Category Archives: Food Safety

Food Safety

Food safety is such a big issue in China that it deserves its own category. Here are all articles regarding this topic.

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Rubber Ducky You’re The One — To Cause Diabetes and Cancer?

My boys are now both over two years old, but they still like the occasional chew on their toys, which are mostly made of plastic. Rubber duckies, Lego men, Brio trains — it’s still a ton of fun to put in their mouths if it makes mommy and daddy really mad. I choose my battles with them, but I try to stop them partly because I’m worried about the chemicals in the plastic. Surely, microscopic parts of that plastic must be getting into their systems? One set of bath toys was very typical, made in China but exported to America, from a company vowing they are “safe and dependable”, with standards that “meet and exceed” US laws. What exactly does that mean? What are these laws? Should I be worried? And just how well can I or any parent protect our children from all environmental harms?

When I think about our modern world’s reliance on chemicals and plastics, I’m reminded of what Donald Rumsfeld called the “known unknowns” – we know that we understand almost nothing about the safety of the 80,000 consumer chemicals created since World War II, because they’ve never been required to be tested on humans. As the WHO states in their 2012 report State of The Science of Endocrine Disrupting Chemicals, “the vast majority of chemicals in current commercial use have not been tested at all.

bathtoy

The chief concern is that some of these chemicals are endocrine disruptors, which are chemicals whose molecular structure is similar to our natural hormones. With this mimicry, they can bind to the same receptors that our natural hormones do, thus altering our normal endocrine activities which control  just about every aspect of our health. We are mostly worried about children because these endocrine disruptors could cause permanent damage during our most sensitive growth spurts: while still developing in the womb, and later during puberty. The most notorious example of an endocrine disruptor is diethylstilbestrol (DES), a synthetic estrogen which was given to many pregnant women in the decades after World War II as a treatment to prevent birth complications. But slowly it became clear that many newborn girls of these mothers were getting a rare vaginal cancer, and DES was banned and declared a carcinogenic — but even right now many of these same “DES daughters” are continuing to have reproductive health problems both for themselves as well as in their own children, which means some endocrine disruptors can permanently alter our DNA, affecting generations.

The US Endocrine Society published an even more damning document, their 2015 Scientific Statement on Endocrine-Disrupting Chemicals, which concludes that

…there is strong mechanistic, experimental, animal, and epidemiological evidence for endocrine disruption, namely: obesity and diabetes, female reproduction, male reproduction, hormone-sensitive cancers in females, prostate cancer, thyroid, and neurodevelopment and neuroendocrine systems.

The prestigious JAMA Pediatrics published their own review of endocrine disruptors in 2012, essentially agreeing with the WHO’s assessment that while hard data on humans isn’t very strong, there’s enough concerning data to conclude that “efforts to reduce EDC exposure as a precaution among pregnant women and children are warranted.” Chemicals such as BPA, PVC and phthalates are most often mentioned as causing harm in boys and girls, associated with infertility, obesity, cancers and neurodevelopmental problems such as behavioral issues and a lower IQ.

Plastic ID Codes and Properties. Source: tinyurl.com/o487x9o
Plastic ID Codes and Properties. Click to enlarge. Source: tinyurl.com/o487x9o

So what can we all do to protect ourselves? After all, everything we touch almost literally has plastic as part of it. I’ve found a few consumer groups and blogs that offer helpful advice for worried parents. My favorite is The Soft Landing blog, which has a very useful collection of safer product shopping guides. The Pediatric Environmental Health Specialty Unit also offers similar advice. Here’s a small summary of what most are advising:

  • Try to buy products (especially for babies) that are free of BPA, phthalates and PVC (The Soft Landing website has great blog lists).
  • Switch all your plastic food containers to glass.
  • With the Plastic Coding System, avoid numbers 3, 6 and 7 and try to use numbers 1,2,4 or 5.
  • Consider buying organic produce to reduce exposure to pesticides..
  • If you must use plastic cling wrap, only use PE wrap; minimize contact of cling wrap plastic with the food; and try not to microwave with the plastic on it. Especially don’t let the plastic sit on top of liquids, whether cold or hot.
  • Reduce indoor dust exposure by cleaning carpets and dusty surfaces regularly using a vacuum cleaner with a high-efficiency particulate air (HEPA) filter.
  • Always immediately transfer your restaurant leftovers into glass containers at home, and never reheat your leftovers or eat directly from takeaway plastic containers.

