Lead poisoning

The  problem.… Lead is  a  naturally  occurring element   of the earth.It  is not biodegradable. It goes on  accumulating, wherever it is  deposited .    

LEAD POISONING :protect your children

This post is a bit long you can go through this content list and jump to  any  section.  

Shocking Statistics

Lead  poisoning sources

How is  lead metabolised?  

Systemic effect of lead

Symptoms of lead toxicity

Management of toxic effect of lead poisoning

Action plan:  what  you  can do

Take home message  

Lead can stay, in the soil, air, water your homes for years. It  can  enter  your  body through food , water, air..it  can even  be  absorbed through your  skin.   Lead   has  zero  need in  the body.

There is no known level  of lead that is needed by your  body and  studies  show  that  any   amount  of  lead  is  potentially Dangerous! Lead  is  a known  xenobiotic element.  

Continuously accumulating lead   over  years can poison generations of children and adults. All  social economic and  geographical boundaries are crossed by the poisoning  effects  of  lead.

  Due  to its widespread  usage  in  various industries , chronic lead poisoning is  a very  real  public  health  hazard, specially  in developing  countries  like our motherland.   Lead  is  still widely  used  in  most house  paints   used  in  India and  is one  of  the  very  important source  of  exposure .  

Pregnant  women  and children are  at  most  risk  from  exposure to  this  metal.     The    controversy  regarding  high proportion  of  lead  in  Maggi noodles has  brought  into  focus the the  need  for  more  awareness  and stricter  regulatory  measures. Nestle,and  it’s  counterpart in India are  world renowned companies, with long  history  of quality  products.

If  they , can’t  keep  a  check  on  their products, I wonder about the  quality  of any packaged  food  !   There are  more  than  enough, environmental sources  of  lead  exposure  without  food  items contributing to the  chronic  poisoning.

Individual , government and the corporate sector all need  to work together to stop poisoning ourselves… because  nobody’s  safe.   In the  meantime  educating  yourself  to keep  you  and   your  family  healthy shouldn’t  be delayed!  

Shocking Statistics

According to   CDC  data , there are 4 million households  in  USA ,where children are  being exposed  to  high levels of  lead . Lead  poisoning  is the  number one environmental  disease affecting  children in  developing countries.  

 Lead Poisoning Sources

How do  you  get  lead Poisoning?

• Leaded petrol

The  majority of the  countries have banned the sale & use of leaded petrol . Afghanistan, Myanmar, North Korea, Algeria , Yemen and Iran, 6 countries were still using  leaded petrol as late as 2011(The LEAD group data).

Algeria and Iraq have promised to phase out its use of  leaded petrol by  2015. Canada and USA were one  of  the first  few  countries to take up the difficult task of going against the petrol companies. Unfortunately India was one  of those who still allowed leaded petrol  till 2000,  when good sense  prevailed.

Tetra ethyl lead is an organic lead  compound  in petrol which  has unimaginable notoriety and  was responsible for  decreased IQ  and  development of antisocial  behaviour traits  in children. It’s a blessing that the  world  woke  up and  stopped the  use of  this poison.  

• Lead smelting
• coal combustion

• Lead paints

Paint  companies unfortunately have questionable standards in self  regulation of  lead  levels  in paint. In  countries were strict legislation is  absent in this  matter we  find  shockingly  high lead levels  in paint.  USA &UK have  banned lead  usage in paints for  painting homes.

But many countries including India, still  don’t have adequate  legal infrastructure to  check & control lead  levels  in house paints. The  major culprits are often small  and  medium   sized paint companies of  the  unorganised sector. Yellow,green, red  and white paints generally have  lead pigments.  

• Lead  containing  pipes,
• Lead  based  solder in  water  pipes
• Batteries
• Ceramics ; improperly  glazed
• Plastics
• Food  can  soldering
• Drinking water systems

• Cosmetic and folk  remedies

lead poisoning sources

Environmental exposure to paint, demolition of lead painted houses, bridges, stained glass, contaminated  herbal  remedies, candies, are  some  of the  very  common sources of chronic  lead  exposure. Top  

Industries  with high  level

 of  lead  usage include:

• Automobile
• Paint
• Ceramics
• Plastic

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How is Lead metabolised?

Absorption:

Ingestion Inhalation Dermally (organic lead)

Distribution of lead

in the  body

Blood:

95% to 99% of lead may  be  stored in the   red  blood  cells. You  really  need  to  measure  your blood  level  of  lead  ( not  serum) which  helps  to  find  out  recent  exposure .  

Soft tissue:

Extensive  storage with  half  life of  30  days.  

