A paleo autoimmune diet…
I hope the solutions I share will make you feel a little better about this issue! Let’s jump in.
Exposure to arsenic happens through ingestion, inhalation, or skin exposure (Kapaj, Peterson, Liber, & Bhattacharya, 2006). Arsenic is found in two forms.
- A highly toxic inorganic form, a known carcinogen (IARC 2004; NRC 1999), comes from two sources:
- Arsenic-contaminated well water, with Argentina, Bangladesh, Chile, China, India, Mexico, and the US having particularly high levels of inorganic arsenic in groundwater, according to the World Health Organization.
- Industry, e.g., building products, copper and lead smelting, a preservative in pressure treated lumber and animal hides, in glass processing, pigments, textiles, paper, metal adhesives, ammunition, pesticides, feed additives and even pharmaceuticals (WHO; Cancer.org).
- The less toxic organic form, not implicated in cancer, nevertheless still toxic, comes from foods like fish and shellfish, rice and rice products, poultry, and mushrooms (Cancer.org). In fact, even fruits and vegetables that grow in contaminated areas contain arsenic!
Symptoms of Overexposure to/Toxicity from Arsenic
Acute arsenic poisoning can cause vomiting, abdominal pain and diarrhea and then numbness and tingling of the extremities, muscle cramping and death (Cancer.org).
Long-term exposure can cause:
- Skin, lung, bladder, kidney, and liver cancer (Smith et al., 1992)
Arsenic has also been associated with:
- cardiovascular disease (Islam, 2015)
- neurotoxicity (Vahidnia, van der Voet, & de Wolff, 2007)
- liver damage (Guha Mazumder, 2001)
- kidney disease (Zheng et al., 2014)
- diabetes (Navas-Acien, Silbergeld, Pastor-Barriuso, & Guallar, 2008)
- cancer mortality and all-cause mortality (Wade et al., 2009)
- infant mortality (Rahman et al., 2010)
- prostate cancer (Bulka, Jones, Turyk, Stayner, & Argos, 2016)
- ovary and adrenal tumors in animals (Waalkes, Ward, & Diwan, 2004)
- reproductive disturbances (Rana, 2014)
This certainly calls for a filtration system for drinking water in every household!
A Study on Arsenic in Breast Milk
When reviewing studies from 2016 on the effects of arsenic on human health, I decided to look into the issue of arsenic exposure to infants because it has gained the most public attention. A recent review analyzed studies on heavy metals, including arsenic, in breast milk.
This is a relevant topic because heavy metals cross the placenta and reach the developing fetus. Eighteen studies on arsenic were analyzed: the levels of arsenic were higher in areas with higher arsenic concentrations in water. The study concluded that the intake of arsenic (as well as the other heavy metals analyzed) “can be considered a health concern in most regions of the world” (Rebelo & Caldas, 2016), making this a global issue. This certainly calls for a filtration system for drinking water in every household!
Arsenic and Bottled Water
Arsenic is toxic even at low-level exposure. For example, long-term exposure to even low-level arsenic in drinking water may contribute to the development of diabetes (Brauner et al., 2014). Remember that the US ground water has been found to be particularly high in the inorganic form of arsenic.
Bottled water is another concern. Bottled water was shown in a study from 2008 commissioned by Environmental Working Group to be no safer than tap water. According to their findings, “the lab tests of 10 major brands identified 38 pollutants, ranging from fertilizer residue to industrial solvents. Pollutants in 2 brands exceeded some state and industry health standards.” And here’s the kicker: approximately 40% of bottled water was shown to be derived from tap water sources anyway.
Approximately 40% of bottled water was shown to be derived from
tap water sources.
Now, there is also a growing concern that arsenic may be found in bottled water too. It should not be surprising given that the World Health Organization has concerns with the levels of arsenic in ground water in the US and the fact that a substantial percentage of bottled water comes from tap water! For example, earlier this year, the Center for Environmental Health, a nonprofit organization based in Oakland, California, did independent testing and found high levels of arsenic in a few brands of bottled water: Starkey bottled water (owned by Whole Foods) and Peñafiel bottled water (owned by Dr Pepper Snapple).
Rice and Your Baby
While the fetus is exposed to arsenic in the womb, there is an increased and sustained dietary exposure during infancy. Infant foods often contain concentrated rice, so arsenic levels in baby food are a concern. FDA has called rice “the leading dietary source of inorganic arsenic” but failed to recommend decreasing rice consumption (2016). Instead, in April 2017, FDA set a limit of 100 parts per billion for inorganic arsenic in infant rice cereals. When FDA had tested 76 samples of infant rice cereals from retail stores for inorganic arsenic, about half of the samples contained levels higher than 100 ppb, most exceeding it only slightly (FDA, 2013).