We’ve put most of these into practice in our home, so I feel a bit less stressed about this issue.  And the boys’ bath toys? While The Soft Landing blog reassuringly listed them on their list of safer bath toys, their own company rep emailed me to confirm they are “BPA-free, phthalate-free, and non-phthalate PVC”. So I am letting them munch away — for now. Choose your battles…

 

This post was originally published on my new blog at MyFamilyHealthGuide.com. Please follow my new blog! (and my Facebook page

Safe Salmon in China? Yes!

 

I love the unique taste of salmon, which is fortunate for me as it’s truly one of nature’s superfoods. Salmon is packed with heart-healthy omega-3 oils EPA and DHA, protein and vitamin D and also is low in dangerous metals such as mercury. I oftentell people to eat oily fish such as salmon at least once a week to dramatically decrease their risk for heart disease. A 2006 review study in JAMA  shows that a daily dose of only 250-500 mg of omega-3 fatty oils can lower your risk of sudden death from heart disease by 36%, and from all-cause mortality by 17%; more than 500 mg daily actually provides very little extra benefit. And as 100 grams (3 ounces) of farmed salmon has over 2 grams of omega-3 (more than wild salmon has), even one serving a week may be enough because the healthy oils can remain in our tissues forweeks. This is all great news, right? But when I tell my patients in Beijing this fantastic news, they usually reply the same way: “I’d love to eat more fish here, but I never know which store I can trust.”589px-Salmon_sashimi

When my wife and I first arrived in Beijing nine years ago, we first bought our fish and other meat from the large international supermarkets Carrefour and Walmart, mostly because we assumed (for better or worse) that these stores would have superior quality control and safety standards, especially with imported foods. And that worked well for many years, especially as these markets slowly started to sell more organic options. Later on, we discovered the German-run Metro 麦德龙 hypermarket, and we immediately switched almost all our meat and produce purchases there, due to their outstanding logistics and traceable food chain. In other words, we trust them, and trust is a really big deal here in China. Metro’s salmon is mostly from farmed ponds in Faroe Island, a very safe area in the north Atlantic which is antibiotic-free and also certified by the non-profit Aquaculture Stewardship Council (ASC). Ikea, just up the street from Metro, also has an impressive selection of imported frozen salmon from Scandinavian waters, again all certified by the ASC or MSC (Marine Stewardship Council), and at very reasonable prices. Both stores sell their salmon for ~60-70 RMB/500g. So for those of you who don’t trust your fish in Beijing: there’s my answer.

omega-3 Fatty Acid Fish Safety Doses
Comparison of omega-3 and mercury levels in various fish

We still love Metro and Ikea but our #1 choice now for salmon is the monthly group buy, called GroupBuyByBianca, organized by the staff formerly from the Chef Too restaurant. Once a month they’ll trek to Beijing’s wholesale fish market; choose farmed salmon from Norway, Canada, or Faroe Island; de-bone and vacuum pack and then deliver to your door in chilled containers. It’s a fantastic service, and we usually get half a salmon every couple of months which we store in our freezer. Bianca and the team also sell imported cod and other meats in season. To sign up and order, follow their WeChat ID “GroupBuyByBianca” or email [email protected]. The cost depends on market prices but recently is usually ~45RMB/500g plus 10% and a flat 65 RMB processing fee.

