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