FDA has called rice “the leading dietary source
of inorganic arsenic”
A study published in JAMA Pediatrics just in June 2017 showed an association between rice consumption and arsenic levels in infants in the first year of life (Karagas et al., 2016). Data included 759 infants. Data on rice and rice product intake was collected at 4, 8, and 12 months from birth. Urinary arsenic and commonly reported rice products were tested for arsenic. At 12 months, among infants that did not eat fish or seafood, arsenic concentration in urine was higher in the infants that ate rice cereal (9.53 microg/L) or rice snacks (4.97 microg/L) compared with those who did not eat rice or rice products (2.85 microg/L; all P < .01). Infant rice snacks contained between 36 and 568 ng/g of arsenic and 5 to 201 ng/g of inorganic arsenic. How does that relate to the FDA’s 100ppb? I am honestly not sure. But no arsenic exposure is good to a human, and especially if that is an infant.
Adrenals and Thyroid
Another important aspect of arsenic, which I believe may not be discussed enough, is its effect on the endocrine system, especially the adrenals and thyroid. This is particularly relevant considering how many patients under chronic stress and with hypothyroidism or Hashimoto’s Thyroiditis I and my colleagues see clinically and how ubiquitous arsenic is in our immediate environment: water, air, and food.
Just being exposed to arsenic in polluted air on a job as an urban
traffic policeman can affect thyroid markers.
Arsenic is now considered an endocrine (gonadal, adrenal, and thyroid) disruptor (Sun et al., 2016). The proposed mechanisms of this toxicity include arsenic methylation, oxidative stress, and binding of arsenite to thiols (sulfur-containing compounds). According to this latest review, however, we need more research to look into these toxicity mechanisms. Effects of arsenic on thyroid, including its key nutrient, selenium, are actually quite well established (Meltzer et al., 2002). Just being exposed to arsenic in polluted air on a job as an urban traffic policeman can affect thyroid markers (Ciarrocca et al., 2012). What did surprise me was not being able to find more studies on adrenal impact of exposure to arsenic. A very old study from 1915 discusses adrenal enlargement as well as congestion and hemorrhage (in acute cases) in an animal model (Brown and Pearce, 1915). This topic warrants more research.
Arsenic and Viral Infections?
This brings me to the final topic of my latest clinical interest: individuals with underlying and misdiagnosed viral infections (especially chronic EBV). Given the detrimental effects on health of even a low dose of arsenic as previously indicated, I am intrigued by the potential involvement of arsenic as a substrate for viral replication, based on some anecdotal evidence that viruses thrive while feeding on heavy metals. I only was able to find one study from 2015 that confirmed the researchers’ clinical observations of zoster virus reactivation from high doses of arsenic exposure (Cardenas et al., 2015). This was a cross-sectional analysis of 3,348 participants in NHANES from 2003-2004 and 2009-2010, so a substantial group was studied. It would be interesting to see more studies looking at changes in EBV virulence during arsenic exposure.
Anecdotal evidence suggests that viruses thrive while feeding on heavy metals.
Arsenic in Your Poultry
It is disturbing that arsenic has been fed to poultry in the US since 1940s. The arsenic-containing drug Roxarsone has been added to chicken feed to improve growth, kill parasites, and improve pigmentation of the chicken meat—at a certain point, about 70% of the chicken bred for food in the US were fed this medication.
Despite FDA calling for its removal in 2014, it is unclear what percentage of these chickens are still exposed to it, and neither FDA nor the Department of Agriculture has actually measured the level of arsenic in the poultry meat that you may be consuming!
The Rice Dilemma
Arsenic has made its way into soil, water, produce, and poultry through pesticides and poultry fertilizers (chickens were fed arsenic for decades). As a result, it is unescapable from our food chain. Rice tends to absorb arsenic more readily than many other plants, and therefore it has been the most controversial arsenic-related food outside of chicken.
Consumer Reports has tested various grains concluding that brown rice had on average 80% more arsenic than white rice of the same type because arsenic accumulates in the outer layer of rice that is stripped to make white rice. White rice from Texas, Arkansas, Louisiana, and Missouri was among the highest in arsenic, while basmati rice from California and sushi rice from the US were the lowest. By the same token, brown basmati from California, India, and Pakistan are probably the safest sources of brown rice—they contained only about one-third of the amount of arsenic as compared to other types of brown rice.
Brown rice had on average 80% more arsenic than white rice of the same type because arsenic
accumulates in the outer layer of rice that is stripped to make white rice.