Our other newer options for buying fish and meat are again online. The first is the wonderful local organic farm TooToo, which I’ve mentioned before as a very trustworthy, internationally certified local organic farm with a terrific distribution chain, easy online payment, professional delivery service and unbeatable value of organic produce. It’s an awesome resource for Beijingers — plus their website at tootoo.cn has English and Chinese! You can buy 200g bags of Norwegian salmon for 36-50 RMB each. Besides salmon, they now offer a large selection of meats from many different sources — check out their long list of imported fish here. We’ve had particular success with shellfish from Europe — mussels from Scotland and shrimp from Ecuador were delicious.

 

Where? Cost (RMB) per jin Notes
Ikea 69/500g ASC certified, Atlantic
Metro market 60-70/500g ASC (Faroe Island: Bakkafrost)
Carrefour market 128/500g Faroe Island
Jingkelong market 78/500g
Tootoo.cn online store 90/500g (36 RMB/200g) Norway
Group Buy by Bianca ~70/500g (~95/kg+10% + 65RMB) Farmed: Faroe Island, Norway or USA
April Gourmet 123/500g (245/kg) Norway

 

Besides TooToo, there are now a bewildering number of players in China selling foods online via apps and websites, with ridiculous amounts of investments from all the big internet players and finance companies. One such store my wife uses often is called yiguo (易果) at yiguo.com. We liked them initially for their imported fruits but they also have a decent selection of meat, including a special section for imported beef. Other large sites like yihaodianWomai and JD.com’s grocery store are notable because they both have their own supply chains and distribution centers, which in theory could provide consumers better quality and more traceable products (with quicker deliveries, I’ve noticed). Amazon China also has their own online grocery store. All of these e-markets carry a big selection of imported foods of all types, far more than you would ever see in any local market.

Many expats get their salmon and meat from the small international markets such as April Gourmet or Jenny Lou’s, and that’s fine of course, and it’s certainly convenient for many on the way home from work. I just think the prices can be a lot higher than other options (see the comparison chart below), and I also worry about low sales volumes in small markets in terms of food safety. Many people also buy salmon at local markets like the popular Sanyuanli market, but I personally feel they have extremely inadequate food safety there; most vendors’ meats sit in the open air at room temperature, uncovered, on wooden slabs, with flies buzzing around. Do I really need to break down how many violations of basic food safety I just mentioned in that one sentence? I wouldn’t recommend buying meat from any market anywhere in the world if it’s sitting at room temperature for more than two hours.

ikea-salmon
Notice the ASC certification label…

Besides making your own salmon, eating in restaurants is definitely the next best option. All you sushi lovers can easily get your weekly omega-3 fix with even a few slices of salmon. Beijing is blessed with plenty of excellent Japanese restaurants and salmon dishes. Our favorite sushi place is a small Japanese market called yuqing (鱼清) just next to Yotsuba along the Liangma canal waterfront across from the Four Seasons Hotel; you can choose your raw fish from their shelf and the chef will prepare it right there for you to eat in the store.

What about the big percentage of readers who take a daily supplement of fish oil, including myself? This indeed has been long recommended even by the American Heart Association, but unfortunately the most recent studies, much larger than earlier studies, disturbingly show very little benefit from the supplement. There must be something else besides omega-3 in the actual fish that provides the heart-healthy benefit. Anyway, when my supply runs out, I won’t be continuing that anymore.

So there you have it; I hope I’ve convinced some of you that healthy fish = healthy heart. And for Beijingers, it’s not nearly as hard as you may have thought to add safe salmon into your diet, even at a reasonable price. For those of you in China out of the tier one cities or not near a good market, now there are plenty of online options to get salmon delivered right to your door. If you’re really worried about trust, sustainable fishing, and seafood free of chemicals and antibiotics, just stick with vendors that have ASC, BAP or MSC certification stickers on the fish packaging — Ikea and Metro would be your safest bets.

