discussed and is still not completely clarified.” Those occupationally exposed to aluminum—for instance, in smelter plants—suffer from oxidative stress and free radicals that can damage their DNA. What about just using aluminum cookware? Articles like “Metal Exposures from Aluminum Cookware: An Unrecognized Public Health Risk in Developing Countries,” suggesting an “unrecognized public health risk,” were limited to the developing world where “cookware is made in informal shops by casting liquid aluminum melted from a collection of scrap metal,” including the likes of vehicle radiators, lead batteries, and computer parts, which is how you can get so much lead leaching into people’s food.

Then “The Relationship Between Plasma Aluminum Content, Lymphocyte DNA Damage, and Oxidative Status in Persons Using Aluminum Containers and Utensils Daily” was published, suggesting that aluminum itself may be harmful. Most of our aluminum exposure comes from processed junk food containing aluminum additives, “including those within some processed cheeses, baking powders, cake mixes, frozen dough, and pancake mixes.” However, about 20 percent of the daily intake of aluminum may come from aluminum cooking utensils, such as “pans, pots, kettles, and trays.”

Might this cause a problem? Researchers took blood from consumers who used aluminum cookware versus those who did not and found that not only did the aluminum users have twice the level of aluminum in their blood, as you can see below and at 1:33 in my video Are Aluminum Pots, Bottles, and Foil Safe?, but they had more free radical damage of their body fats and proteins. What’s more, the total antioxidant capacity of the bloodstream of those using aluminum cookware was compromised, so they suffered significantly more DNA damage.

Indeed, as you can see below and at 1:52 in my video, those with the highest levels of aluminum in their blood tended to suffer significantly more damage to their DNA. No surprise, since “aluminum is considered to be a pro-oxidant agent.”

These folks weren’t just casually using aluminum pots, though. Specifically, they use them every day to cook and store acidic foods, like yogurt and tomato sauce, which can leach out more aluminum. But, even using “camping dishes,” which tend to be aluminum since it’s so light, for just one week, could greatly exceed the tolerable weekly intake guidelines, especially for children, if you incorporated something acidic, like marinating a fresh catch in lemon juice. Once in a while won’t make much difference, but these findings suggest that you may not want to cook in aluminum day in and day out.

What about aluminum drinking bottles? They’re nice and light, but children drinking two cups a day of tea or juice from them could exceed the tolerable aluminum exposure limit. So, out of an abundance of caution, safety authorities like the German Federal Institute for Risk Assessment “recommend that consumers avoid the use of aluminum pots or dishes for acidic or salted foodstuffs such as apple sauce, rhubarb, tomato puree, or salt herring…thus prophylactically avoiding the ‘unnecessary ingestion’ of aluminum.”

What about aluminum foil? Wrapping and baking food in aluminum foil is a common culinary practice. The concern is that this could represent “a potentially hazardous source of aluminum in the human diet.” When put to the test, there was leakage of aluminum from the foil to the food, but the amount was so small that it would be more of an issue for small children or those suffering from diminished kidney function.

What about just wrapping food in foil to store it in the refrigerator? Only marginal increases in aluminum are seen—except when the food is in contact with the foil and, at the same time, certain other types of metal, such as stainless steel, which is largely iron. That sets up a battery and “can lead to tremendous food aluminum concentrations.” For example, as you can see below and at 4:34 in my video, the aluminum levels in a ham before and after a day coveredin foil are negligible; there’s hardly a bump in the foil-covered ham. But, if that same foil-wrapped ham sits on top of a steel tray or serving plate for a day, the aluminum levels in the ham shoot up.

Finally, you know how aluminum foil is often glossy on one side and dull on the other? Which would be worse? Fish fillets were baked and grilled both ways, wrapped with the glossy side out versus the dull side out, and no significant difference was found.

This is the first in a series of three videos on cookware. Stay tuned for Stainless Steel or Cast Iron: Which Cookware Is Best? Is Teflon Safe? and Are Melamine Dishes and Polyamide Plastic Utensils Safe?.

I’ve discussed aluminum in antiperspirants, food, medications, and tea. Check out the related posts.

