In this week's Dose: what's going on with lead in protein powders, 15 governors unite for public health, and the falsehoods swirling around mammograms.
Thank you both for this. What I liked most was the news about the Governors working together. Since fortunately l live in a blue state, my governor is actively participating in coalition building that I’ve been encouraging her to do along with other proactive Governors. Call and encourage them to continue building a strong resilient firewall. We all need to stay well, strong and informed with these two wonderful epidemiologists!
John, I’m feeling really out of it. I thought: Dr Pepper? Our summer neighbor on Cape Cod also from Mississippi had the syrup, and we could make our own concoctions. Or Atlanta GA? Good grief!!
The discussion about lead in protein powder failed to mention that plant-based protein powders are the primary offenders and that whey protein powders would be the better choice for those concerned about lead contamination.
IDK if the additional Pb exposure from chocolate flavoring is worth considering. I was using a vanilla-flavored whey isolate which was pretty hard to take. Might be better off with unflavored (though I kinda gagged on that too).
Oh my gooooodnessss you remember that from the White House?! I feel like just because of that I need to share with you. BTW they are now my lucky pair of shoes. I was wearing them in that stage picture above.
On mammograms: The comparison with flying to California is somewhat deceptive. Since radiation exposure is cumulative, what if one flies back and forth regularly and/or has other increased forms of exposure?
They're testing a new method that doesn't involve radiation. Let's hope it works and is widely adopted ASAP!
I agree that it's wrong to compare mammograms to plane flights, since most people are exposed to both. It's not an either/or. On environmental issues, YLE seems to often miss the key concept of cumulative exposures, which may not be obvious to people whose expertise is in the infectious disease arena.
No, it's not either/or. But it's rare in my experience to consider radiation exposure from flights, and though maybe there are people who won't fly because of the putative risk, but I've never heard anyone tell me that. On the other hand, plenty of people avoid diagnostic radiation exposure. While of course diagnostic radiation exposure should be kept to a minimum (and I'd agree that a risk/benefit analysis is not always considered), there is USUALLY a very good reason to have these diagnostic tests.
I just took the breast risk test….sigh. It said one of the reasons for raised risk was I gained weight since I was 18! I am 80. I went from 104 to 125. Sigh. Then it said to cut out the 1-glass of wine each day. Double sigh. It then said I used to smoke. I cut out smoking 57 years ago. Triple sigh. I have had 6 false positive mammograms with invasive treatments and devastating emotional impacts to prove the false positive. No breast cancer in my family ever, either side. My mother died at 94 from a broken bone. So I take bio-identical hormones to keep bone density strong, and to quell the nights sweats that required ice packs on my abdomen and lower back that never stopped. But it said the hormones were bad. Quadruple sigh.
This strikes me as so much fingering wagging to create fright. There needs to better counseling about this test before you recommend it.
Ps. And what should that additional counseling look like that should probably be in the test? Instead of ‘increased risk with age’ say what the risk is, for instance, Is it 1 in a 1000 to 2 in a 1000…or 1 in a 1000 to 50 in a thousand? .01% to .02% or .01 % to .5%, for instance? This is just an example. You speak about how public health should change yet you send me to the same old same old scare tactic.
For what it's worth , the United States Preventive Services Task Force basically throws up its hands regarding mammograms for women over age 75:
"Evidence is insufficient to recommend for or against screening. Decisions should be made between a woman and her healthcare provider based on individual health status and history."
Just went through a "false alarm" with my 29-year old daughter. In my cancer-prone family, I well know the stresses of "scanxiety".
Yes, the scanxiery is more real than the doctors who, as a matter of course, tell you to get the mammogram, acknowledge. There was ZERO attempts to acknowledge or mitigate the fear despite my prolonged explanation of my emotional situation.
And the thing about over 75….the doctor who did my biopsy last year casually wrote in the report ‘return to yearly mammography’. I am SO DONE with this. Same goes for colonoscopies. The problem is twofold: there is not a lot of attention paid to the emotional side effects of over testing AND everyone is protecting themselves from suit, at the expense of women scared out their wits….they do not seem to care about that…because if they did there would be more conversation about pros, cons, and statistics.