In terms of general value, here’s a nice graph from the JAMA review showing relative money spent on different types of fish to get your daily 250 mg of omega-3:

Estimated Costs of Consuming the equivalent of 250 mg/d EPA + DHA From Fish

 

Pollution: Air, Water, Food, Oh My!

I’ve discussed many wellness topics on this health blog, but the major interest, by far, is pollution. Everyone in China is very concerned about the safety of the air they breathe and the food and drinks they put into their bodies. It’s easy to be overwhelmed by the seemingly constant food scandals and pollution spikes, but you actually have full control over your environment. You can limit your exposure to most of these risks, and you can thrive here as much as anywhere! Let’s now get into more details.

Air

air pollution beijing chinaIn terms of health risks, there is accumulating research that air pollution causes both long-term and short-term risks, and children are considered more at long-term risk because their lungs are still developing. For girls, lungs nish developing at 18 years, while a boy’s lungs mature by their early 20’s. The American Academy of Pediatrics published an ocial position paper in 2004 detailing the health risks and recommending an aggressive community approach, led by pediatricians, to ensure children’s health. One of most concerning research findings is from the University of Southern California Children’s Health Study, following thousands of kids in smoggy Los Angeles over 9 years, from 4th to 12th grade. The results showed a worsening of lung function over those years of exposure in those children who had the most exposure to air pollution. In Los Angeles, the average annual Air Quality Index (AQI) is around 50, which is at least 2 times lower than most major metropolitan areas in China.

In order to minimize your risks, you rst must understand the data. That’s why many people monitor the Air Quality Index (AQI) from smartphone apps or dozens of websites. Until recently, the Chinese AQI assessed particulate matter of 10 microns (PM10), but growing research showed that the smaller particles, PM2.5, cause many more health effects. This is why China recently upgraded their system to monitor the more relevant PM2.5 with hourly reports in dozens of cities, and they are now ahead of many developing countries with their monitoring system.

When people must be outside on bad days (which I would say includes any AQI over 200), I recommend using a good protective mask; the key is to find a good mask. Officially certified “N95” commercial masks are the best. ”N95” means that the mask eliminates 95% of larger air particles; this theoretically would bring down an AQI day of 500 to a healthy 25 AQI. You can usually find good masks, especially made by 3M, in most major Chinese cities. Totobobo also manufactures comfortable and less awkward-looking masks made from transparent plastic. These can also be cut down to t the smaller faces of your children. Other well designed masks include Vogmask and I Can Breathe. Parents should know that Vogmask has just come out with a line of masks designed specifically for children’s smaller faces.

It’s important to remember that we all spend about 80-90% of our lifetime indoors, so it’s also good to protect your indoor air, which often has similar pollution levels as outside. Evidence suggests that indoor air purifier systems are very effective, whether it’s a stand-alone machine or built-in HVAC filters in your home vents and air conditioning units. Such machines, especially in bedrooms, are very effective in lowering indoor air pollution levels. Indoor plants also will help, but only slightly, and are no substitute for a good air purifier, especially in your child’s bedroom.

Water

When it comes to the essentials of life, there isn’t anything more basic than water. We all require H2O every day of our lives and you wouldn’t last more than a few days without any water. OK, we get that, but as usual when living in China, we need to filter this basic concept through our gray-tinted glasses and ask which water is safe to drink?

My initial response is that you shouldn’t drink straight from the tap, as while many central water systems are clean, there may be heavy metals and bacteria collected in the piping along the way. But I would be saying this in almost any city in the world, so the same idea applies here. Actually, in New York City the tap water is famously clean, but even while living in San Francisco I always used a Brita table-top water filter and kept refilling it all day.

I think the same concept applies to the major cities in China: a recent Global Times headline, “Half of Tap Water Undrinkable,” certainly didn’t dissuade me from my caution. Several years ago, the Beijing Times exposed that half of Beijing’s bottled water jugs were counterfeit, using tap water or fake Watson’s stickers. Also, the water jugs you get delivered to your homes and offices may not be as safe as you think. One very concerning stat from a July 2011 survey in the China Daily showed that 31 water brands had failed inspection due to high levels of bacteria.