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Michael Greger M.D. FACLM

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September 19, 2024
What About Omega-3s and Vegetarians’ Stroke Risk? | NutritionFacts.org

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Does eating fish or taking fish oil supplements reduce stroke risk?

In my last video, we started to explore what might explain the higher stroke risk in vegetarians found in the EPIC-Oxford study. As you can see below and at 0:25 in my video Vegetarians and Stroke Risk Factors: Omega-3s?, vegetarians have a lower risk of heart disease and cardiovascular disease overall, but a higher risk of stroke. We looked into vitamin D levels as a potential mechanism, but that didn’t seem to be the reason. What about long-chain omega-3s, the fish fats like EPA and DHA?

Not surprisingly, their levels are found to be “markedly lower in vegetarians and particularly in vegans than in meat-eaters.” They’re about 30 percent lower in vegetarians and more than half as low in vegans, as you can see below and at 0:45 in my video.

According to “the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date,” combining 28 randomized controlled trials, stroke has no benefit. There is evidence that taking fish oil “does not reduce heart disease, stroke or death,” or overall mortality, either. This may be because, on the one hand, the omega-3s may be helping, but the mercury in fish may be making things worse. “Balancing the benefits with the contaminant risks of fish consumption has represented a challenge for regulatory agencies and public health professionals.”

For example, dietary exposure to polychlorinated biphenyls (PCBs) may be associated with an increased risk of stroke. In one study, for instance, “neither ﬁsh nor intake of PCBs was related to stroke risk. However, with adjustment for fish intake,” that is, at the same ﬁsh intake, “dietary PCBs were associated with an increased risk of total stroke,” so the PCB pollutants may be masking the fish benefit. If we had a time machine and could go back before the Industrial Revolution and find ﬁsh in an unpolluted state, we might find that it is protective against stroke. Still, looking at the EPIC-Oxford study data, if fish were protective, then we might expect that the pescatarians (those who eat fish but no other meat) would have lower numbers of strokes since they would have the fish benefit without the risk from other meat. But, no. That isn’t the reality. So, it doesn’t seem to be the omega-3s either.

Let’s take a closer look at what the vegetarians are eating.

When it comes to plant-based diets for cardiovascular disease prevention, all plant foods are not created equal. There are two types of vegetarians—those who do it for their health, and those who do it for ethical reasons, like global warming or animals—and the latter tend to eat different diets. Health vegans tend to eat more fruits and fewer sweets, for instance, and you don’t tend to see them chomping down on vegan donuts, as shown below and at 2:41 in my video.

“Concerns about health and costs were primary motivations for [meat] reduction” in the United States. A middle-class American family is four times more likely to reduce meat for health reasons compared to environmental or animal welfare concerns, as you can see in the graph below and at 2:55 in my video.

But in the United Kingdom, where the EPIC-Oxford stroke study was done, ethics was the number one reason given for becoming vegetarian or vegan, as you can see in below and at 3:05 in my video.

We know that “plant-based diets, diets that emphasize higher intakes of plant foods and lower intakes of animal foods, are associated with a lower risk of incident cardiovascular disease, cardiovascular disease mortality, and all-cause mortality”—a lower risk of dying from all causes put together—“in a general US adult population.” But, that’s only for healthy plant foods. Eating a lot of Wonder Bread, soda, and apple pie isn’t going to do you any favors. “For all types of plant-based diets, however, it is crucial that the choice of plant foods is given careful consideration.” We should choose whole fruits and whole grains over reﬁned grains and avoid trans fats and added sugars. Could it be that the veggie Brits were just eating more chips? We’ll find out next.

Another strikeout trying to explain the increased risk. Could it be that the vegetarians were eating particularly unhealthy diets? Labels like vegetarian or vegan just tell me what is not being eaten. You can be vegetarian and consume a lot of unhealthy fare, like french fries, potato chips, and soda. That’s why, as a physician, I prefer the term whole food, plant-based nutrition. That tells me what you do eat. You eat vegetables and follow a diet centered around the healthiest foods out there.