It depends. Our interactions with the oncology staff at MSKCC during my late wife's lung cancer were very supportive almost without fail. I believe the USPSTF also recommends "shared decision making" re: colonoscopies after age 75. I'm going for my post-surgery annual PSA assay next week, so yeah, we'll see.
Ah, Memorial Sloan Kettering…both my father and father-in-law had colon cancer surgery there. MSK is a different beast…you are gifted to have them caring for you.
You're totally off-base on the protein powder issue. First of all, saying that California's recommendation doesn't make sense because people get lead from other foods is absolutely contradictory. It's precisely necessary to have a low lead threshold for one food source because it is ONE food source among many lead-contaminated foods people consume daily, and as everyone knows, lead exposure is cumulative. Another point that you totally missed is that California's level is not a regulatory limit, it's a warning threshold. This is different and shouldn't be compared directly with those other numbers, which are regulatory levels. Finally, this piece misses a key point, which is that protein powder is not necessary for most people, so it's a hazard that doesn't necessarily carry benefits. In addition, people are paying a lot of their hard-earned money for this highly-processed luxury supplement, so the least they can expect is that it's not contaminated.
Hi Gina, thank you for your comment. You bring up valid points – there is no safe level of lead and that’s particularly important for early development (pregnancy and childhood) so why not have a conservative threshold?
We aimed to balance the contributions of the report with federal guidance and scientific literature. The common pushback on California’s MADL of 0.5 is that its value is not rooted in research on adverse outcomes like FDA’s IRLs are. Consumer Reports even acknowledges this stating: “Our results are meant to provide guidance on which products have comparatively higher levels of lead, not to identify the point at which lead exposure will have measurable harmful health effects.” I do think *this point* is important, but something many readers may not know (or read in the headlines). Indeed a low reference point can certainly be helpful as you said, but context can also help reduce unnecessary fear. We made sure to include how mcg/day can quickly add up with those certain products.
You’re correct, California’s MADL is not a regulatory limit but considered a “right-to-know” law used for warning labels. I also agree, protein is best consumed from whole foods (along with the benefits of its food matrix) – but protein powders can also be a tool for folks with unique needs or goals (performance, body composition, sarcopenia, malnutrition, feeding issues).
All this to say, I think two things can be true. The report and CA’s Prop 65 MADL bring awareness and advocacy to the important public health issue of heavy metal contamination, and, headlines and interpretation of the results have not been necessarily grounded in science. Our goal was to balance the two to help readers feel informed (in under 500 words 😊).
It should be possible for you to make your points (and they are good ones) without inflammatory flourishes and maligning those that have a specialization in infectious disease. I probably shouldn’t open this can of worms but I am fed up with the circular firing squad.
This might sound nit-picky -- but -- mammograms don't save lives, in themselves. Lives are saved if a suspicious mammogram leads to correct diagnosis and effective treatment. Mammography has to be part of a system of care.
Am I right in calculating that the FDA level (12.5 mcg/day) is 25 times the California level (0.5 mcg/day) ? The Consumers Report on lead levels in one ounce of many brands of chocolate were alarming (e.g. well over 150% higher than "recommended" level). If that's converted to the FDA level, it seems reassuring. Am I thinking about this incorrectly ?
You are thinking about it correctly. The report is useful to compare the levels found in common food products/brands, but detection does not necessarily mean danger. As you said, the 0.5 mcg/day threshold is much lower (25x) than the FDA's IRL, which is based on toxicology research. These reports can be useful for folks to be aware and make purchase decisions on those products (and advocate for more regulations), but necessarily shouldn't be a reason for alarm on its own (e.g., the % statistics used comparing products to the CA 0.5 level can be misleading for most of the public without additional context).
Who the hell are these so-called "influencers", anyway? It takes work and money to rise about he screaming masses on antisocial media. Who is underwriting them?