That’s why I recommend you use a water filtration system at home and avoid home water delivery. When I first came to China, we used a table-top lter for a several years, but we later upgraded to an installed water lter under the kitchen sink. You can read a lot of good consumer information about water filtration systems at www.consumersearch.com/water-filters/review.

Food

Yogurt Helps Weight LossIn a number of recent Chinese polls, food safety is currently the number one major health concern. How could it not be? Every few weeks it seems we read about a new food scandal, or even worse, the recurrence of an old scandal. It might be yet another “gutter oil” crackdown; exploding watermelons; illegal clenbuterol found in pork; etc. The most well-known food safety scandal, by far, involved contaminated infant formula in 2008, which killed 6 children and sickened 300,000 others, many with permanent kidney disease. Unfortunately, since then this melamine chemical has been rediscovered in a few dairy products, and thus all of China remains justifiably wary of the entire dairy industry.

If you have a newborn baby, the healthiest milk in any country remains breast milk, so it would be best to breast feed for as long as possible. Otherwise, most doctors I know recommend only buying infant formulas imported from other countries, from the most reputable brands, as well as
from the most famous stores. I would definitely not recommend getting formula or anything of consequence from Taobao, as the counterfeit industry is very large. For grown-ups, if you don’t trust regular milk products, give soy milk a try—it has better nutritional value and is easier to digest for many.

For fruits and vegetables—an essential part of everyone’s diet—again the main issue is trust: do you know exactly where they come from? If you buy your produce direct from an organic farm, and you’re comfortable with the farm’s practices, then you should be safe. However for most of us this is an impractical or expensive option, so I prefer to buy organics as often as possible from the large hypermarkets such as Carrefour, Metro, Walmart, Tesco and Auchan. I prefer organics not so much for the taste and quality, but more for their quality chain of production, traceability and oversight by multiple governmental agencies. In other words, you have a much better chance of getting healthy and safe produce from a heavily monitored farm than elsewhere. You should be wary of getting produce grown on small farms, where pesticide, growth hormone and other chemical rates are enormous, not to mention very high rates of water pollution runoff.

No matter where you buy your produce, it remains crucial to wash them all very well, especially the leafy greens. If you do not prepare food at home yourself, it is important you educate whoever does, not only on proper food washing, but also simple hygiene such as correct hand washing or not mixing raw meats and veggies on the same cutting tables. There’s a program from the World Health Organization called the “Five keys to food safety” which I really like; they have many handouts in multiple languages which you can print out.

Of all food groups, I am most uncomfortable with seafood in China. A diet rich in fish is beneficial for all ages, as fatty fishes are filled with nutritious omega 3, a crucial element for a child’s brain, as well as an adult’s heart. But finding any safe fish in China is a serious issue, as many local rivers and waterways are seriously polluted. As usual, always buy the freshest seafood from a popular market; try to avoid smaller seafood restaurants with slow turnover; or spend a little bit more for imported frozen fish (Alaskan or Norwegian salmon, for example). As for meats, again I recommend organic meats at larger markets, mostly again because they have their own, independent supply chains, traceability and stricter government oversight.

When eating out, the unfortunate truth is that the smallest mom-and-pop restaurants and street vendors simply may not have the money to offer the safest or freshest foods, nor is the hygiene in the kitchen as reliable. Also, you should look for the mandatory restaurant ratings that are commonly found inside the front entrance. If it is not an A or B rating (Beijing) or a green happy face (Shanghai), perhaps you should reconsider eating there.

To sum up, we all need to be more careful in order to ensure safe food for our families. But with a little extra knowledge, we can thrive just fine.