Bone storage:

Upto  15%  of  exposure  dose  may  be  stored in  the  bones. An astounding  20  years is  the  half life  of  lead in bones.Bone  lead  levels  shows the cumulative exposure  of   this ubiquitous element  over  several  years.  

Excretion:

Mainly  in  urine May  also  appear  in   other   bodily fluids  including  breast milk.  

Systemic Effects of Lead

Effects  of lead  poisoning  in  humans are manifold All  the  imp  systems  of   the   body may   be   affected.

Most  seriously  affected systems are:

Nervous  system Hematopoietic  system(Blood) Renal  system(Kidneys) Hepatic system(liver)  

What are the Symptoms?

Children  are the  most  affected as their developing nervous  system absorbs a  larger  amount  of lead.

Children

Common nonspecific symptoms

Children appear inattentive, hyperactive or decreased  activity, temperamental, irritable delayed developmental  milestones, language delay.

Studies  done  by  CDC  have  shown that  even with  low blood  levels  ( 3-4 microgram per decilitre)  of  lead the  long term  effect   on  cognition, learning abilities of  children , is significant.  

Symptoms  needing  urgent  attention

• Loss of  appetite,
• nausea,
• vomiting,
• abdominal pain
• Sleepiness,
• ethargy,
• ataxia,
• headache,
• stupor ,coma.  

Adults

Nonspecific

• Mood swings,
• irritability,
• Sleep  disorders
• Altered sex drive,
• headache,
• depression,
• even constipation

Though  all  these  have  a  multitude of  causes , chronic  lead poisoning may have to  be  ruled  out.

Acute high  dose exposure symptoms include:

• wrist drop,
• Foot drop,
• delirium
• , hallucinations,  

Both  children  and  adults may  present with  neuropsychiatric   problems,impaired cognition, learning  difficulties, and  antisocial  behaviour. Top

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Management

• Treatment
• Prevention
• Public health education and awareness

Treatment;

What blood levels of  lead need  Treatment?

Whole  blood lead levels (BLL) needs to be checked. CDC has some  guidelines for  treatment  of  lead exposure.

More  than 70 microgram per decilitre of  BLL is   a  medical   emergency, even without  neurological  symptoms.  

BLL  greater than  or  equal  to 45 micrograms per decilitre  needs  treatment.   New  guidelines  of CDC  indicate all children  with  blood lead levels greater than 5micrograms per decilitre need  evaluation and  active  management.

Dietary guidelines

Lead is  responsible  for  oxidative  stress in  the body.There  occurs  increased generation  of  free radicals  due  to oxidation of  cellular proteins,DNA, RNA, which  may even  cause  cancer. Antioxidants  in the  diet can  help prevent  lead toxicity  (Garcia  and Gonzalez 2008)

• Flavonoids , the natural  polyphenols: present

in fruits, vegetables , tea.

• Vitamins B, C, E :  Important  to  fight

the  toxic  effects  of  lead.The  dietary sources of these antioxidants can  be found here

• Alphalipoic acids : synthesised by the

body in  small  amounts, present in carrots, spinach,beet, potatoes, red  meat are  an  important group of  dietary  antioxidant.

• Garlic  :  Allicin  is  its  active  agent

which  is  responsible  for  the  odour and medicinal property (Sharma et Al 2010).The   disease  fighting property of  garlic  is   well  known.

• Curcumin :  This is  the  principal  active

component of  turmeric with anti -inflammatory  and  antioxidant property.Along  with  chelating agents like  DMSA, Curcumin  has  shown promise, regarding  treatment  of lead  induced  oxidative stress in rats( Saxena &Flora  2006)  

Medicines

Symptomatic,  highly  exposed people :

Mainstay  of  treatment  is chelation. The  sulfhydryl  group  in  chelating  agents, bind  the  free  lead  in  the  blood  and  help in removing   it  from  our  body  through  the kidneys and  liver.  

As  the   blood   levels  of  lead   decreases the  body  stores  of  lead like  in  the  bones become  mobilised  and  there  may  occur rise  in blood  lead  levels  with   toxicity including  encephalopathy  .  

Chelation  is  to  be  done  , definitely  under a doctor’s  supervision.

Oral  agents    include: DMSA (Succimer), and  oral  penicillamine. If  acutely  toxic, hospitalization with intravenous or  intramuscular  chelation with edentate  calcium  disodium (CaEDTA) may  be  needed. Dimercaprol  is added  to  prevent encephalopathy. 

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Action Plan:What you can do?

1) Stop  the  exposure: The  most  important  thing  about heavy  metal  poisoning  is  to  stop the  chronic  exposure  through  various sources.  

2) Get  tested A  simple  blood  test  will  help  you decide  regarding  treatment. Definitely  check   whether the  lab,can test  for  low  blood  levels  of  lead.  