The question is especially relevant since they appear to be targeting things that actually prevent and/or cure serious illnesses. Why would anyone want to do that? Qui bono?
I'll answer my own question: someone or a group of someones who wants most Americans to be weaker, sicker, and without access to decent health care.
Love your info and how you break it down so we can easily digest it. I am wondering if you have any input on the frequency of pap smears for women? I have had cervical cancer and have several close relatives who have had it or ovarian cancer, 2 that does in their early 40’s. My daughter is 37 and her docs tell her every 3 years is the recommendation. I disagree and want her to push for one every year. Thank you!
Dr. Gil Carvalho, in his popular youtube channel, references a larger survey of protein supplements that was less alarmist than the Consumers Union study.
This issue may be more important to we older folk, who are being bombarded by alarmist talk about sarcopenia, resistance exercise, protein supplementation etc. etc.
(Incidentally, when I moved into my house at 69 and finally had a back yard to grow vegetables, had the soil tested, which turned out to have very high Pb content, so if I want to grow veggies I'll need clean soil in raised beds. Also, as a dentist now retired who was up to my eyeballs in Hg for 45 years, it's amazing I'm still on the right side of the grass)
Thank you both for this. What I liked most was the news about the Governors working together. Since fortunately l live in a blue state, my governor is actively participating in coalition building that I’ve been encouraging her to do along with other proactive Governors. Call and encourage them to continue building a strong resilient firewall. We all need to stay well, strong and informed with these two wonderful epidemiologists!
Lucky you!
I live in the Big Red State (a reference to a popular, super sugary soda pop popular here), mentioned by name.
John, I’m feeling really out of it. I thought: Dr Pepper? Our summer neighbor on Cape Cod also from Mississippi had the syrup, and we could make our own concoctions. Or Atlanta GA? Good grief!!
💯💯💯
Aha! Poet:-) I continue to call.
I’m betting you do plus write them. We are a family of poets. And, you may know my sister, who lived in DC for decades, founded the Washington Revels.
The discussion about lead in protein powder failed to mention that plant-based protein powders are the primary offenders and that whey protein powders would be the better choice for those concerned about lead contamination.
Yes, great point and that can help people make evidence informed decisions
Thank you and good build - plant proteins get more from lead in the soil. This is an important consideration for folks who prefer plant-based options.
IDK if the additional Pb exposure from chocolate flavoring is worth considering. I was using a vanilla-flavored whey isolate which was pretty hard to take. Might be better off with unflavored (though I kinda gagged on that too).
Thank you YET AGAIN for your voice of reason. I will contact my governor (SC) and ask why we are not participating.
More importantly, does your picture finally give us a long-awaited look at the famous SHOES?
Oh my gooooodnessss you remember that from the White House?! I feel like just because of that I need to share with you. BTW they are now my lucky pair of shoes. I was wearing them in that stage picture above.
I KNEW IT!!!!
Please share details of your vision for the future of public health.
On mammograms: The comparison with flying to California is somewhat deceptive. Since radiation exposure is cumulative, what if one flies back and forth regularly and/or has other increased forms of exposure?
They're testing a new method that doesn't involve radiation. Let's hope it works and is widely adopted ASAP!
I agree that it's wrong to compare mammograms to plane flights, since most people are exposed to both. It's not an either/or. On environmental issues, YLE seems to often miss the key concept of cumulative exposures, which may not be obvious to people whose expertise is in the infectious disease arena.
No, it's not either/or. But it's rare in my experience to consider radiation exposure from flights, and though maybe there are people who won't fly because of the putative risk, but I've never heard anyone tell me that. On the other hand, plenty of people avoid diagnostic radiation exposure. While of course diagnostic radiation exposure should be kept to a minimum (and I'd agree that a risk/benefit analysis is not always considered), there is USUALLY a very good reason to have these diagnostic tests.
Well, there's sonography, but it's not as sensitive. My daughter gets periodic sonograms--they don't want to start with mammograms yet--she's only 29.
