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Nov. 26, 2008 -- Tiny "trace" amounts of potentially toxic melamine reportedly detected in U.S.-made infant formula pose little if any risk to kids, experts tell WebMD.

Investigative reporters for the Associated Press obtained FDA documents showing the agency has been testing U.S. made baby formula for melamine.

According to the AP report, one brand of formula contained very small amounts of melamine. Another brand contained similarly tiny amounts of cyanuric acid, a related chemical. And a third maker of infant formula told the AP that its own tests detected small amounts of melamine in its product.

In China, melamine was deliberately added to infant formula to make it appear to have a higher protein content. Over 52,000 children developed kidney stones. There were over 13,000 hospitalizations and at least two deaths.

The FDA has not found any Chinese infant formula in the U.S., and has warned all manufacturers not to use milk products imported from China unless they have been tested for melamine contamination.

American-made infant formula is not made with milk products from China. The trace amounts of melamine detected in U.S. infant formula apparently came from routine contact with melamine-containing substances during the manufacturing process. There is no reason to suspect the melamine was added deliberately.

Should parents worry? WebMD consulted with experts who answered your questions.

What is melamine?

Melamine, also known as cyanuramide, is a synthetic chemical product that forms hard resins when combined with formaldehyde. It is used in a wide range of products such as cooking utensils, plates, industrial coatings, paper and paperboard, and flame retardant.

Melamine has also been used as fertilizer, although not in the U.S.

What happens when kids consume melamine?

Humans and animals that consume toxic doses of melamine develop kidney stones. These hard crystals can block urinary flow and make urination painful. They can also cause kidney failure and death, pediatric kidney specialist Marc B. Lande, MD, MPH, of the University of Rochester, N.Y., tells WebMD.

Which brands of U.S. baby formula contain melamine?

According to the Associated Press, FDA tests detected trace amounts of melamine in Mead Johnson's Infant Formula Powder, Enfamil LIPIL with Iron.

Melamine levels in the product were very low: about 0.14 parts per million. The deliberately contaminated baby formula in China contained over 250 parts per million of melamine -- at least two thousand times higher than the U.S. contamination.

The AP report also said the FDA detected cyanuric acid in tests of Nestle's Good Start Supreme Infant Formula with Iron, at about 0.25 parts per million -- again, some thousand-fold less than in Chinese formula.

In addition, the AP report said that while the FDA tests came up negative, Similac maker Abbott Laboratories said some company tests did find traces of melamine, at concentrations below 0.05 parts per million.

These three manufacturers -- Mead Johnson, Nestle, and Abbott -- make more than 90% of the baby formula sold in the U.S.

Is U.S. baby formula safe?

Nobody knows for sure -- but several experts tell WebMD they think U.S. baby formula is safe, despite containing trace amounts of melamine.

Here's the opinion of Marcel Casavant, MD, chief of clinical pharmacology/toxicology at Nationwide Children's Hospital in Columbus, Ohio, medical director of The Central Ohio Poison Center, and director of the Central Ohio Lead Clinic.

"We don't really know for sure how much melamine is safe," Casavant tells WebMD. "We do know how much is bad. It's really the dose that makes something a poison or not. Concentrations of more than 250 parts per million cause big troubles for some babies. How low does the concentration have to be to cause no problems for any babies? That's what we don't know for certain."

Casavant notes that the FDA finds melamine concentrations up to 2.5 parts per million to be safe in products used to feed sick children in the hospital. Health Canada says a level of 1.0 part per million is safe in infant formula and 2.5 parts per million is safe in other foods and beverages.

"They based this on finding the lowest concentration to cause problems in animals, and then divide by 100," Casavant says. "It's just a guess, but it's the way these guesses are usually made."

Gary Wasserman, DO, chief of medical toxicology at Children's Mercy Hospitals and Clinics in Kansas City, Mo., says trace levels of melamine and other chemicals have probably been present in infant formula for decades. We find it now because we've just started to test for it.

That's also the opinion of Marvin Wang, MD, assistant professor of pediatrics at Harvard Medical School and director of newborn nurseries at Massachusetts General Hospital for Children.

"These formulas have done remarkably well in terms of safety for all the years they've been on the market," Wang tells WebMD. "We have not seen reports of the kinds of symptoms you would see in melamine toxicity. … Unless the infant formula manufacturers declare they recently made a change in the way they process the formula, or that they obtained milk products from China, there is no reason to think these infant formulas are any less safe than infant formulas that have been on the market for many years."

