First Nations Food, Nutrition and Environment Study

Assembly of First Nations National Water Conference Edmonton, Alberta March 6, 2012 Dr. Don Sharp, A/Director Environmental Stewardship, AFN

Funding for this study is provided by Health Canada.

The information and opinions expressed in this presentation are those of the authors/researchers and do not necessarily reflect the official views of Health Canada.

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2

Many Sources Of Pollution

3

First Nations Unique Food System

MarketFood

TraditionalFood

Total Diet

4

Why do this study?

• Gap in knowledge at the national and regional level on nutritional composition and the environmental safety of foods consumed by First Nations peoples living on reserve lands south of 60th parallel across Canada

• Lack of knowledge on the baseline levels of environmental pollutants in the traditional foods across Canada

• Gap in knowledge on the total diet of First Nations across Canada

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First Nations Food, Nutrition and Environment Study

Resolution no. 30 at the AFN Annual General Assembly July 12, 2007

Halifax, NS

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Project Led by:

Dr. Laurie Chan, Toxicologist and Professor, University of Ottawa

Dr. Olivier Receveur, Nutritionist and Professor, Université de Montréal

Dr. Donald Sharp, A/Director Environmental Stewardship, Assembly of First Nations

With contributions from: Dr. Constantine Tikhonov and Dr. Harold Schwartz

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What is the study about?

• What kinds of traditional foods are people eating?

• How well are people eating?• What level of mercury are people

exposed to?• What amount of trace metals and

pharmaceuticals are in the water?• Is traditional food safe to eat?

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Five Components

First Nations Food, Nutrition

and Environment Study

(FNFNES)

1. HouseholdQuestionnaire

2. Food Sampling for a Suite of

Contaminants

3. Water Sampling for

Trace Metals

5. Hair sampling for Mercury

4. Surface water Sampling for

Pharmaceuticals

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Partnership and Community Participation

• The project involves the participating communities at all stages of the project.

• Canadian Institutes for Health Research (CIHR) guidelines are respected.

• Data is kept confidential.

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Approach

• Methodology workshop• Community visits and negotiation of Research

Agreement• Hiring of research assistants in communities• Collecting seasonal food samples• Training of research assistants• Interviews, hair and drinking water collection• Data and sample analysis• Result reporting and communications

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The FNFNES Sample

• 100 communities from 2008-2018• ~8 - 12 communities per year and

returning back in the last 2 years • Systematic Random Sampling by

region and ecozone

FNFNES Sampling Framework

2010 12

12

189 6

6

13

21 British Columbia communities in 5 Ecozones participated in the study in 2008-2009

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Who can participate•19 years or older•Able to provide written consent•Self-identifies as a FN person living on reserve

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Key BC Results- Nutritional quality of food intake below that required for optimal health—but improved when traditional food is eaten

- Excess body weight (overweight and obesity) a major issue

- Food insecurity an important problem

- Water quality satisfactory, but close monitoring recommended- Mercury exposure, as measured by levels in hair and food intake, not a health concern- Chemical contamination of traditional food not a health concern—but information important to monitor future changes

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Nutrition Issues RaisedNutrients of concern:

• Vitamin A• Calcium• Iron

Food security

Diet related concerns• Obesity• Diabetes• Heart disease

Traditional Food

Important source of many nutrients that are not consumed in sufficient amounts

Diets are healthier when traditional food is eaten in addition to market foods

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Metals in Drinking WaterHarold Schwartz PhDManager, Chemical Safety of Traditional FoodsEvironmental Health Research DivisionFirst Nations and Inuit Health BranchHealth Canada

Assembly of First Nations National Water ConferenceEdmonton, AlbertaMarch 6, 2012

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Why a Drinking Water Component?Designed to complement the food component

• Test for exposure to metals coming from drinking water and compare to total diet

Interested in water in households because plumbing systems can contain trace metals so they can contribute to total intake

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Sources of Lead & Copper at the Tap

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1. Estimate How Much Water Consumed

The household interviews include questions about the water consumed, e.g.:

– The water used for drinking and cooking

– Daily consumption of water (e.g. how many cups of water, coffee, tea, juice, etc. does the interviewee drink every day?)