 

References:
1. American Academy of Pediatrics: www.pediatrics.org/cgi/content/full/114/6/1699
2. China Xiaokang: http://xkzz.chinaxiaokang.com/xkzz3/newsview.asp?id=6079
3. “Half of tap water undrinkable.” Global Times. www.globaltimes.cn/NEWS/tabid/99/ID/708496/Half-of-tap-waterundrinkable.
aspx
4. My Health Beijing: www.myhealthbeijing.com/pollution/
5. “Questions remain over safety of bottled water.” China Daily. www.chinadaily.com.cn/cndy/2011-08/16/content_13119459.htm
6. WHO: www.who.int/foodsafety/consumer/5keys/en/index.html


Originally printed in my hospital’s Health Matters magazine, Autumn 2013 issue. Click here for all issues.

Water Safety in China: An Interview With PureLiving China

I’m a bit maxed out on my air pollution blogging and now am focused more on other environmental issues, such as water safety. A couple months ago I invited the PureLiving China indoor environmental testing company to our home for an inspection, and I blogged about their findings last month. I still had a lot of questions about water, so company founder Louie Cheng and I have been corresponding by email. Our discussion is very topical for most in China, so here’s our conversation below:

Q. Your company, PureLiving China, has sampled many water sources both here in Beijing as well as Shanghai. What are the most common problems you see in the tap water?

The situation is different in Beijing and Shanghai. Beijing tends to have bacterial problems a little more often. I would attribute this to older piping infrastructure and also because Shanghai has been getting more of its water from the Qingcaosha Reservoir, which has much higher quality than the majority of Chinese groundwater. Shanghai has higher chlorine in some districts. Shanghai also has some high levels of copper. Both often have either high chlorine (used as a disinfectant) or sometimes low chlorine (if far from the municipal treatment plant). However, a key thing to note is that BJ & SH are split into multiple districts — 6 in SH alone — and each district has its own treatment company. So, methods, as well as water quality vary significantly based on location.

Q. What about shower water samples — what common problems do you find?

Shower water is very much the same as the tap, since the only difference is maybe 10-30 meters of plumbing.

Q. Many expats use delivered water in those large 19 liter jugs. Have you tested those, and what are your concerns, if any?

Yes, generally we don’t find many problems. During hot weather, we have found elevated bacteria. The main issue is that the same water is found in multiple brands, which wouldn’t normally happen if they were “legit”. My guess is that a distributor is filling different brands with the same filtered water. It’s a problem if you order distilled because of dietary requirements or say dialysis, and you got spring water. The safest thing is to buy where the distribution is owned by the bottler. The second preventative is to make sure you disinfect your water dispenser every 6-8 weeks. Simple instructions in English and Chinese are posted on our website blog here.

Q. There are many types of water filters, from tabletop to under the sink, from simple filters to reverse osmosis. What’s your general findings on these?

Effectiveness depends on the level of contamination of source water. Many times, any of them are fine if you don’t have problems. However, in general, from least protection to most is something like this: ceramic jugs (Berkee), boiling, whole house filters, Brita, multistage carbon, distillation, reverse osmosis.

Q. Many people think Beijing’s water is too hard; what’s your best advice to help with this?

Use a water softener (assuming you don’t have a sodium intake problem). Some shower filters with KDF/carbon mix also do help.

Q. Parents of newborns are always worried about having clean water for infant formula, and always want to know what’s the safest way in Beijing to get this. Many use Watson’s distilled; some boil; some use filters; some use imported bottled water. What’s your opinion on the safest approach?

I covered this above, but either get a reverse osmosis system certified by NSF for not only contaminant reduction performance, but also manufacturing quality (ie. no parts leaching lead). Or, get bottled water by someone who delivers their own water.

Q. Calcium levels in the tap water always leave a whitish residue on pans, tea kettles, faucets and humidifiers. What’s the best way to fix this?

My research suggested only reverse osmosis filters could help, what’s your opinion? Scale is caused by calcium carbonate and magnesium — reverse osmosis definitely helps. I know that shower filters do help remove as well, and anything that does ion exchange, such as softeners.

