Asking for a Friend,

Being a first-time father to a 1.5-year-old child means addressing unexpected questions from the first-time grandparents of a 1.5-year-old child. My father sent my wife and me a somewhat guilty-sounding email about the latest New York Times scare piece on the topic of mac and cheese, a foodstuff he presents to my son when he visits their home each week ... I would love your take.

Jacob


I’m glad you asked. A few other people were curious about this, too. Actually more than a few others. Since that Times story came out earlier this month, most of my time has been spent asking and answering questions about either John McCain or powdered cheese.

Which is fine, that’s the idea of a column like this. Though the stakes feel different here. People are less curious than genuinely, eyelid-spasming scared. The terror-intro of the July article: “Potentially harmful chemicals that were banned from children’s teething rings and rubber duck toys a decade ago may still be present in high concentrations in your child’s favorite meal: macaroni and cheese mixes made with powdered cheese.”

All of these words are true. Except—except—for the word high. Arguably the most important word. The words are also misleading, and potentially more dangerous than the macaroni powder they describe.

“A new study of 30 cheese products has detected phthalates in all but one of the samples tested,” the story continues, explaining that phthalates are chemicals that “can disrupt male hormones like testosterone and have been linked to genital birth defects in infant boys and learning and behavior problems in older children.”

According to the group that distributed the report, nine of the products tested were of the Kraft variety, eight of which contained phthalates.

Katie Martin / The Atlantic

I was scared too, as an occasional non-child consumer. Some nights I justify it in that it’s cheap and fast, and I make it with olive oil instead of butter, which Kraft purists will say is sacrilegious. I know it’s not substantially healthier that way, but we tell ourselves stories to get by.

Of course the darker part of me knows I eat it because I want to eat it, because of the sodium and the white pasta-starch that becomes sugar in my veins, and also because of the nostalgic comfort in the ritual of making and eating it. Those blue and yellow boxes signified the food of my Midwestern childhood. I am not alone in this. Every year Kraft alone sells something like 300 million boxes of their signature product. The gas stations that dot rural America define their grocery sections by its presence. Expect to find Campbell’s soup, graham crackers, probably marshmallows, and Kraft macaroni and cheese.

So it’s big news when the paper of record tells us this is toxic. Especially that it’s toxic to kids, and to pregnant women, and that the powdered cheese may affect sexualization of fetuses in a way that might even hypothetically account for what some people say is a feminized generation of American males. And not just Kraft but “many common brands.” The only other common brand is Annie’s, but it remains undisclosed whether Annie’s products were tested.

I’ll give you the nut here in case you don’t want to read all 2,000 words on powdered cheese. Phthalates are probably a problem in our food system, but macaroni and cheese is not a unique problem, and if it’s one of the few highly processed foods that you eat, risk of phthalate toxicity is as close to zero as possible.

Some research has found that high phthalate exposure can have negative health effects—for example, some people with high levels in their bodies have increased rates of hypertension and insulin resistance—but never has a case of phthalate toxicity been linked specifically to eating macaroni and cheese.

The mac-and-cheese analysis described in the Times story looked for phthalates in processed cheeses, and it found them. It reported absolute levels—e.g. 940 micrograms of phthalates per kilogram of powdered cheese. What does that mean? How much of it stays in my body? How much macaroni would I have to eat to put myself at risk? Even though these questions are unaddressed, the conclusion of the report makes a huge leap: “Action should be taken to eliminate phthalates in any food products.”

This was not a study of the value of action, nor was it a study of the health significance of phthalates in macaroni and cheese. It was only a study that tells us how many micrograms of phthalates are in a kilogram of various forms of powdered cheese. (One definitive thing I can recommend, never eat a kilogram of powdered cheese.)

The central tenet of toxicology is “the dose makes the poison”—meaning that even water is toxic in high enough quantities, and in small enough amounts cyanide is inconsequential. No earnest analysis of a suspiciously toxic product would stop at giving values of a toxic substance without studying what that value means for human health.

So the role of macaroni and cheese in the phthalate problem is sort of like the role of a particular type of chair in the problem of people living sedentary lifestyles.

Katie Martin / The Atlantic

All of that said, many experts agree that phthlates are a problem in the food system as a whole.

“Phthalates are a class of chemicals about which I am quite concerned,” said Phil Landrigan, dean for global health and a professor of environmental medicine at Mount Sinai School of Medicine. “They are extremely widespread in American society, and processed food is a major route of exposure.” Those routes used to involve plastic in toys and household products, where phthalates have since been banned.

They are also not allowed as an ingredient in food—and there would be no plausible reason to add them to food purposely, outside of some sort of super-villain plot—but they make their way into foods during processing, leaching from plastic tubes. This means the amounts in any given food are very tiny. The concern is the cumulative effect for people who eat processed foods constantly. The people shopping in gas stations, and elsewhere in food deserts. And most other places.

