How can a food additive be considered a cancer risk on one continent yet safe on another? Keep reading to find out how the United States’ approach to food safety influences the ingredients in your food, and what you need to know about additives that are prohibited in Europe but still deemed safe by the U.S. Food and Drug Administration (FDA).
When It Comes to Additives, U.S. Regulators Focus on Probability, EU Considers Possibilities
Europe takes a more precautionary approach to evaluating chemicals and additives compared to the United States, says Justin J. Kastner, PhD, associate professor in the department of diagnostic medicine and pathobiology at Kansas State University in Manhattan. “One key difference is that historically the United States has been more insistent in focusing on the probability or likelihood of hazards or bad things occurring, and the European Union approach has been more precautionary; they give attention to not just probabilities of something going wrong, but also the mere possibility,” says Dr. Kastner. That has resulted in the EU banning more additives than the United States, he adds. RELATED: Potentially Toxic Chemicals PFAS Are Common in Makeup Products, Study Finds
Food Industry Lobbying Helps Shape Policy in the U.S.
The European Union is more conservative in the way they regulate food additives, agrees Sheela Sathyanarayana, MD, associate professor of pediatrics and adjunct associate professor within the department of environmental and occupational health sciences at the University of Washington in Seattle. Dr. Sathyanarayana currently serves on the U.S. Environmental Protection Agency’s Scientific Advisory Board for the Toxics Substances Control Act. “Another difference between the United States and Europe is that the food industry has a very strong lobbying presence in the United States. A lot of times those voices are really heard, and they help drive the creation of regulation and policy that exists around these kinds of additives,” says Sathyanarayana.
FDA Lags Behind Europe in Updating Regulations and Reevaluating Additives
Although the United States Environmental Protection Agency (EPA) revised the Toxic Substances Control Act (TSCA) so that chemicals may be evaluated before they are put on the market, it didn’t really account for the legacy of decades of things that are already out there, says Sathyanarayana. By contrast, the European food chemical review system recently implemented a system where they reevaluated all approved food chemicals, says Maegan McBride, MPH, science policy associate at the Center for Science in the Public Interest (CSPI) in Washington, D.C. CSPI is an independent consumer advocacy organization founded in 1971 that provides practical and science-based advice around food safety. “Because the United States doesn’t have a system in place for reevaluation, it means that certain chemicals haven’t been reevaluated since they were first approved, which could have been any number of years ago,” says McBride. “It’s important to reevaluate because the field of toxicology is always progressing,” she adds. RELATED: California Bans 24 Toxic Chemicals in Personal-Care Products
Consumer Preference Is Helping to Reduce Use of Food Additives
Manufacturers are really paying attention to some of these issues because now there are consumers who are saying, “We don’t want these things in our food,” says Sathyanarayana. “Almost every manufacturer has a natural or alternative product line, or they have acquired one for their portfolio. I do think that there’s a trend toward paying attention to these kinds of things and hopefully trying to eliminate them when they can,” she says.
Food Additives and Cancer: What’s the Evidence?
There are definitely challenges in determining cancer risk of additives in humans, says McBride. “When there is a chemical of concern or it’s suspected that it’s associated with an adverse outcome such as cancer, it’s unethical to conduct the gold standard of research studies, which would be a randomized placebo-controlled trial in humans,” she says. “It would be unethical to administer something to someone that you thought might have potential to hurt them; that makes it difficult to get very strong evidence in humans and why it’s so common to see animal testing in these cases, or more observational studies in humans,” adds McBride. Although lab studies can’t always predict if a substance will cause cancer, most carcinogens that are found to cause cancer in lab animals are later found to cause cancer in people, according to the American Cancer Society. That said, most of the time animals are exposed to much higher amounts of the substance than a person who typically encounter and so it’s difficult to determine risk. According to the American Cancer Society, if a substance is found to cause cancer in animals “it is reasonable for public health purposes to assume that lowering human exposure will reduce risk.” Because most chemicals and additives known to cause cancer in animals have not been proven to cause cancer in people, they are sometimes called possible human carcinogens, according to the Centers for Disease Control and Prevention (CDC). RELATED: Food Rx: A Cancer Expert Shares What He Eats in a Day
Additives That Are Banned in Europe That Are Allowed in the U.S.