Q. Anything else you’d like to mention?

One additional tidbit you could add is that we very frequently find that water from water filters is worse than tap. Why? If the filter has not been changed and it gets too full, it can start leaching the contaminants back into the effluent. Also, if you go on vacation and don’t have a filter with silver or other antimicrobial, you can get some bacteria that grows in the filter. So, have someone turn on your kitchen filter for a few minutes every month or so.

New Baby Dilemma: What To Eat in China?

AlexPassportI’m a bit sleep deprived these last few days, so please forgive me if I start to ramble. Everyone warned me that becoming a father would permanently destroy my eight hour sleep routine, and they were right. As a new parent of the world’s cutest boy (of course), I am now driven with every parent’s natural instinct while living here in China: protecting my family from a toxic environment. There are so many environmental concerns here in China, but which one is the most important to protect my new baby? Air pollution is always the top concern on my blog and in my family medicine clinic, and my previous New York Times article  (Chinese version here) touched on air pollution’s health risks to children as well as ways to help.

But food safety is close behind as a major health concern, and in some Chinese polls is the #1 concern. How could it not be? Every few weeks it seems we read about a new scandal, or even worse, the recurrence of an old scandal. It might be yet another “gutter oil” crackdown; exploding watermelons; illegal clenbuterol again found in pork; on and on. As Adidas says, in China “impossible is nothing” and you can even find 100% artificially created eggs and wine. I would almost admire their creators’ creativity and ingenuity, if I weren’t so disgusted with their lack of a moral core.

Given the tough reality of our environment, where should a new parent focus? I like to simplify this overwhelming task with this one commandment: take control of your family’s exposure to all environmental toxins. That includes everything: the air we breathe, the foods we eat — even noise and light pollution have major health effects on our immune system and mental health. Empower yourself! Don’t assume anything you eat or drink is healthy; try to know everything you can about the source of your food and drink. This advice isn’t specific to China at all, but it certainly is much more of an everyday dilemma here compared to my more benign choices back in San Francisco. My typical California food dilemma involved wandering the Saturday market and deciding if I want regular tomatoes or should I splurge on the multicolored heirlooms. It wasn’t exactly a cause for panic attacks, not when compared to my wandering our local Beijing market, wondering just how and why those piles of carrots are as thick as my wrist and glowing orange.

At least it’s much easier to plan a meal for a newborn: today would you like milk, milk, or milk? Easy choices here, with only two options: breast or bottle. The healthiest milk, of course, forever will be mother’s breast milk. Breast milk also gives mom complete control over toxin exposure, besides all the health benefits from mom’s antibodies, DHA and other nutrients. But like many working parents, we decided to use infant formula for our baby, which brings us to the next major choice: which formula brand and type is best for our little emperor? This should be relatively easy, but here in China all parents also have a couple of stressful extra questions: which formula won’t cause kidney failure in my baby? And which store do we trust? This awful state of affairs exploded in 2008, with the infamous melamine scandal. This unhealthy protein substitute found its way into much locally produced infant formula and caused serious kidney problems in hundreds of thousands of Chinese newborns, killing six.

This melamine scandal remains the most concerning public health scandal, by far, during my six years in China. And I completely understand why many parents in China — including myself — now would only use imported milk formula for our precious newborns. There’s no way that I would risk the health of my only child on a locally made infant formula, and no amount of PR or advertising is going to get me to make my son a test subject. Sorry, but that’s the hard fact with the dairy industry right now. That’s why we hear crazy reports of mainland Chinese flying to Hong Kong and stocking up on imported formula, forcing the government to limit purchases. I was in Hong Kong over the Christmas holiday and was amazed that almost every street corner market had piles of infant formula displayed. China’s insatiable appetite apparently has spread to Europe, where Dutch moms suddenly were not finding their usual formula on the shelves, now being bought up and shipped to China to feed all the new Dragon babies.