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2. Collect Drinking Water Samples

In each community, 20 households invited to participate

In each household we collect:• a first draw sample• a flushed sample • if applicable, an additional sample for alternative sources of

drinking water• if needed a duplicate sample

Send to lab for analysis

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Lab Measures the Following Metals:Aluminum Chromium Molybdenum TelluriumAntimony Cobalt Nickel ThalliumArsenic Copper Phosphorus ThoriumBarium Iron Potassium Tin

Beryllium Lead Selenium TitaniumBismuth Lithium Silicon UraniumBoron Magnesium Silver VanadiumCadmium Manganese Sodium ZincCalcium Mercury Strontium Zirconium

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Reporting Results• All samples above the maximum acceptable concentration

(MAC) and/or aesthetic objective (AO) reported to:– Chief and Council– Regional Environmental Health Manager– Households

• All results summarized and communicated at the community and regional levels

• No households identified in the summary reports

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Metals – Maximum Acceptable Concentration (MAC) Exceedances

Metal# of communities

with MAC exceedances

# of households with MAC exceedances

Lead, Pb 3 3

20.4

10

0

5

10

15

20

25

Lead, Pb (3)

ug/L

Metal (# of samples over MAC guideline)

Maximum Acceptable Concentration (MAC) Exceedances n = 284

Maximum Level Detected (ug/L)

MAC Guideline (ug/L)

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Title

Metal# of communities with AO

exeedances # of households with AO exeedances

Manganese, Mn 2 6

Aluminum, Al 1 6

Iron, Fe 3 2

Copper, Cu 4 16*

Sodium, Na 1 1

Metals – Aesthetic Objectives Exceedances

* First draw sample, no exceedances after 5 minute flush

Aesthetic Objective Exceedances n=284

250 287

1420

0

250

500

750

1000

1250

1500

1750

2000

2250

2500

2750

3000

Manganese, Mn (6) Aluminum, Al (6) Iron, Fe (3) Copper, Cu (16) Sodium, Na (1)

Metal (# of samples over AO guideline)

ug/L Maximum Level Detected (ug/L)

AO Guideline (ug/L)

2930

50200

300

1000

298000 / 200000

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Recommendations

There is generally no concern regarding the trace metal levels in the drinking water.

It is recommended that the tap water be flushed once in the morning before consumption.

In addition, flushing the toilet or using the shower before drinking tap water, will also reduce levels of exposure to metals from indoor plumbing.

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Pharmaceuticals in Surface WaterHarold Schwartz PhDManager, Chemical Safety of Traditional FoodsEnvironmental Health Research DivisionFirst Nations and Inuit Health BranchAssembly of First Nations National Water ConferenceEdmonton, AlbertaMarch 6, 2012

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What are Pharmaceuticals? (Merck Manual 1997)

Substances used in the:

• Cure• Relief• Treatment, and • Prevention of disease

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Origins of Pharmaceuticals in the Environment (Daughton, 2002 & 2007)

Unused medication disposed of expired & unwanted in the toilet, drains or garbage

Unmetabolized drugs (typically 30 – 50%) in sewage

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Veterinary Use Pharmaceuticals

Livestock ProductionHogsCattleChickensSheep

Antibiotics - Prophylactic

Hormones

Antiparasitics

Growth promotors

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Aquaculture SourcesInputs of:

Antibiotics and Antiparasitics

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Analgesics / Anti-Inflammatories

• Acetaminophen• Codeine• Diclofenac• Ibuprofen• Indomethacin• Ketoprofen• Naproxen

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Antacids• Cimetidine• Ranitidine

Diuretics• Furosemide• Hydrochlorothiazide

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Antibiotics

• Chlortetracycline• Ciprofloxacin• Clarithromycin• Erythromycin• Lincomycin• Monensin

• Oxytetracycline• Roxithromycin• Sulfamethazine• Sulfamethoxazole• Tetracycline• Trimethoprim

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Antidiabetics

• Metformin• Pentoxyfylline

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Antihypertensives

• Atenolol• Diltiazem• Metoprolol• Dehydronifedipine

(metabolite of Nifedipine)

Statins • Atorvastatin

• Bezafibrate• Clofibric acid

(metabolite of Clofibrate)

• Gemfibrozil

Lipid Regulators

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Oral contraceptives

• 17 a-Ethinylestradiol

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Stimulants•Caffeine

Relaxants•Cotinine (Metabolite of Nicotine)

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Other pharmaceuticals

• Carbamazepine• Diphenhydramine• Fluoxetine• Warfarin

Anticonvulsant

Antihistamine

Antidepressant

Anticoagulant

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British Columbia (21 Communities)

Manitoba (12 Communities)

Ontario 2011 (4 Communities)

Recreational/Fishing(20 of 62) 33%

Recreational/Fishing(12 of 36) 33%

Recreational/Fishing(4/12) 33%

Sewage Discharge (11 of 62) 18%

Sewage Discharge (4 of 36) 11%

Sewage Discharge (3/12) 25%

Drinking Water Intake (8 of 62) 13%

Drinking Water Intake (10 of 36) 28%

Drinking Water Intake(3/12) 25%

Possible Contaminant Source

(4 of 62) <1%

Possible Contaminant Source

(2 of 36) 6%

Exploratory Sampling(21 of 62) 35%

Exploratory Sampling (8 of 36) 22%

Exploratory Sampling (2/12) 17%

Criteria used for the selection of BC and MB and ON Sampling Sites for the selection of pharmaceuticals

pharmaceuticals

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British Columbia – Pharmaceutical Sampling Sites