If you missed the first four videos in this series, see:

Surprised about the fishy oil findings? Learn more: Is Fish Oil Just Snake Oil? and Omega-3s and the Eskimo Fish Tale.

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Michael Greger M.D. FACLM

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August 22, 2024
Say No to Fish for Five Years Before Pregnancy | NutritionFacts.org

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Advisories telling pregnant women to cut down on fish consumption may be too late for certain persistent pollutants.

If you intentionally expose people to mercury by feeding them fish (like tuna) for 14 weeks, the level of mercury in their bloodstream goes up, as you can see in the graph below and at 0:14 in my video Avoiding Fish for Five Years Before Pregnancy. As soon as they stop eating fish, it drops back down such that they can detox by half in about 100 days. (So, the half-life of total mercury in our blood is approximately 100 days.) Even if you eat a lot of fish, within a few months of stopping, you can clear much of the mercury out of your blood. But what about your brain?

The results from modeling studies are all over the place, providing “some extreme estimates (69 days vs. 22 years).” When put to the test, though, autopsy findings suggest the half-life may be even longer still at 27.4 years. Once mercury gets in our brains, it can be decades before our body can get rid of even half of it. So, better than detoxing is not “toxing” in the first place.

That’s the problem with advisories that tell pregnant women to cut down on fish intake. For pollutants with long half-lives, such as PCBs and dioxins, “temporary fish advisory-related decreases in daily contaminant intake will not necessarily translate to appreciable decreases in maternal POP [persistent organic pollutant] body burdens,” which help determine the dose the baby gets.

Consider this: As you can see in the graph below and at 1:32 in my video, an infant may be exposed to a tumor-promoting pollutant called PCB 153 if their mom ate fish. But if mom ate only half the fish or no fish at all for one year, levels wouldn’t budge much. A substantial drop in infant exposure levels may only be seen if the mom had cut out all fish for five years before getting pregnant. That is the “fish consumption caveat.” “[T]he only scenarios that produced a significant impact on children’s exposures required mothers to eliminate fish from their diets for 5 years before their children were conceived. The model predicted that substituting produce for fish would reduce prenatal and breastfeeding exposures by 37% each and subsequent childhood exposures by 23%.” So, “a complete ban on fish consumption may be preferable to targeted, life stage–based fish consumption advisories…”

If you are going to eat fish, though, which is less polluted—wild-caught or farmed fish? In a recent study, researchers measured the levels of pesticides, such as DDT, PCBs, polycyclic aromatic hydrocarbons, and toxic elements, such as mercury and lead, in a large sample of farmed and wild-caught seafood. In general, they found that farmed fish were worse. Think of the suspect as farmed and dangerous. The measured levels of most organic and many inorganic pollutants were higher in the farmed seafood products and, consequently, so were the intake levels for the consumer if such products were consumed. For example, as you can see in the graphs below and at 3:09 in my video, there was significantly more contamination by polycyclic hydrocarbons, persistent pesticides, and PCBs in all of the farmed fish samples, including the salmon and seabass (though it didn’t seem to matter for crayfish), and the wild-caught mussels were actually worse. If you split adult and child consumers into those only eating farmed seafood or only eating wild-caught seafood, the level of pollutant exposure was significantly worse with the farmed seafood.

Overall, the researchers, who were Spanish, investigated a total of 59 pollutants and toxic elements. They concluded: “Taking all these data as a whole, and based on the rates of consumption of fish and seafood of the Spanish population, our results indicate that a theoretical consumer who chose to consume only aquaculture [farmed] products would be exposed to levels of pollutants investigated about twice higher than if this theoretical consumer had chosen only products from extractive fisheries [wild-caught fish].” So, when it comes to pollutants, you could eat twice the amount of fish if you stuck to wild-caught. That’s easier said than done, though. Mislabeling rates for fish and other seafood in the United States are between 30 and 38 percent, so the average fraud rate is around one in three.

In my previous video on this topic, How Long to Detox from Fish Before Pregnancy, I mentioned a study that suggests detoxing from fish for one year to lower mercury levels, but other pollutants take longer to leave our system.

