Contamination of baby milk" The Chinese story"

1. Contamination of baby milk" The Chinese story" Mohammed Jawad Musmar, Ph.D,R.Ph, Dean, College of Pharmacy An-Najah National University

2. Infant formula industry is an $8 billion per year business. Risks of infant formula feeding accounts for : up to 26% of Insulin DDM in children higher Otitis media infections. Infants having 10- fold risk of being hospitalized contaminant in powdered formula i.e. melamine and neurotoxins. There may be a connection between glutamate – heavy foods and Alzheimer’s disease glutamate is also a factor in other neurodegenerative diseases such as Parkinson’s, MS, Fibromyalgia and Huntington’s. Formula feeding risk

3. What does Infant formula contain? • Water– high levels of Fluoride, Nitrates, Metals i.e. lead, Cd. etc. • Corn syrup– contains glucose (Mother’s milk contains lactose) • Sucrose– wrong sugar for babies. • Soy oil– processed using high temp. and chemicals i.e. bleached & deodorized • Whey protein– processed using high temp. likely to destroy fragile whey proteins. • Soy protein isolate contains phytoestrogens • Carrageenan– hard to digest in infants • Soy Lecithin– high in pesticides

4. Cont. • Synthetic Vitamins– often have the opposite effect of “Natural” vitamins • free glutamic acid (MSG) and aspartic acid – neurotoxins • Concerning phytoestrogens infant fed soy formula may have concentrations higher than 20,000 times the normal levels in early life. Soy formula has been linked to premature thelarche (breast development in infants and girls under “8” years of age • “It is true that infant formula contains far lower quantities of dioxins, PCB’s and Organochlorine pesticides than breast milk. However formula has serious drawbacks that tip the scale against it”

5. The “Plastic World” has a broader social impact and raises awareness of increasingly important issues. Plastic identification symbol and abbreviations. PET or PETE HDPE PVC LDPE PP PS PC or Others i.e. acrylnitnile, butadiene styrene acrylic What about the plastic bottles? 1 2 3 6 5 4 7

6. Use #’s 1, 2, 4, 5 plastic and avoid plastic that contain • PVC, polyvinylchloride; (note Vinyl chloide is carcinogen). Contains phthalates. • Phthalates – block production of male sex, hormone • Bisphenol-A or BPA used in polycarbonate plastic #7 = mimic the action of estrogen. • PBDE’s used in several plastics = interfere with thyroid hormone“fetal rat exposure to BPA or PBDE’s disrupts normal development of the brain and behavior in rats and perhaps in humans”. We see massive contamination of the oceans, in biology known as “phthalate syndrome”. • 10 billion pounds of PVC resin produced annually in the USA alone • PVC, the most dangerous plastic and NOT recyclable.

7. The additives are very dangerous to health because they don’t bind with plastic, so it can leach out of the polymer. The resins are part of the protective lining used in food & beverage cans. Old or scratched plastic leaks more (teethers of infants) Microwave use results in breaking down and leakage of toxic additives. Toxic chemicals are concentrated in breast milk at very high levels. note that “the mother is concentrating these poisons and delivering them in high dose to inflants. More mothers are nursing their babies. (in USA: from 25% to 75% in the last 30 years)

8. Very important question to ask? • “Should some women with a genetic history that includes family developmental disorders such as language impairment or dyslexia or with male partner who have a similar genetic background breast – feed her baby? • PCB’s & PCBS’s can scramble a developing brain – and how the varying cognition deficits we know as autism and Asperger’s syndrome might be the consequence • Hundreds of thousands of tons of PCBE’s accumulating in the environment every year. * 93 percent of Americans tested positive for BPC at age 6 years? • What do you do when you have a hot potato like this in your hands?