Mount Currie Skidegate

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Manitoba – Pharmaceutical Sampling Sites

Tadoule Lake Shamattawa

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Analysis – Liquid Chromatography/Tandem Mass Spectrometry (LC/MS/MS)

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Frequency of Pharmaceuticals Detected — found in 30 of 62 sites in British Columbia

6.512.9

3.222.6

12.94.84.84.8

3.21.61.6

14.53.2

0 5 10 15 20 25

WarfarinFluoxetineCotinineCaffeine

Clofibric acidDehydronifidepine

AtenololPentoxyfyllineTrimethoprimClarithromycinCiprofloxacinKetoprofen

Acetaminophen

Percentage of Sites (%)Analgesics

Antibiotics

Antidiabetic

Antihypertensives

Lipid regulator

StimulantRelaxant

Antidepressant

Anticoagulant

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Pharmaceuticals in the Environment - Analgesics

Acetaminophen

17.5

3,500

10,000

13,216

0

2000

4000

6000

8000

10000

12000

14000

FNFNES Canada (SK) USA Costa Rica

ng/L 

Ketoprofen

307 79

9,808

0

2000

4000

6000

8000

10000

12000

FNFNES Canada (NL) Costa Rica

ng/L

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Pharmaceuticals in the Environment - Antibiotics

Ciprofloxacin

29.4

114

360

740

0

100

200

300

400

500

600

700

800

FNFNES Canada(AB)

USA Costa Rica

ng/L

Clarithromycin

9.4

79

950

0

100

200

300

400

500

600

700

800

900

1000

FNFNES Canada (ON) Costa Rica

ng/L

4.3

150

800

569

0

100

200

300

400

500

600

700

800

900

FNFNES Canada(SK)

USA Costa Rica

ng/L

Trimethoprim

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Pharmaceuticals In the Environment – Antihypertensives & Antidepressants

Atenolol

6.7 28.2

432

1,237

0

200

400

600

800

1000

1200

1400

FNFNES Canada(ON)

USA Spain

ng/L

9.5

36

0

5

10

15

20

25

30

35

40

FNFNES USA

ng/L

Dehydronifedipine (Nifedipine metabolite)

50.7

46

21

34

0

10

20

30

40

50

60

FNFNES Canada(ON)

USA UK

ng/L

Fluoxetine

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Pharmaceuticals in the Environment – Stimulants & Relaxants

Caffeine

91.5

1,470

6,000

9,700

0

2000

4000

6000

8000

10000

12000

FNFNES Canada (SK) USA Romania

ng/L

Cotinine (Nicotine metabolite)

15.8

180

900

15.4

0

100

200

300

400

500

600

700

800

900

1000

FNFNES Canada (AB) USA Switzerland

ng/L

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Pharmaceuticals in the Environment – Anticoagulants, Antidiabetics & Lipid Regulators

Warfarin

7.8

15

0

2

4

6

8

10

12

14

16

FNFNES USA

ng/L

Pentoxyfylline

4.5 9

299

0

50

100

150

200

250

300

350

FNFNES Canada (ON) Romania

ng/L

8.6

178

630

550

0

100

200

300

400

500

600

700

FNFNES Canada(ON)

USA Germany

ng/L

Clofibric acid (Clofibrate metabolite)

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Ethinyl estradiol wipes out fish population in experimental lake, Ontario

• Department of Fisheries and Oceans dosed an experimmental lake in northwestern Ontario with 5 ng/L of 17-a ethinyl estradiol

• Caused complete collapse of fathead minnow population – 100% intersex fish (Kidd, 2007)

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Wastewater Chemicals Cause Intersex Fish USGS, 2008

Wastewater treatment plant effluent (Boulder, Colorado) containing endocrine disruptors including ethinyl estradiol cause 20% intersex white suckers

No intersex fish upstream

USGS scientist dissecting a fish to determine possible effects from exposure to endocrine disrupting contaminants

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Health Effects and Caffeine Levels in Water

• Caffeine is a tracer for human waste• Elevated caffeine levels correlate to fecal coliform

levels• 400 ng/L caffeine correlates to 200 colony forming

units (CFU) / 100 mL• Above 200 CFU / 100 mL water is too polluted for

swimming (Sauvé et al., 2012)

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Environmental Pharmaceutical Health Effects