For optimum brain development, consider a pollutant-free source of omega-3 fatty acids. Check out Should Vegan Women Supplement with DHA during Pregnancy?.

Aside from pollutants, there are other reasons we may want to avoid excessive amounts of animal protein. See Flashback Friday: The Effect of Animal Protein on Stress Hormones, Testosterone, and Pregnancy.

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Michael Greger M.D. FACLM

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November 7, 2023
Should You Skip Dark Chocolate This Valentine’s Day?
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Feb. 14, 2023 — Dark chocolate is rich. It’s intense. Some believe it’s an aphrodisiac. Plus, it has numerous proven health benefits. A box of smooth, luscious bonbons seems like just the thing to give your Valentine. But recent headlines may have you rethinking that sweet, sexy gift. Here’s what you should know.

Towards the end of last year, Consumer Reports announced they’d tested 28 different dark chocolate bars — and found lead and cadmium in every one of them.

“I was devastated,” says Taryn FitzGerald. The Brooklyn-based artist and healer has been enjoying dark chocolate for years and enjoys a “tiny little square” each night. “Dark chocolate is one of my passions. It has a lot of health benefits.”

What the Report Said

The presence of cadmium and lead in dark chocolate isn’t news. Environmental health watchdog group As You Sow sued a group of chocolate makers over it several years ago. As part of the settlement, researchers studied how heavy metals contaminate cacao beans, dark chocolate’s main ingredient. Their report came out in August of last year. It found that cadmium enters the beans from the soil where they grow, while lead contamination occurs during chocolate processing.

Consumer Reports wanted to test the current in-store reality and provide new details.

“There are always new products, or reformulation of food products,” says Jim Rogers, PhD, Consumer Reports’ director of food safety research. “We might think we know a lot about food — that may or may not be true.”

The organization tested bars from big companies like Dove, Hershey’s, and Trader Joe’s as well as smaller ones like Tony’s Chocolonely and Mast Brothers, some grown conventionally and some organic. There are no federal limits for lead and cadmium content in food, so they set their threshold at California’s maximum allowable dose level for each.

“We use what we consider health protective standards,” Rogers says. “We always say no level of lead is safe, right? We want that to be as close to zero as possible in all food products.”

Testing looked at how much of these metals would be found in a single, 1-ounce serving. Of the 28 bars tested, Consumer Reports found that 23 provide a potentially harmful dose of at least one.

Eight bars had more than 100% of the allowable limit for cadmium, 10 surpassed the level for lead, and another five exceeded both. Some had more than twice the maximum amount of one metal or the other. For instance, a one-ounce square of Lindt Excellence Dark Chocolate 85% Cocoa — the bar FitzGerald ate every night for years — contains 166% of the allowable limit for lead and 80% for cadmium.

Consumer Reports’ “safer choices” list includes just five bars with levels below 100% of both metals. None were completely lead- or cadmium-free.

The National Confectioners Association issued a statement in response to the findings: “The products cited in this study are in compliance with strict quality and safety requirements, and the levels provided to us by Consumer Reports testing are well under the limits established by our settlement.”

The Health Risks of Heavy Metals

Both cadmium and lead are naturally occurring elements found in soil and elsewhere in the environment. But just because they’re natural, it doesn’t mean they’re good for you.

“Some heavy metals really don’t have a function in your body. They don’t need to be there, and some of them accumulate,” says Katarzyna Kordas, PhD, asssociate professor of epidemiology and environmental health at the University at Buffalo School of Public Health. “These metals are not a joke. We want to have as little of them as possible in our environment, which includes food.”

Once absorbed, cadmium stays in your body for decades. It’s known to cause cancer, and it can cause kidney damage and weaken your bones. Among other things, lead targets your respiratory and gastrointestinal tracts, your nervous system, and your kidneys.

The accumulation of these metals in your body is what makes them so dangerous. And dark chocolate is far from the only source we eat. The FDA’s Total Diet Study monitors both nutrients and contaminants in thousands of foods. Researchers found cadmium in 61% of the samples tested, and lead in 15%.
Because cadmium is in soil, some of the highest food concentrations appear in plants, like spinach and root vegetables. Lead tends to enter the food chain during manufacturing, so it shows up in things like baby food and sandwich cookies. It’s virtually impossible to avoid these two metals completely.