Scientists never say never. None of the experts who spoke with WebMD would guarantee that all U.S. infant formulas are safe for all babies. But every one of the experts says the evidence so far strongly indicates that U.S. infant formula is safe.

"I'm sorry I can't be more specific, and can't guarantee safety at 0.14 parts per million," Casavant says. "The trouble is we really don't have a lot of experience and data with this poison in infant formula. People smarter than I are guessing at safe levels, and I'm only able to report their guesses. But I do think they're guessing right. I don't think 0.14 parts per million in formula is going to turn out to be a problem."

If I feed my child formula, will melamine build up in his or her body?

Wasserman notes that the body gets rid of melamine in three to four hours, so it's very unlikely that tiny amounts will build up in a child's system.

"The human body is an amazing organ that has hundreds of mechanisms to protect itself from toxins," Wasserman tells WebMD. "We are bombarded every day by lots of chemicals we don't know about, and our bodies just handle them."

That's true, agrees Ingolf Gruen, PhD, associate professor of food science at the University of Missouri, Columbia.

"Our ability to analyze foods for specific chemicals is improving all the time," Gruen tells WebMD. "Of course, when you have infants and baby formula, I fully understand when moms say I want zero toxins. But in all honesty, I don't think that is a reasonable expectation. Even if you grow your own squash and carrots and process it into homemade baby food, don't fool yourself into thinking it is contaminant free. It probably picked up traces of something along the way."

Should I switch my child to a different brand of formula?

There's no guarantee that any brand of infant formula is entirely free of melamine.

"Each of the three big manufacturers -- Abbott, Nestle, and Mead Johnson -- found similar concentrations of either melamine or one of its relatives in their products," Casavant says. "These three companies apparently make almost all of the formula sold in the USA -- so if parents wanted to switch from Enfamil Lipil to something else, we couldn't really suggest another product that we know to be safer. Breast milk's always best, but I've not found whether anyone's tested breast milk for melamine yet."

What are the symptoms of melamine poisoning?

Wang says symptoms of melamine poisoning are related to kidney stones or bladder stones.

"Infants with these kinds of problems will have severe abdominal pain, blood in the urine, and/or difficulty urinating," Wang says. "If you are not seeing that, there is no need to think the child has suffered any ill effect from his or her formula."

According to the American Society of Pediatric Nephrology, signs and symptoms of melamine poisoning in infants include:

• Unexplained crying in infants, especially when urinating
• Vomiting
• Unexplained fever due to urinary tract infection caused by urinary obstruction
• Blood in the urine
• Stones discharged while passing urine
• Signs of kidney infection
• High blood pressure
• Flank pain
• Kidney failure

View Article Sources

SOURCES:

Mendoza, M. and Pritchard, J. Associated Press, "FDA and Industry Detect Traces of Melamine in U.S.-Produced Infant Formula," Nov. 26, 2008.

FDA, "Interim Safety and Risk Assessment of Melamine and Its Analogues in Food for Humans," Oct. 3, 2008.

American Society of Pediatric Nephrology, "Kidney Disease from Powdered Infant Formula-Based Melamine Exposure in Chinese Infants," Oct. 22, 2008

Ingolf Gruen, PhD, associate professor of food science, University of Missouri, Columbia.

Marc B. Lande, MD, MPH, associate professor of pediatric nephrology, University of Rochester Medical Center, N.Y.

Marvin Wang, MD, assistant professor of pediatrics, Harvard Medical School; associate pediatrician and director of newborn nurseries, Massachusetts General Hospital for Children, Boston.

Marcel Casavant, MD, chief of clinical pharmacology/toxicology, Nationwide Children's Hospital; professor of medicine, Ohio State University College of Medicine; medical director, Central Ohio Poison Center; director, Central Ohio Lead Clinic, Columbus, Ohio.

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Nov. 26, 2008 -- No matter how earnestly you resolve not to overindulge this Thanksgiving, you will probably eat more than you should.

After all, a typical Thanksgiving meal can add up to 3,000 calories or more. And if you snack throughout the day or eat two big meals, you could easily double that for the day.

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One of the biggest culprits? Pecan pie. A single slice with whipped cream has about 800 calories -- more than a meal's worth of calories in a single dessert.