I just took the breast risk test….sigh. It said one of the reasons for raised risk was I gained weight since I was 18! I am 80. I went from 104 to 125. Sigh. Then it said to cut out the 1-glass of wine each day. Double sigh. It then said I used to smoke. I cut out smoking 57 years ago. Triple sigh. I have had 6 false positive mammograms with invasive treatments and devastating emotional impacts to prove the false positive. No breast cancer in my family ever, either side. My mother died at 94 from a broken bone. So I take bio-identical hormones to keep bone density strong, and to quell the nights sweats that required ice packs on my abdomen and lower back that never stopped. But it said the hormones were bad. Quadruple sigh.
This strikes me as so much fingering wagging to create fright. There needs to better counseling about this test before you recommend it.
Ps. And what should that additional counseling look like that should probably be in the test? Instead of ‘increased risk with age’ say what the risk is, for instance, Is it 1 in a 1000 to 2 in a 1000…or 1 in a 1000 to 50 in a thousand? .01% to .02% or .01 % to .5%, for instance? This is just an example. You speak about how public health should change yet you send me to the same old same old scare tactic.
For what it's worth , the United States Preventive Services Task Force basically throws up its hands regarding mammograms for women over age 75:
"Evidence is insufficient to recommend for or against screening. Decisions should be made between a woman and her healthcare provider based on individual health status and history."
Just went through a "false alarm" with my 29-year old daughter. In my cancer-prone family, I well know the stresses of "scanxiety".
Yes, the scanxiery is more real than the doctors who, as a matter of course, tell you to get the mammogram, acknowledge. There was ZERO attempts to acknowledge or mitigate the fear despite my prolonged explanation of my emotional situation.
And the thing about over 75….the doctor who did my biopsy last year casually wrote in the report ‘return to yearly mammography’. I am SO DONE with this. Same goes for colonoscopies. The problem is twofold: there is not a lot of attention paid to the emotional side effects of over testing AND everyone is protecting themselves from suit, at the expense of women scared out their wits….they do not seem to care about that…because if they did there would be more conversation about pros, cons, and statistics.
I’m dreaming of the day when cancer can be detected in a screening blood test.
It depends. Our interactions with the oncology staff at MSKCC during my late wife's lung cancer were very supportive almost without fail. I believe the USPSTF also recommends "shared decision making" re: colonoscopies after age 75. I'm going for my post-surgery annual PSA assay next week, so yeah, we'll see.
Ah, Memorial Sloan Kettering…both my father and father-in-law had colon cancer surgery there. MSK is a different beast…you are gifted to have them caring for you.
You're totally off-base on the protein powder issue. First of all, saying that California's recommendation doesn't make sense because people get lead from other foods is absolutely contradictory. It's precisely necessary to have a low lead threshold for one food source because it is ONE food source among many lead-contaminated foods people consume daily, and as everyone knows, lead exposure is cumulative. Another point that you totally missed is that California's level is not a regulatory limit, it's a warning threshold. This is different and shouldn't be compared directly with those other numbers, which are regulatory levels. Finally, this piece misses a key point, which is that protein powder is not necessary for most people, so it's a hazard that doesn't necessarily carry benefits. In addition, people are paying a lot of their hard-earned money for this highly-processed luxury supplement, so the least they can expect is that it's not contaminated.
Hi Gina, thank you for your comment. You bring up valid points – there is no safe level of lead and that’s particularly important for early development (pregnancy and childhood) so why not have a conservative threshold?
We aimed to balance the contributions of the report with federal guidance and scientific literature. The common pushback on California’s MADL of 0.5 is that its value is not rooted in research on adverse outcomes like FDA’s IRLs are. Consumer Reports even acknowledges this stating: “Our results are meant to provide guidance on which products have comparatively higher levels of lead, not to identify the point at which lead exposure will have measurable harmful health effects.” I do think *this point* is important, but something many readers may not know (or read in the headlines). Indeed a low reference point can certainly be helpful as you said, but context can also help reduce unnecessary fear. We made sure to include how mcg/day can quickly add up with those certain products.