“I suspect all foods have this stuff,” says Marion Nestle, PhD, who studies and writes about our food systems. “When they do test, they find heavy metals in astonishing proportions. It’s like with pesticides — everyone has them.”

The challenge, then, is to limit your exposure.

One obvious solution would be to give up dark chocolate (and spinach) entirely, no matter how many other benefits it offers. But nobody’s saying you should cut out all food known to have cadmium or lead. That might backfire.

“The risk of eliminating a food that’s high in nutrients,” Kordas says, “could potentially be as bad as eating something that has some contaminants.”
Chocolatiers Can Reduce Heavy Metals

Because cadmium and lead get into chocolate in different ways, no single solution will address the problem. Instead, experts recommend a handful of steps cacao growers and chocolate makers can take, both right away and in the future.

To reduce cadmium, which cacao plants absorb from the soil:

Purchase beans with lower levels. Soil contamination varies by region and even by farm, with some Latin American countries having the highest levels and African countries the lowest. Chocolate makers can choose to buy beans from areas with less contamination.

Blend bean harvests. If a chocolatier combines cacao from different regions with varying levels of contamination, it moderates the overall levels. Some chocolate makers already do this. One of them, Tazo, has a bar on Consumer Reports “safer choices” list.

Add balancing substances to the soil. If growers change the makeup of the soil itself, that can make it harder for plants to absorb cadmium.

For lead, which can contaminate cacao beans at several points during harvesting and manufacturing, the changes may be easier to undertake — some could show results within a year of implementation. They focus on reducing the beans’ exposure to lead along the journey from soil to store.
How to Choose Safer Chocolate

It should be obvious by now: You don’t have to remove dark chocolate from your life, though you may choose to. Every person’s risk is different, based on your health history and what else you eat. Experts do, however, recommend that pregnant people and children avoid dark chocolate.

Here’s what you can do to lower your exposure:

Eat less chocolate. If you don’t want to give it up, just don’t make dark chocolate an everyday thing. “We think that our findings and other findings are important enough to make recommendations of reducing your consumption of dark chocolates,” Rogers says.

Variety, variety, variety. Just as manufacturers can reduce risk by mixing bean harvests, you can protect yourself by eating different brands and types of chocolate. Dark chocolates with lower percentages of cacao, in the 65-70% range, seem to have lower levels of cadmium and lead. Milk chocolate uses even less cacao, which means diminished amounts of heavy metals. “Never eat the same chocolate over and over,” Nestle says. “This is true for every food — the more variation you have in what you eat, the more likely you are to get the nutrients you need and avoid what’s not good for you.”

Boost your iron and calcium. Your body absorbs cadmium in the same way it does iron and calcium, two metals you actually need. If your diet doesn’t provide enough of them, it can let more cadmium enter your system. “One reason the CDC recommends a diet rich in calcium and iron is that it’s one way to prevent the accumulation of lead in children,” Kordas says.

Become an informed consumer. If you’re concerned about your risk, Rogers suggests reaching out to your favorite chocolate makers. Ask what their own testing shows. “Good companies will know what’s going on with their product,” he says.
FitzGerald hasn’t eaten her favorite chocolate since Consumer Reports’ research came out. She’s glad to know she might not have to stop enjoying her nightly treat altogether.

“I’m going to start exploring other brands,” she says, “and also, just see how I do without chocolate.”
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February 14, 2023
Is Cord-Blood Banking Worth It?

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In the fall of 1988, Matthew Farrow, a 5-year-old boy with a rare blood disorder, received the world’s first transplant of umbilical-cord blood from a newborn sibling. It worked: Farrow was cured. This miraculous outcome broke open a whole new field in medicine—and, not long after, a whole new industry aimed at getting expecting parents to bank their baby’s umbilical-cord blood, just in case.