You won't find much that's low calorie elsewhere, either, unless your feast happens to have a raw veggie plate. Here's how some other Thanksgiving favorites stack up:

• Roasted dark and white meat turkey with skin -- 450 calories
• Homemade stuffing with gravy -- 600 calories
• Cranberry relish -- 200 calories
• Candied sweet potatoes -- 400 calories
• Green bean casserole -- 190 calories
• Pumpkin pie with whipped cream -- 400 calories
• Cup of eggnog -- 400 calories

Who even wants to think about how long it would take to work all that off!

So what's a dieter to do?

WebMD contacted three well-known experts to get their take on Thanksgiving feasting. Their advice: Enjoy the day, and get back on track Friday.

"It's not the easiest time to eat sensibly and I don't advise trying very hard," says NYU professor of nutrition Marion Nestle, PhD, MPH, who wrote the 2006 book What to Eat.

"My approach is to pick and choose," she tells WebMD. "I taste everything, keep the servings really small, and save room for seconds of the foods I really like. But if family dynamics mean that the cook will never forgive you if you don't eat the food, it's best to eat the food, enjoy every bite, and deal with dieting later in the week."

Physician John La Puma, MD, says even totally out-of-control days won't lead to significant weight gain if you have only few of them a year.

An accomplished cook who has adopted the pseudonym 'ChefMD,' La Puma is the author of the book ChefMD's Big Book of Culinary Medicine.

La Puma recommends choosing four days a year as "feast days" when you can eat and drink anything you want in any quantity you want.

"I think the idea of feasting that Thanksgiving represents is kind of lost in American society because we tend to feast all year long," he tells WebMD.

"The problem isn't Thanksgiving, it is the fact that many people don't stop eating between Thanksgiving and the New Year," he says.

Pete Thomas was once one of those people.

"Before I lost weight I viewed Thanksgiving as a day to gorge myself and eat everything in sight," Thomas tells WebMD. "That turned into a month of gorging between Thanksgiving and Christmas."

continued...

In November 2005, Thomas walked away from the finale of NBC's Biggest Loser $100,000 richer after losing 185 pounds in nine months.

Now a motivational speaker, Thomas specializes in helping extremely obese people lose weight.

WebMD's Health Tools and Slide Shows

Check out some of WebMD's popular health tools and slide shows:

• 9 Least Effective Exercises
• Weird Body Quirks
• Common Childhood Skin Problems
• Is Your Type 2 Diabetes Under Control
• Fibromyalgia: Check Your Symptoms

© 2008 WebMD, LLC. All rights reserved.

Thomas' strategy for staying in control during the holidays involves planning.
"If you plan to get some exercise the morning of Thanksgiving and the morning after, that will go a long way to keeping you on track," he says. "And develop a plan for holiday eating so you don't eat everything in sight."

Some of Thomas' other tips include:

• Enjoy the foods you really love in reasonable portions, but skip the foods you don't.
• Plan activities to compliment the day that everyone can do together. "Make it about more than just the food," he says.
• If you are the cook or are contributing to the holiday meal, make a dish that you like that meets your nutritional needs.
• Clear the table and put the food away immediately after the big meal and send food home with guests.
• Have reasonable expectations.

"You probably won't lose weight during the holidays, but with careful planning you can avoid gaining weight," he says.

View Article Sources

SOURCES:

Marion Nestle, PhD, MPH, professor of nutrition, New York University.

John La Puma, MD, medical director, Santa Barbara Institute for Medical Nutrition and Healthy Weight, Santa Barbara, Calif.

Pete Thomas, motivational speaker, Ypsilanti, Mich.

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Nov. 25, 2008 -- Going to church -- or any kind of religious service -- may prolong your life.

A new study shows that older women who regularly attend religious services reduce their risk of death by 20%. The study was published in Psychology and Health.

Researchers from Yeshiva University's Albert Einstein College of Medicine grouped all religions together, looking only at whether the women attended services regularly and whether those services brought them comfort.

Organized religion creates a social network with regular routines, which is known to enhance well-being. However, even when researchers adjusted for that factor, the women going to services were still less likely to die.

"Interestingly, the protection against mortality provided by religion cannot be entirely explained by expected factors that include enhanced social support of friends or family, lifestyle choices, and reduced smoking and alcohol consumption," lead author and clinical assistant professor of psychology Eliezer Schnall says in a news release. "There is something here that we don't quite understand. It is always possible that some unknown or unmeasured factors confounded these results."