Here’s a rundown of food additives that aren’t allowed in Europe but are still used in the United States:
Titanium Dioxide
This additive is used for coloring and is found in Skittles, Starburst, baked goods, soups, broths, sauces, and sandwich spreads. “Titanium dioxide is something that can build up over time — it doesn’t get excreted very well,” says Sathyanarayana. The additive has been shown to be genotoxic in studies, which is why it is banned in Europe, she explains. Genotoxicity refers to the ability of a chemical substance to damage DNA, which is the genetic material in all cells, and it may lead to carcinogenic, or cancerous, effects. On May 6, 2021, the European Food Safety Authority (EFSA) issued a statement that it no longer considered titanium dioxide safe when used as a food additive. The EU regulators didn’t find conclusive evidence on the toxic effects of titanium dioxide, but they couldn’t rule out a concern for genotoxicity. Consequently, they couldn’t establish a safe level of daily intake of the additive. Although the EFSA’s recommendation likely means the additive will be banned eventually, it hasn’t happened yet — that will be decided by the European Commission and Member States. Right now, neither the CSPI nor the EFSA have issued recommendations on whether people should eliminate titanium dioxide from their diets.
Potassium Bromate
This additive is used in white flour, bread, and rolls to increase the volume of the bread and give it a fine crumb (not crusty) structure. Most bromate rapidly breaks down to form bromide, which is harmless. However, bromate has been shown to cause cancer in animals, and trace amounts of the chemical may remain in bread which could potentially be a small health risk to consumers, says McBride. Bromate has been banned in most countries around the world except for Japan and the United States. In 1999, CSPI petitioned the FDA to ban bromate, and it recommends consumers avoid this additive. Many millers and bakers have stopped using bromate, and it’s rarely used in California because a cancer warning may have to be included on the label, according to the organization. In 1986, California created a law called Proposition 65 that requires businesses to provide warnings on product labels if it contains a chemical that may cause cancer, birth defects, or other reproductive harm. Some food and product safety experts consider the state a bellwether for such regulation.
Azodicarbonamide
This additive is typically found in bread and packaged baked good products, says McBride. According to CSPI, the two potentially risky chemicals form when azodicarbonamide is baked. One of those, semicarbazide, doesn’t appear to pose a risk to humans, but the second breakdown product, urethane, is a recognized carcinogen. Although the risk is small, CSPI claims azodicarbonamide isn’t necessary for the food supply and should be banned in the United States, and they recommend avoiding it.
Butylated Hydroxyanisole (BHA) and Butylated Hydroxytoluene (BHT)
These additives work as preservatives for foods that contain oils or fats. It preserves foods and keeps them from getting rancid, says McBride. “There is concern for cancer risk with BHA,” she says. A previous study found that BHA caused cancer in the forestomach of rats and concluded that the additive should be classified in the category of “sufficient evidence of carcinogenicity” according to the International Agency for Research on Cancer (IARC) criteria. U.S. Department of Health and Human Services stated that BHA is “reasonably anticipated to be a human carcinogen” in a 2011 report. CSPI recommends people avoid consuming BHA. BHT is the chemical cousin to BHA and the two compounds are often used together, according to the Environmental Working Group (EWG), a nonprofit that works to protect public health. It’s not listed as a carcinogen, but there have been studies where rats fed BHT have developed cancer, and it has been shown to cause developmental effects and thyroid changes in animals, according to a safety report on BHA. EWG recommends avoiding BHT, especially when it’s used along with BHA.
Recombinant Bovine Growth Hormone (rBGH)
There was big movement that was featured prominently in the news a little more than a decade ago for the dairy industry to be hormone-free, says Sathyanarayana. “There are some brands of hormone-free dairy products available, but there are many that still contain them,” she says. “The major concern is that there are hormone-dependent cancers — there is concern that if you’re exposed those hormones, are you increasing your cancer risk down the line?” she explains. Not everyone agrees that this poses a risk, says Sathyanarayana. “Some people will say that these hormones aren’t biologically active hormones that are getting transferred to the human body, but others would say that we don’t know because all of that data comes from animal studies — it’s not coming from human studies,” she says. Hormones affect almost every system in our body, so if there is hormonal transfer that could influence health, she explains. “Many of those hormones used are steroid hormones such as testosterone and androgen, which are found naturally in our bodies, but if you have higher concentrations of them, they could certainly be associated with health risks,” she says. There isn’t a scientific consensus on whether products that come from rBGH-treated cows pose a risk to health, says Sathyanarayana. If you want to avoid milk with added hormones, buy products that state “rBGH-free milk” or “rBST-free milk” or “from cows not supplemented with rBST,” according to the Milk Processor Education Program (MilkPEP).