Paul Blanc, professor of medicine and chair of occupational and environmental medicine at the University of California, San Francisco, agreed with this appraisal. I sent him the Times article and he wrote of the lab analysis, “It would seem the best advice is to follow the fat.” That is, if you’re looking for phthalates, they tend to be found in higher levels in higher-fat foods.

But this study is not evidence that people should turn against fat again, unless we want to relive the 1990s. Well, actually, even if we did, the message is not that fat is toxic. If anything, the clear risk to human health posed by macaroni and cheese is that it is primarily low-nutrient, low-fiber white flour, as is so much of the American food system. Eating a diet of largely white flour is clearly associated with metabolic disease, the basis of many leading causes of death.

Based on epidemiological studies, Landrigan’s area of expertise, he does believe that eating a lot of high-phthalates foods during pregnancy can interfere with masculinization in male fetuses. “In utero,” he added, “exposure is associated also with behavioral anomalies in children that resemble autism.” Other researchers have questioned the strength of this association, and whether the levels present in most diets pose any actual risk. All agree, though, insofar as there is a problem with phthalates, it’s much bigger than macaroni and cheese.

It’s bigger even than processed food, because phthalates can come to us via cosmetics and other products with which we may be in regular contact. “In every industry,” said Landrigan, “prevention of exposure and minimization of the use of phthalates in consumer products is the way to go.”

“And, if you like to give practical advice, advise your readers not to microwave their food in plastic. Because microwaving drives phthalates out of the container and into the food.”

Katie Martin / The Atlantic

This isn’t really a column for practical advice. It’s about assessing risk and exploring processes. Speaking of which, the critical thing to consider here might actually be how this story came about. How did it get in front of so many concerned parents, and parents-to-be, and general hypochondriacs, before it ever even made it to a peer-reviewed scientific journal?

That was the most interesting part of this story to me, and it actually starts before the cheese analysis was published, with the very first email I received about it, more than three weeks ago. That came from a publicist asking me to please write about the dangers of macaroni and cheese.

I ignored the publicist’s pitch because the email started by mentioning National Macaroni and Cheese Day, which my belief system does not recognize as a holiday. It was followed by two more emails, from the same publicist, asking me again to write about the dangers of macaroni and cheese. Someone at the Times apparently did not ignore the publicist, and the paper ran with “The Chemicals in Your Mac and Cheese.”

The publicist’s emails offered that she could put me in touch with Mike Belliveau, executive director of the Environmental Health Strategy Center (one of four advocacy groups that funded the analysis) to comment. Belliveau told the Times: “Our belief is that it’s in every mac ‘n’ cheese product—you can’t shop your way out of the problem.”

He did not mention Kraft by name in the Times piece, though the Environmental Health Strategy Center’s efforts to reform Kraft predate this story. The group runs a site called Kleanupkraft.org, where this new analysis is published. Visitors to the site are greeted by the image of a pregnant woman and warned, “Scientists agree that phthalates threaten children’s health.” The page then offers a link to “See our cheese test results.”

Publication on this site is different from publication in an academic journal, in a few ways, and it is different even from publication by an outlet that purports to seek objective truth. This is the site of an organization that explicitly intends to get certain chemicals out of macaroni and cheese. Kraft did not respond to a request for comment.

I eventually did speak with Belliveau, too, and he was clear about the genesis of this project: “We’ve been in conversation with half a dozen major food manufacturers over the last six months about this problem, and we find they have very low awareness, and very, very little data. And very little motivation to do anything. So as part of that process, we decided to develop some of our own data. And so we embarked upon this testing project.”

    Which is to say this was an act of fact-based advocacy, as opposed to science, a distinction worth considering. It also informed why he didn’t go the route of trying to publish the findings in a peer-reviewed scientific journal.

    “We looked at scientific papers on phthalates, and we saw that the industry just ignored them,” Belliveau said, “and the FDA just sat on them. So we said, you know what, we need to get our data out there, and to communicate directly with the public about what it means.”

    And what does it mean?

    “It means that some pregnant women and children are getting too many phthalates. And it’s coming from a lot of different products—this isn’t about any one single product.” So, he says, the real practical takeaway is the long-standing advice: “Try to minimize consumption of highly processed food in favor of, you know, fresher and more wholesome ingredients.”

    An analysis conducted with the express purpose of justifying a cause means bias, which is evident in the reporting of the results, which omit practical analysis of the levels of phthalates in the cheeses. And yet the choice was made to analyze and warn against macaroni and cheese—a product that would resonate with pregnant people and parents with young children. This was a scare-based publicity move undertaken with apparently noble intentions, to raise awareness for what the advocacy group deems to be a dire cause. It worked. It also caused undue concern and regret.

    If I could end this answer with a question to you, it would be, do you think this sort of approach is justifiable? Is this kind of stunt a necessary means to call attention to an issue that has gone largely ignored for decades? Or does it do more harm by undermining the idea of science and the public’s trust in the process, if readers start to assume that studies are simply means of gathering data to justify a pre-existing agenda? Asking for a friend.


    Have a health question, “for a friend?” Please email AskJim@TheAtlantic.com.