The “Lead Diet”: Can Dietary Approaches Prevent or Treat Lead Exposure?

Abstract

lthough blood lead levels (BLLs) have been declining in the US for decades, pediatric lead exposure is an ongoing public health issue. 1 Given the welldocumented cognitive deficits at BLLs <10 mg/ dL, in 2012 the Centers for Disease Control and Prevention (CDC) called for renewed efforts for the primary prevention of any lead exposure in children. 2 Recent events in Flint, Michigan, also have served to refocus the public and health professionals on the seriousness of lead exposure. According to CDC statistics for years 2010-2014, 0.5%-0.6% of children (13 000-26 000) had confirmed BLLs ≥10 mg/dL and 4%-6% (106 000-282 000) ≥5 mg/dL. 3 Only 10%-18% of all children in the US aged <6 years, however, had a BLL test during that period. A recent study based on a national clinical laboratory database reported an overall prevalence of BLLs ≥10 mg/dL at 0.58% and ≥5 mg/dL at 2.95% for the years 2009-2015, with certain US states and cities particularly affected. 4 Whether through contaminated water, lead-based paint, or a combination of sources, the problem of lead exposure resurfaces periodically in US municipalities like Flint, Michigan, Washington, DC, or Buffalo, New York, 5-7 highlighting issues of aging infrastructures, under-resourced communities, poor decision making, and environmental injustice. Overlaid on these systemic causes are personal poverty and complex family situations, potentially creating multiple threats to optimal child health and development, including factors such as poor diet or low developmental stimulation. Parents and frontline health workers often are left to figure out how to help affected children, posing questions regarding effective interventions. Because dietary approaches seem relatively easy to implement compared with, for example, lead abatement or replacing old plumbing infrastructure, the conversation often turns to dietary recommendations. The 2012 CDC report highlights the role of pediatricians in educating families on nutrition as one primary prevention approach. 2 It should be emphasized that the prevention of lead exposure among vulnerable populations is the best solution to this problem and that intervening in exposure via dietary approaches does not address the root cause. Furthermore, careful examination of the links between nutrition (nutritional status, nutrients, diet) and lead exposure reveals limited and tenuous evidence. BLL Blood lead level CaT1 Calcium transport protein 1 CDC Centers for Disease Control and Prevention DMT1 Divalent metal transporter 1 RCT Randomized controlled trials See related article, p 218

Does Involving Parents in Soil Sampling Identify Causes of Child Exposure to Lead? A Case Study of Community Engagement in Mining‐Impacted Towns in Peru

“…These factors are robust enough that they remain significant when considering only the youngest child per parent across BLL category (Table 2). Finally, child age and individual variations in child nutritional status, especially iron-deficiency, can also impact BLL (Kordas, 2017); nutritional information is not available for this study. It appears that the interviewer observations, rather than self-reported actions, better capture behaviors that are associated with child BLL, and perhaps represent more standardized or less biased indicators of behavior.…”

“…This could reflect the small sample size of n = 110 when taking the youngest child per parent and n = 138 when taking each child individually and repeating parental factors. Finally, child age and individual variations in child nutritional status, especially iron-deficiency, can also impact BLL (Kordas, 2017); nutritional information is not available for this study.…”

An Evaluation of the Mitigating Effects of Α-Tocopherol (Vitamin E) and Ascorbic Acid (Vitamin C) on the Renal Function and Histology of Adult Male Albino Wistar Rats with Sub-Acute Lead Acetate Exposure

“…This pathogenic process therefore generates a potential role for antioxidants in the reduction of Pb induced tissue damage. To the extent that various studies have evaluated the role of antioxidants in preventing Pb induced tissue damage and even suggested a role for incorporation of antioxidants in the diets of highly lead exposed populations for prevention [8] [9] [10] [11].…”

Urinary calcium: a promising predictive biomarker for early recognition of environmental lead exposure in children

“…3 Following its absorption into the blood stream, this metal is distributed to different organs and tissues where it has no known biological function. 4 Blood Lead Level (BLL) is a frequently used biomarker of lead exposure but there has been controversy over its use and interpretation in early detection of lead toxicity. 5 This therefore, necessitates a continuous search for a simple, accessible and reliable biomarker for early detection of lead exposure and its toxicity particularly in the paediatric population in chemical-laden, nutritionaldeficit environments.…”

“…[13][14][15][16] In the continuous search for indices of early recognition of environmental lead exposure, the interaction between blood lead level and indices of calcium and bone metabolism has not been given serious considerations in developing countries, particularly, in children who experience constant bone re-modelling for continuous skeletal growth and higher risk of nutritional deficiency that might predispose to increased lead exposure. 4 This study was therefore, designed to investigate the interaction between blood lead level and indices of calcium and bone metabolism and their possible use in the early recognition of environmental lead exposure and toxicity in children.…”