The following article is written by pediatrician, Dr. Shally Sinha and exposes the dangers of lead poisoning.

Maggi Noodles and Lead Poisoning Cases in My Clinic

You’ve probably heard that Maggi noodles, a staple food in nearly every Indian household, was recently found to contain lead.  Many Indian-American children in Boston were being diagnosed with lead poisoning and the FDSA (Food and Drug Safety Administration) took notice.  Scientists set out to find where the lead might be coming from, and after examining many common Indian staples, they realized that these fast-cooking noodles were the culprit.  An analysis of these noodles found that their levels of both lead and MSG were illegally high. With the acceptable range being between .01 and 2.5 ppm (parts per million), the noodles showed alarming results of 17.2 ppm.

Despite the press from the Maggi noodles story, lead poisoning has been a longtime health concern for children.  I will never forget some of the cases of lead poisoning I saw in my clinic.  We will go over the basics of lead poisoning in a moment, but I wanted to go through these cases first.

Generally I would screen kids by checking a blood lead level (aka BLL) if:

a) they had just moved here from India or

b) if they were using any imported cosmetics or herbal remedies or

c) if they had any other risk factors such as living in a home or visiting a facility regularly which was built before 1978 (when lead-based paint became banned).

The Center for Disease Control (CDC) recommends you follow your state or local health department screening guidelines, since different areas have different levels of exposure. If there is no local guideline, then the American Academy of Pediatrics (AAP) recommends screening lead levels at ages 1 and 2.

When a child is exposed to lead, 80% of that lead is stored in the bones. So it can take months for the lead to slowly come out of his/her bones and be cleared from the bloodstream.

A blood lead level (BLL) of 5 mcg/dL or more is considered an unsafe level and your child will need more frequent blood testing to monitor it, as well as to eliminate any source(s) of lead exposure. A level of 45 mcg/dL or higher would need treatment, i.e. hospitalization for chelation therapy.

In California, two BLL of 14.5 mcg/dL or higher, done 30 days apart, becomes an official state medical case of lead poisoning. Depending on the county, a Public Health nurse case worker may make a home visit to review lead education, do a nutrition assessment, and developmental screening. The lead program will often do an environmental investigation to try to identify the source of lead exposure for that child.

I had the fortune of working with the dedicated staff of the Alameda County lead poisoning prevention program for some of my patients who lived in Fremont, California.  One case I saw was a beautiful 1 year old Indian child whose lead level screen came back at 18 mcg/dL. For the first 8-9 months of her life, she had been receiving the ceremonial black paste known as “surma” or “kajal” (seen on the baby’s eyes in the featured post image) on her face and on her feet to ward off evil spirits.  Luckily she had been exposed to it only 2-3 times a week, whereas another child who had surma applied 2 times a day in the first year of life had a BLL of 38 mcg/dL!

Another Indian child was found to have high blood lead levels from exposure to a turmeric root that the family had brought back from India.  I was told by the case worker in the first patient case, that in 98% of her Indian, Afghan, Pakistani and Yemeni cases, the source of lead exposure was from eye makeup (surma, khol, gazal).

Most children are asymptomatic until they have a BLL of 40 mcg/dL or higher. They may show speech delay or be hyperactive, among other symptoms described below.  However, some studies have shown neurodevelopmental effects in levels much lower than 40. For example, a study published in the New England Journal of Medicine showed that blood lead concentrations even lower than 10 mcg/dL are inversely associated with IQ scores at three and five years of age.

This latest news story on Maggi noodles has many parents wondering just what is in their children’s’ food.   Lead can be damaging to nearly every organ in the body and small children are particularly susceptible to the dangers.  It can affect their brain development and be stored in their bones.  It also stays in their bodies longer and can be found in their blood for years.

It is extremely important that we are aware of this danger and look out for symptoms.  Although the vast majority of foods in the US should be just fine, imported foods are a different story.  Different food regulations, as well as poisoned soil overseas, may make imported pre-packaged foods a serious concern. Common household items such as cosmetics (surma), home remedies (ayurvedic), and imported ceramic pots also are potential lead sources.

What is Lead Poisoning?

Lead poisoning is the buildup of lead in the human body.  Even small amounts of lead can be damaging and large amounts can be fatal.  In children, some developmental delay cases and behavioral disorders have been linked to lead poisoning.

There are treatments, so if you have any reason to think that you or someone you love has been poisoned by lead, see a doctor immediately.