Drinking Water Acceptable Average Equivalent Level = Daily X Body Weight

(DWEL) Intake (ADI) (ABW) / 2 Litres

Margin of DWEL (4.219)Exposure = maximum X Number of Glasses (MOE) concentration of Water to exceed

in Drinking Water ADI

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Number of Glasses of Water that would Exceed Acceptable Daily Intake (ADI)

Pharmaceutical Maximum Concentration

ng/L

Number of Glasses of

Water1 Ketoprofen 307 480 *2 Fluoxetine 50.7 800 *3 Cotinine 15.8 2,600 *4 Warfarin 7.8 3,400 **5 Dehydronefedipine 9.8 8,400 *6 Ciprofloxacin 29.4 36,000 *7 Atenolol 6.7 42,000 ***8 Clarithromycin 9.4 117,000 *9 Clofibric acid 8.6 350,000 *10 Acetaminophen 17.5 410,000 *11 Trimethoprim 4.3 738,000 *12 Caffeine 91.5 9,000,000 ****13 Pentoxyfylline 4.5 708,000,000 *****

Legend:

* Australian Guidelines for Water Recycling, 2009

** Schwab, 2005

*** Snyder, 2008

**** Health Canada 2010

***** US Food & Drug Administration, 2010

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Existing RegulationsCanadian Regulations:

• Subject to the notification requirement of the New Substance Notification Regulations (NSNR) of Canadian Environmental Protection Act (CEPA) since 2001;– HC conducts an environmental risk assessment for these new

substances where use exceeds 100 kg/year. At 1,000 kg/year physical/chemical and acute ecotoxicity study is required (Beck, 2007).

•• British Columbia:

-BC Established Ambient Water Quality Guideline for Pharmaceutical 17a-ethinyl estradiol (EE2) September 2009

-0.5 ng/L

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Existing Regulations Cont’United States:

• US Environmental Protection Agency (EPA) has included 11 pharmaceuticals on its Contaminant Candidate List 3 (CCL 3) that may require a national drinking water regulation in the future (USEPA, 2009). The 11 contaminants are listed below: – 17alpha-estradiol, Equilenin, Equilin, Erythromycin,

Estradiol (17-beta estradiol), Estriol, Estrone, Ethinyl estradiol (17-alpha ethynyl estradiol), Mestranol, Nitroglycerin, and Norethindrone (19-Norethisterone).

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Existing Regulations Cont’Australia:

• 1st country to propose establishing pharmaceutical guidelines for water recycling (Australian Guidelines, 2008);

• List of 645 chemicals is currently used to monitor the environment (water, soil, sediment, air and/or biota) even though guidelines are not available for all compounds (Australian Government, 2008);– The list includes 17 pharmaceuticals: amoxicillin, ampicillin,

benylpenicillin, chloramphenicol, closicillin, erthromycin, monensin, narasin, salinomycin, stretomycin, sulfatroxazole, sulphadiazine, sulphaadimidine, sulphadoxine, sulphafurazole, sulphamerazine and sulphaquinoxaline.

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Conclusion

The levels of pharmaceuticals found in surface waters in the vicinity of First Nations communities in British Columbia are not harmful to human health

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Acknowledgements

Manitoba -EHOs: FNs Band Employees: Health Canada:

Crystal Bull Russell Evans Dan Biggs

Brad Carr Laurie Garmond Alexis Gagnon

Mike Fontaine Johnathan Kitchekeesik Isabelle Hughes

Jenifer Hughes Doug Martin Sarah Kettel

Tim Ness Candace McIvor Richard Millette

Jennifer Nyhof William Miles Carole Nault

Bob Reed Wilfred Richard Marc Paquette

Marvin Robert Jeffrey Thomas Leslie Scott

Peter Skobel Gladys Williams

Tom Smithson

Ontario - Linda Copenace

Ray Alatalo Veronica Fobisher

Mark Johnston Darin Migwaws

Whitney Roos Shawn Petantegoose

British Columbia -EHOs: FNs Band Employees:

Iain Baird Bill Bolan

Paul Broda Russell Bolan

Lucille Lukey J. Chang

Paula Ciocca Erick Christiansen

Lise Fish Sheila Frank

Ken Gillis Sue Gladstone

Alec Johnson Keith Glover

Vivian Lee Grace Maciver

Birgit Luesgen Bernadette Makowski

Peter Mazey Jodi Nole

Neil Nabata Marilyn Pouce Coupe

Angela Van Volkenburg K. Street

Greg Vos Brian Wolfe

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Thank you!Thank you!

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Contact Information

Judy MitchellNational Coordinator Phone: (250)-960-6708 Email: FNFNES@unbc.ca

WEB Site: www.fnfnes.ca