Researchers evaluated 92,395 postmenopausal women participating in the Women's Health Initiative Observational Study, a national, multi-ethnic, long-term study aimed at addressing women's health issues funded by the National Institutes of Health. The women, all between the ages of 50 and 79, answered questions about their behaviors, health, and religious practices.

Researchers followed participants for an average of 7.7 years and made adjustments for known risk factors, such as age and health history, when evaluating risk of death. They found that women attending religious services at least once per week showed a 20% mortality risk reduction compared to those not attending services at all.

In addition to looking at mortality broadly, researchers examined the risk of death from cardiovascular disease. They did not find that religion had an impact on the women's risk of death by this particular cause.

View Article Sources

SOURCES:

Schnall, E. Psychology and Health, 2008.

News release, Yeshiva University.

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Nov. 25, 2008 -- For the first time, cancer rates and cancer deaths both dropped in the U.S., according to the American Cancer Society's 2008 annual report.

The report offers detailed statistics on deaths and new cases for all cancers. The data covers the period 1975 to 2005.

Cancer deaths have been dropping since the early 1990s, but dropped faster in the most recent time period, 2002-2005.

"This is real progress," says the report's lead author, Ahmedin Jemal, PhD, strategic director for cancer surveillance at the American Cancer Society. "It's the result of improvements in early detection and treatment."

Harder to interpret is the overall decline in new cases of cancer.

"It is encouraging, but not as rock solid an indicator of true improvements as mortality," National Cancer Institute epidemiologist Barry Miller, DrPH, tells WebMD.

That's because factors such as cancer screening affect the number of new cases. Increased screening would catch more cancers, but would also catch indolent cancers that might go away on their own if undetected.

Changes in cancer risk factors also affect the number of new cancer cases, Jemal notes. He offers the decline in new cases of breast cancer as an example.

"Is that due to decreases in the number of women on hormone replacement therapy? That would be a good thing. Or is it due to the decrease we've seen in the number of women getting regular mammograms? Maybe we are not detecting as many breast cancers at an early stage, and that is not good news," Jemal says.

Some Cancers Down, Other Cancers Up

Most of the decline in cancer deaths and new cancer cases can be attributed to:

• Declines in the three most common cancers in men: lung cancer, colon cancer, and prostate cancer
• Declines in two of the three most common cancers in women: breast cancer and colon cancer
• Leveling off of cancer death rates of the second most common cancer in women: lung cancer

For several cancers, new cases increased from 1990 to 2005:

• of the skin
• Kidney cancer
• Thyroid cancer

These increases, however, likely are a result of increased detection with improved imaging technology -- so the increases may mostly be early, less lethal cancers.

One cancer, however, dominates the statistics: lung cancer in American smokers. Even with the dramatic decrease in smoking seen in the last decade, cigarette smokers account for nearly a third of all U.S. cancer deaths.

Although lung cancers are down overall, there are huge regional variations. The decline in lung cancer deaths in men, for example, was twice as large in California as in many Midwestern and Southern states.

Among women, lung cancer deaths actually increased in 13 states -- all in the South and Midwest. In these states, there are relatively fewer tobacco control programs, lower taxes on cigarettes, and less tobacco-lawsuit settlement money going to anti-smoking efforts than in other states.

Some Cancers Down, Other Cancers Up continued...

"This report highlights a success story in that it correlates declines in lung cancer deaths with incentives to get people to stop smoking or not take up smoking," Miller says. "We need to redouble efforts to impact populations across the country and make an impact where we haven't before."

"States can get huge dividends from promoting tobacco control programs, but it is always on the back burner," Jemal says. "States got $25 billion from the tobacco settlement, but only 3% goes to tobacco control efforts. And any time state officials have a budget shortfall, the first cut they think of is tobacco control efforts."

Still Too Many Cancer Deaths

Offsetting the good news that U.S. cancer deaths are down is the knowledge that the nation could have done even better.

"This progress could have been accelerated even more by ensuring that all populations in America have timely access to health care and prevention measures," Jemal says. "We know that almost 47 million Americans are uninsured, and there are 25 million more underinsured -- not to mention the underserved populations, such as American Indians. So we are not delivering what we know about cancer interventions to all segments of the population."

A change in focus also is needed. Jemal says that the current system focuses on cancer treatment but fails to give enough attention to cancer prevention.