9. Other contaminant: 1- Aluminum 2- Silicon 3- Cadmium 4- genetically engineered corn or soy 5- Bacteria, parasites etc. 6- carrageenan, maltodextrin, soy protein isolate, whey protein concentrate, whey hydrolysate, milk protein isolate, skim milk powder, corn syrup solids, whey powder, citric acid, hydrolyzed casein, corn starch, modified cornstarch. “Note that glutamate is a by product of hydrolyzing any protein”

10. First it was baby milk formula Then, dairy – based products from yogurt to chocolate Now chicken eggs have been contaminated with melamine And who knows what else! Melamine is used to manufacture plastic and fertilizers Very rich in Nitrogen (66%), give artificially high protein readings. Melamine plastic dinnerware may leach the chemical. Melamine was DELIBERATELY added. Melamine is NOT metabolized; No studies on humans, Melamine LD50 < 3 gram / Kilogram, but with cyanurate forms crystals Melamine FDA limits (2008) is up to 2.5 ppm. Melamine and related compounds : ammeline, ammelide, melamine cyanurate etc. No data on prenatal toxicity and No case report or epidemiological studies on carcinogenetic effects Melamine is now in global food chain

11. What can I do to prevent exposure to BPA derivatives? • Don’t microwave polycarbonate plastic food containers. • Avoid plastic containers with the #7 on the bottom. • Avoid using harsh detergent & dishwasher • Reduce your use of canned food • When possible use glass, porcelain or stainless steel containers • Use BPA-free and PC-free baby bottle, teethers, or toys.

12. References • M.S. food and Drug Administration = http://www.fda.gov/ • Center for Disease Control and Prevention = http://www.cdc.gov/ • M.S. Environmental Protection Agency = http://www.epa.gov/ • National Toxicology Program = http://www.niesh.nih.gov/ • Consumer Product Safety Commission = http://www.cpse.gov/ Thank You

13. Recommendations from the Chinese Ministry of Health:

14. Clinical manifestations: 1-Unexplained crying, especially when urinating, possible vomiting 2- Macroscopic or microscopic haematouria 3-Acute obstructive renal failure: oliguria or anuria 4-Stones discharged while passing urine . Forexample , a baby boy With urethral obstruction with stones normally has dysurea 5-High blood pressure , edema , painful when knocked on kidney area.

15. Key diagnostic criteria: • Been fed with melamine-contaminated infant milk formula. • Having one or more of the above clinical manifestations • Laboratory test results: routine urine tests with macroscopic or microscopic haematouria ; blood biochemistry ; liver and kidney function tests; urine calcium/creatinine ratio (usually normal); Urinary blood cell morphology shows normal morphology of red Blood cells ( not glomerular haematauria ); parathyroid hormone test ( usually normal)

16. 4- Imaging examination: preferably ultrasound B exam of urinary system. 5- Ultrasound examination features: General features:Bilateral renal enlargement; increased echo on solid tissue Stone Features; most stones affect the collecting system and ureters on both Sides. Urinary tract is mostly completely obstructed by the stones.

17. Differential diagnosis: 1-Haematouria differentiation: need to rule out glomerular haematuria. 2-Stone differentiation: the stones are normally radiolucent and have a Negative image on urinary tract x-ray . This feature differentiates the stones From those of radiopaque stones of calcium oxalate and calcium phosphate. 3-differentiation of acute renal failure : need to rule out pre-renal and Renal failure

18. Clinical treatment: Immediately stop using melamine-contaminated infant formula milk powder. Medical treatment: use infusion and urine alkalinization to dispel the stones. Correct the water , electrolyte and acid-base imbalance. Closely monitor routine urine tests , blood biochemistry , renal functions , ultrasound findings (with particular Attention to the renal pelvis , ureter expansion , and the change of stones in shape and location ) . Treatment of complicated acute renal failure : priority should be given to the treatment of life-threatening complications such as hyperkalemia. If , possible blood dialysis and peritoneal dialysis can be used early . Surgical measures can be takento remove the Obstruction if necessary.

19. Follow-up: • Once the urinary obstruction is relieved , and the general condition is good, the children • Can be discharged. • Key issues to follow-up: • Urine routine tests ;ultrasound of urinary system ; renal function tests ; • IVP ( intravenous pyelogram ) if necessary.