These days, in fact, being pregnant means being bombarded at the doctor’s office and on Instagram with ads touting cord blood as too precious to waste. For several hundred dollars upfront, plus a storage fee of $100 to $200 every year, the banks’ ads proclaim, you could save your child’s life. Cord-blood banking has been likened to a “biological insurance policy.”

In the U.S., the two biggest private cord blood banks are Cord Blood Registry and ViaCord. Together, they have collected more than 1 million units. But only a few hundred units of this privately banked cord blood have ever been used in transplant, the great majority by families who chose to bank because they already had a child with a specific and rare disorder treatable with transplant. For everyone else, the odds of using privately banked cord blood are minuscule—so minuscule that the American Academy of Pediatrics (AAP) recommends against private banking. It does make an exception for families with that disease history. “But that’s a rare circumstance,” says Steve Joffe, a pediatric oncologist and ethicist at the University of Pennsylvania, “and not one that anybody is going to build a successful business model around.”

ViaCord and Cord Blood Registry do offer free services for families in which someone has already been diagnosed with a condition treatable with cord blood. In general, the companies reiterated to me, cord blood does save lives and they are simply providing an option for families who want it.

But the marketing also gives the impression of much more expansive uses for cord blood. The private banks’ websites list nearly 80 diseases treatable with transplant—an impressive number, though many are extremely uncommon or closely related to one another. (For example: refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation.) They have also recently taken to highlighting the promise of still-unproven treatments: Temporary infusions of cord blood, they say, could eventually treat more common conditions such as cerebral palsy and autism. Video testimonials feature parents talking excitedly about the potential of cord blood for their children. But the evidence isn’t there yet—and may never appear. Nonetheless, says Paul Knoepfler, a stem-cell scientist at UC Davis, “the cord-blood companies seem to be trying to expand their base of potential customers.”

The initial exuberance around cord blood came from a real place. The blood left over in umbilical cords is replete with cells that have the special ability to turn into any kind of blood, including red blood cells, which carry oxygen, and white blood cells, which make up the immune system. Adults have stem cells in their bone marrow and blood—which can also be used for transplant—but those in a baby’s umbilical cord are more immunologically naive. That means they are less likely to go awry and attack a recipient’s body. “They don’t cause as much havoc,” says Karen Ballen, an oncologist at the University of Virginia. This allows doctors to use cord blood that matches only four out of six immunological markers.

Because cord blood is so valuable, publicly run banks have been collecting donations since the 1990s. Despite amassing fewer units overall, public banks worldwide have provided 30 times as many units of blood for treatment—and saved more lives—than private ones, because they are accessible by any patient in need. Although the AAP recommends against private banking, it does recommend donating to public banks.

One appeal of private banking, though, as the companies highlight, is that the cells in a baby’s umbilical cord are a perfect match for them in later childhood or adulthood. But this is usually irrelevant: In most of the diseases that can be cured by a cord-blood transplant, doctors would, for medical reasons, not use the patient’s own cells. In cases of inherited disorders such as sickle cell anemia, for example, a child’s own cord-blood stems have the same problematic mutation. For children with one of many types of leukemia, the concern is that cord blood could contain leukemia-precursor cells that cause the cancer to reappear; in addition, donor blood-stem cells are better because they can mop up remaining leukemia cells. Doctors would “never” use banked cord blood from a child with these types of leukemia, says Joanne Kurtzberg, a pediatrician and cord-blood pioneer at Duke University, who helped treat Farrow when he was a young boy.

When privately banked cord blood is used in transplants, it is more likely to go to a sibling. Genetically, siblings have about a 25 percent chance of being perfect matches for each other. The chances of finding a suitable match among unrelated bone-marrow or cord-blood donors from a public bank, on the other hand, range from 29 to 79 percent, depending on one’s ethnic background. (The majority of donors are white, so it’s highest for white patients.) In any case, not banking a matched sibling’s cord blood doesn’t foreclose the possibility of a transplant, because that sibling can still donate bone marrow. “I often encounter families who have some guilt around not storing the cord blood, and I will point out, ‘Well, your donor child that matches our patient is still here,’” says Ann Haight, a pediatric hematologist and oncologist at Emory University.