Consumer Reports also tested other grains:
- Gluten-free grains: buckwheat, amaranth, polenta, grits, and millet had negligible levels of arsenic
- Gluten grains: bulgur, barley, and farro contained negligible levels of arsenic
- Quinoa, a gluten-free grain (technically a seed) had “average” levels of arsenic (Consumer Reports 2015)
My reservation is that they did not test organic versus commercial rice, although they claimed that organic brown rice would absorb the same amount of arsenic as non-organic rice. I am not what they based that aassumption on.
Soaking rice overnight and then cooking it
in five of water to one part of rice decreased arsenic by up to 82%.
Solutions to the Arsenic Dilemma
- Install a water filter on your tap water, making sure it filters out arsenic (e.g., Berkey with the addition PF2 filter).
- Skip bottled water. Travel with your own glass or stainless steel water bottled filled with your own filtered water.
- Avoid concentrated rice products like rice drinks, foods, or beverages sweetened with rice syrup, baby foods, and rice snacks.
- Avoid or limit consumption of commercial poultry.
- If you love rice, choose basmati from California (e.g. Lundberg Farm), Pakistan, or India (of course, choose organic). I would still urge you to pick brown rice and follow the instructions below!
- Get rid of arsenic from your rice: First, soak your rice in filtered water overnight. Then rinse it and cook in fresh water in a ratio of 6:1 water to rice. Once the rice is cooked, rinse it again! Andy Meharg PhD, a professor of molecular biosciences at Queens University in Belfast, Northern Ireland, and Michael Mosley, a TV host of Trust Me, I’m a Doctor, did a test and found that soaking rice overnight and then cooking it in five parts of water to one part of rice decreased arsenic by up to 82%. Soaking helps release arsenic from the rice (arsenic is water soluble) and excess water means you can then still rinse off any remaining arsenic that went into water after cooking. The US Rice Foundation goes further and advises to make the ratio of water to rice six to one, so that is what I would recommend. Once the rice is cooked, remember to rinse it again.
- Supplement with selenium: 200mcg goes a long way. We have it available here.
Brown, Wade H., Pearce L. (1915). On the pathological action of arsenicals upon the adrenals. Rockefeller Institute for Medical Research, July 3, New York.
Brauner, E. V., Nordsborg, R. B., Andersen, Z. J., Tjonneland, A., Loft, S., & Raaschou-Nielsen, O. (2014). Long-term exposure to low-level arsenic in drinking water and diabetes incidence: a prospective study of the diet, cancer and health cohort. Environ Health Perspect, 122(10), 1059-1065. doi:10.1289/ehp.1408198
Bulka, C. M., Jones, R. M., Turyk, M. E., Stayner, L. T., & Argos, M. (2016). Arsenic in drinking water and prostate cancer in Illinois counties: An ecologic study. Environ Res, 148, 450-456. doi:10.1016/j.envres.2016.04.030
Cardenas, A., Smit, E., Houseman, E. A., Kerkvliet, N. I., Bethel, J. W., & Kile, M. L. (2015). Arsenic exposure and prevalence of the varicella zoster virus in the United States: NHANES (2003-2004 and 2009-2010). Environ Health Perspect, 123(6), 590-596. doi:10.1289/ehp.1408731
Ciarrocca, M., Tomei, F., Caciari, T., Cetica, C., Andre, J. C., Fiaschetti, M., . . . Sancini, A. (2012). Exposure to arsenic in urban and rural areas and effects on thyroid hormones. Inhal Toxicol, 24(9), 589-598. doi:10.3109/08958378.2012.703251
Guha Mazumder, D. N. (2001). Arsenic and liver disease. J Indian Med Assoc, 99(6), 311, 314-315, 318-320.
IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. (2004). Some drinking-water disinfectants and contaminants, including arsenic: IARC Working Group on the evaluation of carcinogenic risks to humans. Lyon, France: IARC Press.
Islam, MS et al. (2015). Elevated concentrations of serum matrix metalloproteinase-2 and -9 and their associations with circulating markers of cardiovascular diseases in chronic arsenic-exposed individuals. Environ Health. Dec 4;14:92.