So with our imported organic formula shipped directly from Europe, we have complete control over his toxin exposure, at least for his crucial first four months — assuming our supply from Europe doesn’t sell out first. We then faced the next new parent problem: which water to use for his formula? We’re following the American Academy of Pediatric’s recommendations to use distilled, bottled or boiled water. Back in San Francisco I may have considered just installing a filter on the tap water, but here in Beijing we had to decide what’s the safest way. As the father, I did a lot of internet research on water filters, especially reverse osmosis, which filters out all minerals and germs. But we decided to do what many of our friends do: use Watson’s distilled water. Then you have to ensure that your Watson’s isn’t fake, which apparently isn’t such a small problem. My wife and I decided that our local Jenny Lou’s market had a good enough reputation to buy their Watsons bottles. Does this guarantee it is not fake? No, of course not, but on this issue, we find this an acceptable risk.

On to the next new parent issue, this time a bit more subtle: should his bottles be made of plastic, glass, or stainless steel? Many readers may think we are just over-worrying first-time parents, and they’d be correct — on some fronts (I’ve already started to email his doctor with photos of baby’s poop and rashes). But regarding plastics, I do think there is a legitimate concern, especially for babies. Again, this goes back to my main commandment to take control of your family’s exposure — and that definitely includes all plastics. I’ve discussed this issue a couple of times on my blog, highlighting the many Chinese news stories about plastic safety, from cheaply made takeaway boxes at restaurants to high levels of “endocrine disruptors” such as Bisphenol A (BPA) in children’s drinking cups, bottles and plates. My New York Times colleague Nicholas D. Kristof has published a series of columns raising the alarm about plastics, mostly focusing on a powerful position paper in 2009 by the U.S. Endocrine Society which reviewed the literature on “endocrine-disrupting chemicals”, which include plastics and other chemicals. Here’s a bullet point from their key points:

The evidence for adverse reproductive outcomes (infertility, cancers, malformations) from exposure to endocrine disrupting chemicals is strong, and there is mounting evidence for effects on other endocrine systems, including thyroid, neuroendocrine, obesity and metabolism, and insulin and glucose homeostasis.

In other words, plastics may be one of the major causes of obesity, diabetes, infertility, and some cancers. This developing research really got me to look closely at my environment, and my family changed a lot of our daily practices. With our new baby, our choice to avoid plastic completely and to use glass bottles was an easy and logical next step. Many countries already have phased out BPA from plastic baby bottles, but why take chances at all with plastic bottles when you could just use glass or stainless steel?

I think we’ve completely covered our boy’s food exposure during his first crucial months of life. We think we’ve covered most bases: nothing touches his skin except natural cotton and fragrance-free lotions; he breathes toxin-free air from our imported air purifier, which also nicely provides some relaxing white noise; no hand touches him that isn’t disinfected with soap and water or Purell hand sanitizer.

Many pediatricians, including my son’s, think that over protecting a child and attempting to avoid all germs and toxins may actually be harmful, long-term, for a baby. And there actually is some evidence that newborns can be too clean: super clean newborns, not exposed to the usual germs and thus not activating their immune system, may develop more allergic diseases later, such as eczema, allergies and asthma. Even having a dog early on seems to be more helpful than harmful. This theory is called the hygiene hypothesis. But I think this is more relevant when discussing bacteria and viruses; my more pressing concern now is avoiding harmful chemicals. I’m not so worried about avoiding his first cold, which is inevitable and no big deal; I’m worried about long term body damage, both physical and mental, from food pesticides, heavy metals, hormones and chemicals.

So for now, we first-time parents love keeping him in his toxin-free bubble, fighting off as long as possible his inevitable entry into the big bad world.

AlexandMe

 


This is my latest article to be translated into Chinese and printed in the New York Times China edition here at 将我们的新生儿放在无毒“泡沫”里, where I have a regular health column called 北京健康札记. You can read my previous New York Times articles here in English and in Chinese.