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FDA Proposes Limit on Inorganic Arsenic in Infant Rice Cereals
By Kathy Hardy

Nutrition professionals probably have heard by now that the FDA has proposed new limits on inorganic arsenic in infant rice cereals. This naturally occurring element is more toxic than its organic counterpart, but the presence of inorganic arsenic in food is unavoidable. Fruits, vegetables, and grains absorb it from groundwater and the soil in which they grow.

While there's currently no federal limit on arsenic in most foods, that could change, as the FDA on April 1 proposed a limit of 100 parts per billion (ppb) of inorganic arsenic for all types of infant rice cereal. This amount is consistent with levels recently set by the European Commission and is an effort to reduce the amount of inorganic arsenic found in food that's destined for young eaters.

"With the FDA's proposed limit on inorganic arsenic in infant rice cereal parallel with the European Commission limit, that puts the United States on par with the rest of the mainstream world," says Kristi King, MPH, RD, LD, CNSC, senior pediatric dietitian at Houston's Texas Children's Hospital and national spokesperson for the Academy of Nutrition and Dietetics (the Academy). "Information is still emerging regarding the possible link between developmental defects and cognitive learning skills and exposure to inorganic arsenic. The FDA is taking a step toward ensuring that infants get a good start at life."

The FDA's "Advice to Consumers" notes that this proposed limit isn't meant as a warning to the general population to change its current rice consumption patterns based on the presence of arsenic. The agency is suggesting, however, that eating a variety of whole grains is useful for all populations and is especially important in the diets of pregnant women and infants.

The Science of Arsenic Exposure
King says that science is an ongoing process when it comes to research in this area. Research is made more difficult by the fact that most studies are conducted on animals, and then extrapolated for adults and children. That being said, the FDA reports that in its 2016 risk assessment, the agency analyzed scientific studies showing an association between adverse pregnancy outcomes and neurological effects in early life with inorganic arsenic exposure. The FDA also evaluated the feasibility of reducing inorganic arsenic in infant rice cereal. The agency concluded that inorganic arsenic exposure in infants and pregnant women can result in a child's decreased performance on certain developmental tests that measure learning, based on epidemiologic evidence including dietary exposures.

Arsenic in Rice
Rice cereal is a common first food for infants, with benefits including its high iron content. It's less allergenic than other grains, and it's easily digestible. However, rice also tends to absorb more arsenic than other grains, such as wheat, barley, and oats. King notes that while more than one-half of the rice products currently on the market meet the 100 ppb requirement, manufacturers can still do more to reduce the potential for elevated levels of inorganic arsenic in their products.

"The amount of arsenic in rice products depends on where the rice is grown," King says. "Rice is widely grown and products can vary based on weather and other conditions in different areas of the world. [The Academy is] asking manufacturers to pick rice from a variety of areas in order to mix types of rice from areas with higher arsenic concentrations with rice from areas of lower concentrations."

Dietary Variety is Key to Good Health
While the proposed limit brings with it a new perspective on the long-term health concerns of arsenic in food, researchers say that managing proper health with a well-balanced diet remains key. It's not just about eliminating certain foods from the rotation.

"Removing certain foods from the diet creates a greater problem," says Julie Miller Jones, PhD, CNS, LN, CFS, FICC, distinguished scholar and professor emeritus of nutrition in the department of family, consumer, and nutritional sciences at the St. Catherine University in St. Paul, Minnesota. "A good defense for managing the level of inorganic arsenic in the diet is to add foods to the diet. That includes foods with good proteins, a wide variety of fruits and vegetables for vitamin D, and foods rich in selenium. Protein, vitamin D, and selenium help the body deal with arsenic."

King also encourages parents to add variety to their infants' diets as it helps establish eating patterns that extend long into children's lives. At six months, she encourages the introduction of cereals, soon followed by foods like squash, zucchini, green beans, and peas.

Both the FDA and the American Academy of Pediatrics (AAP) also recommend feeding infants and toddlers a variety of foods for a well-balanced diet. The AAP recommends that infants be exclusively breast-fed for about six months, followed by continued breast-feeding as complementary foods are introduced. At around six months, iron-fortified infant cereals can be gradually introduced. While rice cereal fortified with iron is a good source of nutrients, due to its solubility and the fact that it's less allergenic than other grains, it shouldn't be the only source and doesn't have to be the first supplemental food for infants. As Frank Greer, MD, FAAP, a neonatologist with the University of Wisconsin Hospital and Clinics, says, other first-food options such as wheat, oat, or barley cereals might be even better for infants.

"Rice cereal doesn't have the nutrients of a wheat cereal," Greer says. "We really should be adding other grains for our infants—not just rice."

Greer, who also is the former chair of the AAP committee on nutrition and a member of the AAP arsenic in rice expert work group, points to other options for parents to introduce as first foods, including oat, barley, and multigrain cereals, all of which have lower arsenic levels than rice cereal. While his recommendations are meant for the entire infant population, Greer has a particular concern for parents of children born with developmental issues.

"You wouldn't want to feed rice cereal to infants who already have developmental disabilities," he says. "Their ability to tolerate the arsenic is already diminished."

Next Steps
As with any news regarding infant dietary health and safety concerns, parents will look to medical and nutrition professionals for guidance. When dealing with clients, King says RDs should be informed, look at the science and prepare a response based on factual evidence.

"Dietitians should craft a message that calms parents by providing them with a sound, science-based direction for how to proceed," she says. "That will also allow them to be proactive with their clients and provide direction early in their infant's development."

— Kathy Hardy is a freelance writer and editor based in Phoenixville, Pennsylvania.
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