You’re correct, California’s MADL is not a regulatory limit but considered a “right-to-know” law used for warning labels. I also agree, protein is best consumed from whole foods (along with the benefits of its food matrix) – but protein powders can also be a tool for folks with unique needs or goals (performance, body composition, sarcopenia, malnutrition, feeding issues).
All this to say, I think two things can be true. The report and CA’s Prop 65 MADL bring awareness and advocacy to the important public health issue of heavy metal contamination, and, headlines and interpretation of the results have not been necessarily grounded in science. Our goal was to balance the two to help readers feel informed (in under 500 words 😊).
It should be possible for you to make your points (and they are good ones) without inflammatory flourishes and maligning those that have a specialization in infectious disease. I probably shouldn’t open this can of worms but I am fed up with the circular firing squad.
This might sound nit-picky -- but -- mammograms don't save lives, in themselves. Lives are saved if a suspicious mammogram leads to correct diagnosis and effective treatment. Mammography has to be part of a system of care.
On the map showing governors' Health Alliance — I can find only 13 states colored in blue. Can you please list them (i.e., what am I missing?).
Here’s the list of states:
California
Colorado
Connecticut
Delaware
Hawaii
Illinois
Maryland
Massachusetts
New Jersey
New York
North Carolina
Oregon
Rhode Island
Washington
I missed Delaware on the map.
https://govactalliance.org/news/govact-pressrelease-govsforhealth-launch/
At least CR didn't explain LOD and point out that undetectable doesn't mean zero which would surely add to the hysteria.
Am I right in calculating that the FDA level (12.5 mcg/day) is 25 times the California level (0.5 mcg/day) ? The Consumers Report on lead levels in one ounce of many brands of chocolate were alarming (e.g. well over 150% higher than "recommended" level). If that's converted to the FDA level, it seems reassuring. Am I thinking about this incorrectly ?
You are thinking about it correctly. The report is useful to compare the levels found in common food products/brands, but detection does not necessarily mean danger. As you said, the 0.5 mcg/day threshold is much lower (25x) than the FDA's IRL, which is based on toxicology research. These reports can be useful for folks to be aware and make purchase decisions on those products (and advocate for more regulations), but necessarily shouldn't be a reason for alarm on its own (e.g., the % statistics used comparing products to the CA 0.5 level can be misleading for most of the public without additional context).
Who the hell are these so-called "influencers", anyway? It takes work and money to rise about he screaming masses on antisocial media. Who is underwriting them?
The question is especially relevant since they appear to be targeting things that actually prevent and/or cure serious illnesses. Why would anyone want to do that? Qui bono?
I'll answer my own question: someone or a group of someones who wants most Americans to be weaker, sicker, and without access to decent health care.
I think it's pretty obvious who that might be.
Love the "reimagine systems" comment!
Love your info and how you break it down so we can easily digest it. I am wondering if you have any input on the frequency of pap smears for women? I have had cervical cancer and have several close relatives who have had it or ovarian cancer, 2 that does in their early 40’s. My daughter is 37 and her docs tell her every 3 years is the recommendation. I disagree and want her to push for one every year. Thank you!
Could you do a discussion about pros and cons of mammogram for women over 75?
Dr. Gil Carvalho, in his popular youtube channel, references a larger survey of protein supplements that was less alarmist than the Consumers Union study.
This issue may be more important to we older folk, who are being bombarded by alarmist talk about sarcopenia, resistance exercise, protein supplementation etc. etc.
(Incidentally, when I moved into my house at 69 and finally had a back yard to grow vegetables, had the soil tested, which turned out to have very high Pb content, so if I want to grow veggies I'll need clean soil in raised beds. Also, as a dentist now retired who was up to my eyeballs in Hg for 45 years, it's amazing I'm still on the right side of the grass)
Here's that study that Carvalho referenced:
https://cleanlabelproject.org/protein-study-2-0/