Even if a baby’s cord blood is banked, there’s no guarantee that it will contain enough cells for transplant. In fact, most may not: Public banks only keep 5 to 40 percent of their donations, as the rest don’t meet their standards. Private banks will save much smaller samples, which they argue serve a different purpose. Whereas public banks are looking for large samples that are mostly likely to be used for transplant, says Kate Giradi, the director of medical and scientific affairs at ViaCord, “when families are banking with us, this is that child’s only cord, so our threshold is way lower.”

Another reason to bank these smaller samples, a spokesperson for Cord Blood Registry pointed out, is that they can still be used for experimental infusions treating conditions such as cerebral palsy and autism. (About 80 percent of units released by CBR have been used this way, as have about half from ViaCord.) The private banks partner with researchers, such as Kurtzberg at Duke, who are running clinical trials to test these treatments. The theory goes that cells from cord blood can make it to the brain, where they might have some neuroprotective role—but the mechanism remains unknown, and the effects are not entirely clear. As Kurtzberg told me, “The therapy is not proven.”

The current state of cord-blood science might be summed up thus: Proven uses are very uncommon, and unproven uses are, well, unproven. Of course, a future discovery could lead to a real breakthrough in the use of stem cells from cord blood—an idea private banks trade on. Who knows what might be in store for cord blood later, when your baby is 30, 50, 70 years old? In a recent Cord Blood Registry survey of new parents, a spokesperson told me by email, 45 percent named “belief in future treatments” as the primary reason for banking their child’s cord blood and tissue. Knoepfler, the stem-cell scientist, notes that scientists have been excited for decades about the promise of stem cells. But translating interesting results in the lab to a doctor’s office, he says, “is really much harder than many of us realized. I include myself in that.”

Medical discoveries have actually changed the ways cord blood is used over years, but they have so far resulted in less use of cord blood. In the past several years, doctors have refined a protocol to use half-matched donors in transplants. Doctors generally get more cells from these donors than from an infant’s banked cord blood, which means the transplants “take” more quickly and the patient spends less time in the hospital. For this reason, cord blood has been falling out of favor. Public banks have started scaling down their collections; the New York Blood Center, which had launched the world’s first public bank, recently stopped collecting new donations. How cord blood gets used in the future is still unknown.

More than 30 years ago after Kurtzberg first treated Farrow, she is still in touch with him. He’s 39 now, and doing well. Having watched cord banking grow and evolve over the years, she remains a proponent of public banking and the possibilities ahead. When it comes to private banks, however, she says, “I don’t think it’s a necessity. I think it’s nice to have if you can do it.” There isn’t much harm in private banking, after all, as long as parents can afford the several thousand dollars over their child’s lifetime.

Afford might be the key word here. The ads for cord-blood banking feel a lot like those for any number of “nice to have” baby products aimed at anxious parents, be they organic diapers or BPA-free wooden toys tailored to your child’s age and cognitive development. If anything, the stakes of cord-blood banking are higher than anything else you might choose to buy. The opportunity only comes around “once in a lifetime,” and it could literally save your child’s life—even if the chances of that are very, very small. “It’s playing to parental guilt and the desire for parents to have healthy children and do whatever they can for their kids,” says Timothy Caulfield, a health-law professor at the University of Alberta who has studied cord-blood banks. “There’s a huge market based on exactly that.”

It’s telling, perhaps, that Cord Blood Registry ran a giveaway of $20,000 worth of baby products this summer. The curated package of luxury “baby essentials” resembled the registry of parents who want the best for their kid, and can afford it. Included were a Snoo smart bassinet ($1,695), an Uppababy stroller and car seat ($1,400), Coterie diapers ($100 for a month’s supply, guaranteed to be “free of fragrance, lotion, latex, rubber, dyes, alcohol, heavy metals, parabens, phthalates, chlorine bleaching, VOCs, and optical brighteners”), and, of course, a lifetime of cord-blood and tissue banking ($11,860).

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Sarah Zhang

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October 17, 2022