What are the Symptoms?

The symptoms can overlap with symptoms of other illnesses, so none are only specific to lead poisoning. This is NOT an exhaustive list of symptoms.

For children, they include:

  • Hearing loss
  • Learning difficulties
  • Loss of appetite
  • Developmental delay, such as speech delay
  • Fatigue
  • Irritability
  • GI problems such as constipation, vomiting and abdominal pain
  • Anemia
  • Seizures
  • Kidney and nervous system damage
  • Death can result from very high levels in the body

For adults, they include:

  • Memory loss
  • Joint pain
  • Muscle pain
  • GI problems
  • Mental functioning issues
  • Pain and numbness in the extremities

… and more.

Newborns exposed to lead in the womb are especially at high risk for developmental delays and learning difficulties.   If a pregnant woman has a lot of lead in her bones and her calcium is low, the lead will come out of her bones and cross the placenta to enter the baby’s circulatory system. There have been cases when newborns have been born with extremely high levels of lead. This means that pregnant women should be especially careful to avoid sources of exposure.

Young children have very resilient brains, therefore if lead poisoning is caught early, they usually recover with minimal sequelae.

Common Sources of Lead

As mentioned earlier,  food can contain lead. Below are other potential sources of lead to watch for:

– Check what you are eating.  Food sources include:

  • Imported canned goods
  • Imported candies or foods containing chili or tamarind (especially from Mexico)
  • Spices, particularly from India and other parts of Asia, such as cardamom, fenugreek, turmeric and chili powder
  • Be careful with what your children are playing with. Toys may contain lead-based paint.
  • Costume jewelry and inexpensive kids’ jewelries from vending machines, etc.
  • Home remedies:

– Ayurvedic medicines, these types of home remedies are often laden with lead

– Ba-baw-san, a Chinese herbal remedy used to treat colic symptoms in babies

– Greta or Azarcon, a Hispanic home remedy used for upset stomach, constipation, teething pain

– Daw tway, a digestive aid from Thailand containing high levels of lead and arsenic

– Cosmetics from India and other parts of Asia, typically ones that are orange or bright yellow in color, in particular, Srichoornam (made of turmeric and rice paste). Other cosmetics include Kohl, Sindoor, Surma, and Gazal.

Steps to Protect your Children from Lead Poisoning

  1. Keep your home clean and dust-free.  Dirt and dust brought into the home may be contaminated with lead.
  2. Do not allow your child to chew on painted toys or other surfaces.  While most lead-based paints are no longer used in toy manufacturing or furniture, older or imported products may be contaminated. Leaded paint tastes sweet and kids are more likely to want to keep eating it.
  3. Feed them healthy, nutrient dense meals to offset any ill effects of lead. Nutrients like calcium, iron and vitamin C can help protect your child from lead poisoning. Children who are anemic absorb more lead from their intestinal tract.  For example, many vegetarian Indian children who are overfed milk in place of iron rich foods frequently become anemic and are especially susceptible to lead poisoning.
  4. Buy spices like turmeric root/powdered turmeric organic or from trusted sources whenever possible.
  5. Take off shoes or wipe them at the front door before wearing them inside
  6. Cover bare dirt outside (with bushes, grass, gravel, etc.) so that when children play they are not exposed to dirt that has lead.
  7. Do not use older pots or ceramics, or those that are imported.
  8. Use cosmetics manufactured in USA since there are stricter regulations against lead
  9. Talk to your child’s doctor and ask if your child should be screened for lead poisoning

While there is no way to keep yourself or your family totally safe from lead, there is much that you can do to protect your family from toxic levels.  In general, lead is found outdoors and in specific environments.  You or your child are not likely to become exposed to a harmful amount of lead within your house, unless there are very specific items in your home as we have already discussed.

There are many common cultural traditions that are strongly imposed upon families.  As we learned from the case studies, the ritual of applying surma paste to ward off evil ironically resulted in a case of serious lead poisoning.  Be sure to keep track of everything that is put in your child’s mouth (food, toys, etc.) and applied to his or her skin.  This post focuses on lead poisoning, but the broader message is that virtually any food that comes out of a package and is put into your mouth and especially your child’s mouth poses a potential threat to their health.

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1)The California Department of Public Health is a fantastic resource for learning more about lead poisoning, which includes culturally tailored sources of lead poisoning.  Check out their FAQ document.

2)Mayo Clinic resource on lead poisoning