"We need more emphasis on promotion of well-being such as getting more physical activity, achieving a healthy body weight, and eating a healthy diet," he says. "And the 44 million U.S. adults who smoke really need help to quit but are not getting that help. Nearly half of smokers try to quit, but only 20% get needed help from their doctors."

Although new screening tests are needed, existing cancer screening tests are underused. The main example here is colon cancer, which can be detected when about 90% of cases are curable -- yet only half of adults aged 50 and older get the recommended colon cancer screening.

And, Jemal says, more money is needed for research. The declines in cancer deaths we see today are a direct result of past investments in research.

"When you talk about investments in cancer over the last 5-7 years , it has been flat. We have to make cancer a priority," Jemal says.

The American Cancer Society's annual report appears in the Dec. 3 issue of the Journal of the National Cancer Institute.

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View Article Sources

SOURCES:

Jemal, A. Journal of the National Cancer Institute, Dec. 3, 2008; vol 100: pp 1672-1694.

Ahmedin Jemal, PhD, strategic director for cancer surveillance, American Cancer Society, Atlanta.

Barry Miller, DrPH, epidemiologist, Cancer Statistics Branch, National Cancer Institute, Bethesda, Md.

Kathy Cronin, PhD, statistician, Statistical Research & Applications Branch, National Cancer Institute, Bethesda, Md.

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Nov. 25, 2008 -- A consumer watchdog group is urging parents to avoid buying soft plastic toys this holiday season because of a risk that the toys may contain toxic chemicals.

Toys containing the chemicals, called phthalates, can no longer be manufactured or imported after February 2009, according to a product safety law that passed Congress over the summer.

But the group says the Consumer Product Safety Commission is allowing the toy industry to circumvent the law. The agency wrote a letter last week telling manufacturers they can still sell their existing stocks of phthalate-containing toys even after the ban takes effect in February.

"They're giving the industry a loophole," says Liz Hitchcock, a public health advocate for the U.S. Public Interest Research Group (U.S. PIRG).

Phthalates are a group of chemicals used to soften vinyl and other plastics. Congress banned use of the chemicals in toys because of evidence they can have health effects including early puberty, reproductive defects, and lower sperm counts in boys.

U.S. PIRG offered the following tips for avoiding unsafe toys:

• Don't buy soft toys made of "PVC" (polyvinyl chloride) plastic. Many of these contain phthalates and may not be labeled.
• Avoid play cosmetics with xylene or toluene or phthalates.
• Avoid cheap metal play jewelry, key chains, and similar products. Many of these products contain lead.
• Avoid toys with small parts that can pose a choking hazard to young children. Bring along a toilet paper tube on your shopping trip. Any toys or parts that fit inside the tube are too small for children aged 3 and under.

The new law stands to increase the budget and personnel at the Consumer Product Safety Commission and give the agency tougher recall authority.

The agency's move on phthalates sparked angry reactions from several Democratic members of Congress, who accused the Bush Administration of avoiding the intent of the new law.

Julie Vallese, a Consumer Products Safety Commission spokeswoman, says that the agency was not trying to give toy makers a way out of meeting new rules on phthalates. She said the wording of the law sets new standards for phthalates but does not automatically ban their sale in toys.

"Where U.S. PIRG's criticism should be is on Congress. If they don't like the language that they used, Congress has the authority to fix it," Vallese tells WebMD.

Joan Lawrence, vice president for safety standards and regulatory affairs for the Toy Industry Association, defends the industry's safety record. "The industry has been massively inspecting and testing toys since last year and government has too," she says. "The fact is, there are just far fewer issues. There's strong science that says phthalates are safe as used in toys."

Lawrence is critical of advice to avoid purchasing soft plastic toys. "I don't know that that's helpful for parents," she says. "Many soft toys don't contain pthalates, so parents will be avoiding a lot of toys for no reason."

View Article Sources

SOURCES:

Trouble in Toyland, the 23rd Annual Survey of Toy Safety, U.S. Public Interest Research Group. Nov. 25, 2008.

Liz Hitchcock, public health advocate, U.S. PIRG.

Sen. Barbara Boxer, D-Calif., letter to CPSC general counsel, Nov. 21, 2008.

Julie Vallese, spokeswoman, Consumer Product Safety Commission.

Joan Lawrence, vice president for safety standards and regulatory affairs, Toy Industry Association.

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