Color Dyes (Yellow No. 5, No. 6, Red No. 40)
Synthetic dyes give color to food products, but they aren’t necessary, and they are often used create the impression that the food contains real fruits or vegetables even when they don’t, says McBride. “We have some information that those dyes have been associated with hyperactivity and behavioral changes in kids. There’s not a huge amount of literature, but the small amount that we do have makes us concerned,” says Sathyanarayana. A report released in April 2021 by the California Environmental Protection Agency’s Office of Environmental Health Hazard Assessment found that current federal guidelines for safe levels of intake of synthetic food dyes may not be enough to protect children’s behavioral health. The agency concluded that children are exposed to multiple dyes in a day and their effects on the individual can vary. Guidelines for the FDA’s Acceptable Daily Intake levels (ADIs) are based on 35-to 70-year old studies; if newer research were used to revise those levels, they would be much lower, write the authors of the report. According to the American Academy of Pediatrics, existing research raises concerns about these dyes and their role in child behavior and exacerbating attention deficit hyperactivity disorder, and eliminating them may be beneficial. CSPI recommends avoiding all three of these synthetic dyes.
Brominated Vegetable Oil (BVO)
This additive was once found in popular drinks like Mountain Dew and Gatorade, but pressure from the public, including an online petition from a Mississippi teenager, led Coca-Cola and PepsiCo to stop using BVO in their products. There are some beverages, such as the Keurig Dr. Pepper’s soda, Sundrop, and generic lemon-lime drinks, that still contain BVO. BVO is associated with potential health risks, including harm to the nervous system. One early study found that rats that consumed large quantities of BVO showed significant reproductive harm. The FDA’s position on BVO is that it can be used safely “on an interim basis” provided that drinks contained less than 15 parts per million in the finished beverage; the average drink that contains BVO contains about half that amount. CSPI recommends avoiding products that contain BVO. RELATED: How Safe Is the Food We Eat and Serve Our Families?
How to Avoid Potentially Risky Food Additives
The current regulatory system in the United States leaves much of the work of figuring out what’s safe or unsafe to the consumer, says Sathyanarayana. If you want to eliminate or reduce food additives in your diet, she offers these tips: Consume fresh or frozen fruits and vegetables whenever possible. Try to focus on consuming fresh or frozen fruits and vegetables and move away from eating processed foods, she says. “You have to be practical about it. We live in an industrialized world, people are working a lot, and we don’t have time to make everything from scratch. You can make a lot of good food from frozen ingredients where you don’t have to do all the washing and chopping that some fresh vegetables require,” she says. Read product labels. “We’re putting a huge burden on consumers by asking them to do that — it’s really time consuming and hard. But if you are a label reader, selecting foods with fewer ingredients is typically the best way to go,” says Sathyanarayana. Foods that are labeled “organic” can help take some of the guesswork out. In packaged foods, those given an organic designation are prohibited from using ingredients that “have an adverse effect on human health,” according to the EWG. Synthetic ingredients added to organic packaged foods must also be reviewed every five years. Seek out resources to help you. Consumer advocacy groups such as CSPI and EWG provide lists of additives you should reduce or avoid. There also phone apps available to help you make sure the foods you’re buying are safe — just search “food ingredients scanner” in the App Store. Two such apps are Sift Food Labels and Ingredio, which use pictures of food ingredients on the label or a bar code and alert you of any potentially risky additives. Search for products with fewer and more natural ingredients. Snack bars are a good example of a way people can reduce the additives in their diet, says Sathyanarayana. “Some of these can have a very complicated list of ingredients. I would recommend seeking out the bars that have just a handful of recognizable ingredients — nuts, nut butters, or fruits,” she says. Don’t fall into the “all or nothing” trap. “Overall, when I talk with families and patients, we discuss what they can do to limit their exposure to processed foods and maximize nutrition and healthy eating,” says Sathyanarayana. You don’t have to be all or nothing, but try to reduce things that are highly proceeded and full of additives like ultra-spicy bright orange corn snacks, she adds.
