March 15, 2010 -- Visi Tilak, a writer, musician and artist who emigrated from India, prepares her children's daily meals with fragrant spices that are a staple of Indian cooking, including tumeric, coriander and garam masala.
"They have been exposed to Indian spices since they were born," said the Ashland, Mass., blogger and mother of a 1-year-old and a 6-year-old.
Now, a study published today in the journal Pediatrics said young children who regularly ingest some imported Indian spices may be exposed to lead -- a dangerous neurotoxin.
The study, conducted from 2006 to 2008, followed patients from the Pediatric Environmental Health Center at Children's Hospital in Boston who had ingested or been exposed to Indian spices and powders.
One 12-month-old boy in the case study was found to have lead poisoning after regularly eating spices such as tumeric, black mustard seed and asafetida.
When the family discontinued use of the spices, his blood lead levels went down within six months.
But of greater concern to researchers are religious powders like cherry-colored "sindoor" -- which is applied cosmetically on the skin and which Tilak also uses routinely in her home.
Some of these ritual powders comprise 47 to 64 percent lead, according to the study, and can be particularly dangerous when applied on young children.
Food products had a lower percentage of lead compared with powders, but researchers were particularly concerned about children who are chronically exposed to these products -- up to several times a week -- at a young age.
"Although the powders are not meant for consumption, we speculate that infants may be inadvertently exposed by hand-to-mouth transference of topically applied powders or by the hands of parents who handle the powders or who prepare food for the infant," said the study's lead co-author Dr. Cristiane Gurgel Lin, now a pediatrician at Seton Medical Center in Austin, Texas.
Approximately 250,000 American children have dangerous lead levels -- greater than 10 micrograms (ug) of lead per deciliter (dL) of blood, according to the Centers for Disease Control and Prevention (CDC).
Children under age 6 are particularly vulnerable to lead poisoning, which is asymptomatic but can lead to dangerous neurological impairment.
The use of lead-based paints for homes, toys and household furniture has been banned in the United States since 1978, but children can be exposed by eating dust particles from old paint and drinking water from older plumbing fixtures.
Spices and "folk" powders also have been implicated as lead sources in countries including India.
The Boston researchers cited four children with lead poisoning, three of which were linked to the religious powders. Their families' homes were tested to rule out other sources of lead.
One 10-month-old Indian boy was referred for elevated blood levels of 43 ug/dL. His mother reported that she had rubbed religious powder on the boy's forehead since he was several weeks old.
Another 9-month-old Indian boy had levels of 21 ug/dL after his parents routinely applied orange shringar to his forehead. A 3-year-old had levels of 18 ug/dL from ingesting a powder.
The child who had ingested the spices had levels of 28 ug/dL.
"This is not a total shocker," said Dr. David Acheson, the former associate commissioner for foods at the Food and Drug Administration (FDA). "Most come from the color dyes, particularly the reds, which often have lead in them."
"Lead poisoning is a big deal and you could get long-term low-level exposure in spices," said Acheson, who is now a consultant for Leavitt Partners. "You could argue that children are not likely to consume these spices, but in immigrant communities when you grow up with that, lead poisoning could be serious."
FDA Does No Routine Testing of Spices
Spices and cosmetics are regulated by the FDA, but according to Acheson, there is little routine testing of such products. Often the preparations are brought to the United States by relatives.
"If something comes to light or someone gets sick, they typically investigate and get hold of the products and test it," he said. 'If they find the level of toxicity, then you could be talking to whoever make the product about a total recall. They will put on consumer warnings, the whole nine yards."
In the study, scientists tested a variety of Indian products randomly purchased from 15 stores in a 20-mile radius of Boston. Among spices tested, lead levels as high as 7.6 micrograms (ug) per gram (g) were found in 22 of 86 spices tested.
Levels were even higher in powders. Of the 71 powders tested, 46 contained up to 41 ug/g of lead. The content of three sindoor products was more than half lead.
The FDA recommends a 6-ug per day tolerable limit for dietary intake of lead for children aged less than 6 years.
Sindoor, also known as kumkum, is a blood-red or deep-purple colored red powder or liquid dye used by Indian women to indicate they are married, but is sometimes used ritually on children.
Though traditional mixes are herbal, modern sindoor can include synthetic materials like lead, zinc and industrial dyes.
In 2007, the FDA issued an alert warning consumers not to use sindoor, because testing in Illinois determined its lead content was as high as 87 percent. In 2008, the CDC issued a recall on those and other Swad products.
Other imported products from countries like Mexico and Iraq have been implicated in lead poisoning.
A health alert was issued in California in 1998, when a 6-year-old boy was identified with levels of 59 ug/dL during a routine screening. It was later discovered that an aunt had brought tamarindo candy jam products from Mexico.
In May 1997, two toddlers in Michigan had high lead levels caused by eating lozeena, a bright orange powder used by Iraqis to color rice and meat, which contained 7.8-8.9 percent lead. The spice had been brought over by their grandmother.
Study researchers have said that pediatricians need to be more aware of lead poisoning in imported products used in South Asian communities so they can test children more routinely.
Lead targets hemoglobin, the oxygen-carrying protein in red blood cells, according to the Mayo Clinic, and attacks the nervous system. Symptoms usually don't appear until dangerous levels have accumulated.
Symptoms can include irritability, loss of appetite, weight loss, sluggishness and fatigue, as well as abdominal pain and anemia, according to the Mayo Clinic.
When pregnant women are exposed to lead, their babies may exhibit learning difficulties and slowed growth.
Adults are also susceptible to lead poisoning and can experience symptoms of pain or numbing of the extremities, muscular weakness and headaches, as well as memory loss and mood disorders.
Anjani Sarma, mother of a 2-year-old and 5-year-old from Palo Alto, Calif., said her children are not exposed to sindoor, but she is familiar with the powder.
"My mother and a lot of people I know make it by mixing turmeric powder with lime to make it red and then it is mixed with camphor and some other herbs," said Sarma, who was born in India. "Sometimes the rock of alum is also used to make it."
Caution on Tumeric Spice for Children
She is more concerned about the use of tumeric, a yellow spice that is a staple of Indian cooking and has purported health benefits.
"I am going to rethink the use of store-bought ground spices and will grind up my own from fresh ingredients," she said. "I am especially concerned about the possibility of lead in turmeric since I use a pinch in whatever I make. It has always considered good as an anti-inflammatory and an anti-septic.
"I'm in my seventh month of pregnancy and use imported Indian spices for cooking nearly daily," she said. "If this is harming children, it can probably severely harm or even kill a fetus which is still in development and can't protect itself from such hazards as well as children can."
LaVigne also uses powder on herself, but now says she will have to consider changing their family's eating habits.
"This is tragic news to our family as we cook Indian food about 90 percent of the time and use all the imported spices," she said. "In fact, when my mother-in-law comes over to stay with us in a couple of months to help with the newborn...she only cooks Indian food, so what does this mean to us?"
But Tilak, the mother from Ashland, Mass., isn't daunted by the curries her extended family has been preparing for generations, even with two children in the house. She'll just be more careful.
"As with any other product, where these items are purchased are an important consideration," she said. "With this in mind, yes, there needs to be stricter regulation to ensure that these inferior quality products are not marketed to consumers."