Kapaj, S., Peterson, H., Liber, K., & Bhattacharya, P. (2006). Human health effects from chronic arsenic poisoning–a review. J Environ Sci Health A Tox Hazard Subst Environ Eng, 41(10), 2399-2428. doi:10.1080/10934520600873571
Karagas, M. R., Punshon, T., Sayarath, V., Jackson, B. P., Folt, C. L., & Cottingham, K. L. (2016). Association of Rice and Rice-Product Consumption With Arsenic Exposure Early in Life. JAMA Pediatr, 170(6), 609-616. doi:10.1001/jamapediatrics.2016.0120
Meltzer, H. M., Maage, A., Ydersbond, T. A., Haug, E., Glattre, E., & Holm, H. (2002). Fish arsenic may influence human blood arsenic, selenium, and T4:T3 ratio. Biol Trace Elem Res, 90(1-3), 83-98. doi:10.1385/BTER:90:1-3:83
National Research Council. (1999). Arsenic in Drinking Water. Washington, DC: National Academy Press.
Navas-Acien, A., Silbergeld, E. K., Pastor-Barriuso, R., & Guallar, E. (2008). Arsenic exposure and prevalence of type 2 diabetes in US adults. JAMA, 300(7), 814-822. doi:10.1001/jama.300.7.814
Rahman, A., Persson, L. A., Nermell, B., El Arifeen, S., Ekstrom, E. C., Smith, A. H., & Vahter, M. (2010). Arsenic exposure and risk of spontaneous abortion, stillbirth, and infant mortality. Epidemiology, 21(6), 797-804. doi:10.1097/EDE.0b013e3181f56a0d
Rana, S. V. (2014). Perspectives in endocrine toxicity of heavy metals–a review. Biol Trace Elem Res, 160(1), 1-14. doi:10.1007/s12011-014-0023-7
Rebelo, F. M., & Caldas, E. D. (2016). Arsenic, lead, mercury and cadmium: Toxicity, levels in breast milk and the risks for breastfed infants. Environ Res, 151, 671-688. doi:10.1016/j.envres.2016.08.027
Smith, A. H., Hopenhayn-Rich, C., Bates, M. N., Goeden, H. M., Hertz-Picciotto, I., Duggan, H. M., . . . Smith, M. T. (1992). Cancer risks from arsenic in drinking water. Environ Health Perspect, 97, 259-267.
Sun, H. J., Xiang, P., Luo, J., Hong, H., Lin, H., Li, H. B., & Ma, L. Q. (2016). Mechanisms of arsenic disruption on gonadal, adrenal and thyroid endocrine systems in humans: A review. Environ Int, 95, 61-68. doi:10.1016/j.envint.2016.07.020
Vahidnia, A., van der Voet, G. B., & de Wolff, F. A. (2007). Arsenic neurotoxicity–a review. Hum Exp Toxicol, 26(10), 823-832. doi:10.1177/0960327107084539
Waalkes, M. P., Ward, J. M., & Diwan, B. A. (2004). Induction of tumors of the liver, lung, ovary and adrenal in adult mice after brief maternal gestational exposure to inorganic arsenic: promotional effects of postnatal phorbol ester exposure on hepatic and pulmonary, but not dermal cancers. Carcinogenesis, 25(1), 133-141. doi:10.1093/carcin/bgg181
Wade, T. J., Xia, Y., Wu, K., Li, Y., Ning, Z., Le, X. C., . . . Mumford, J. L. (2009). Increased mortality associated with well-water arsenic exposure in Inner Mongolia, China. Int J Environ Res Public Health, 6(3), 1107-1123. doi:10.3390/ijerph6031107
Zheng, L., Kuo, C. C., Fadrowski, J., Agnew, J., Weaver, V. M., & Navas-Acien, A. (2014). Arsenic and Chronic Kidney Disease: A Systematic Review. Curr Environ Health Rep, 1(3), 192-207. doi:10.1007/s40572-014-0024-x
Additional Online Resources:
Arsenic. World Health Organization. Accessed 9-16-16. Retrieved: http://www.who.int/mediacentre/factsheets/fs372/en/
Arsenic. Cancer.org. Accessed: 9-16-16. Retrieved: http://www.cancer.org/cancer/cancercauses/othercarcinogens/intheworkplace/arsenic
Questions and answers: arsenic in rice and rice products. US Food and Drug Administration. Accessed: 9-16-16. Retrieved: http://www.fda.gov/Food/FoodborneIllnessContaminants/Metals/ucm319948.htm
FDA explores impact of arsenic in rice. (2013). US Food and Drug Administration. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm352569.htm
How much arsenic is in your rice? (2015). Consumer Reports. Accessed: 9-16-16. Retrieved: http://www.consumerreports.org/cro/magazine/2015/01/how-much-arsenic-is-in-your-rice/index.htm
FDA Arsenic in Rice and Rice Products Risk Assessment Report (2016): https://www.fda.gov/files/food/published/Arsenic-in-Rice-and-Rice-Products-Risk-Assessment-Report-PDF.pdf
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