3) Decrease  dietary  fat. A  high  fat  diet  increases  the   rate of  absorption  of  lead.  

4)Increase  dietary  fibres This  helps  to   decrease  absorption of  lead.  

5) Correct  dietary  deficiency of  iron

  6)Prevent and  treat  osteoporosis. Correct  dietary deficiency  of  calcium     Osteoporosis causes  mobilization of  bone  stores  of  lead  and  may precipitate  acute symptoms. 600 IU vitamin D3 is  adequate  for  prevention. We  need  a  minimum  of 1000mg of  calcium as daily  requirement  for  our  nutritional needs. Treatment of  osteoporosis needs much  higher  doses, of  both vitamin D and  calcium.

  7) Increase  dietary  sources of  Vitamin B, Vitamin C ,  Vitamin E and other dietary antioxidants Vitamin  C  is  a  naturally  occurring weak  chelating  agent. Upto 1000mg  of  Vitamin C may  be  taken  per day.

  8) Avoid flaking paint  in  the house.

  9) Regularly  clean  surfaces  and children’s  play  area  . Children’s typical  hand  to  mouth  habits are  responsible  for  a  large percentage of  environmental  exposure to lead from lead contaminated dust.  

10) Avoid  using  lead  containing cosmetics. Many  leading  brands  have  high  amount of  lead  in  their products  and  price  has little  to  do  with  it.Research  the  product  well before  buying  and  definitely  never  forget to  remove  makeup at night  

11) Open  shoes  outside  the  front  door. If  this  not  possible  keep  your  shoe rack, mudroom  close  to  the  entryway   to  prevent mud  tracking  indoors. Outdoor   soil  is  a  very common  source  of  lead  indoors.  

12) Choose   lead  free paint  to  paint  your home. Nerolac in  India  offers  lead  free paint  options.

13) In India  you can contact InSLAR  ,for  testing  a product  for  lead in  their  lab .

Indian Society for Lead Awareness & Research – InSLAR

Top

Along with  treatment and  prevention certain Public health strategies may be  able  to  influence  a  larger  population more  effectively.

Public health strategies

Guidotti and Ragain (2007):

2 important strategies

1) Prohibition of setting up industries with lead  close to  habitable areas

2) Complete  banning   use  of  lead, where appropriate  replacement is  available.   Top

Take home message

1)Get your blood  tested  for  lead

2)Stop  the  exposure

3)Diet  rich  in  vitamin,B,C,D,E, Calcium,iron,natural antioxidants 4)Make  your  home  lead  free

5)Use unleaded gasoline     .

Children are  the  future.Unfortunately  they  are also  most  at  risk.Make  your  homes safe, practice  good  housekeeping  and above  all  educate  yourself ,your  family, your  neighbours … anybody  who  will listen!

Your awareness  will go  a  long way  in making the  authorities  make  the much needed   changes.

Do  you  suffer from  any  of  the effects of Lead poisoning? Have you ever tested your blood  lead levels?

Write to  me at dramrita@healthwealthbridge.com

(Disclaimer: this article is  meant to  educate and cannot be  a  replacement for a  doctor’s consultation. )  

If  you liked this  post please share it with  a  friend. 

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Reference:

1)Harrison’s Principles of Internal Medicine 2)CDC  lead poisoning 3)The  George Foundation 4)Toxicity of lead: A review with recent updates  Gagan Flora, Deepesh Gupta, and Archana Tiwari

8)Can antioxidants be beneficial in the treatment of lead poisoning? Gurer H, Ercal N Free Radic Biol Med. 2000;29:927–945.

9) The effect of oral administration of Allium sativum extracts on lead nitrate induced toxicity in male mice. Sharma V, Sharma A, Kansal L. Fd Chem Toxicol. 2010;48:928–936.

10). Changes in brain biogenic amines and haem biosynthesis and their response to combined administration of succimers and Centella asiatica in lead poisoned rats. Saxena G, Flora SJ J Pharm Pharmacol.2006;58:547–559.

11) Nutritional antioxidants mechanisms of action, analyses of activities and medical applications.Vaya J, Aviram M. Curr Med Chem-Immunol Endo Metabolic Agents. 2000;1:99–117.

12)  Toxic effects of perinatal lead exposure on the brain of rats: Involvement of oxidative stress and the beneficial role of antioxidants. Garcia MTA, Gonzalez ELM. Fd Chem Toxicol. 2008;46:2089–2093.

13) Fruits and vegetables:Nature’s multivitamins

14)A Surprising Source of Lead Poisoning: India’s Idols

15)Why Lead Poisoning May be Causing Your Health Problems