tag:theconversation.com,2011:/ca/topics/kidney-1224/articlesKidney – The Conversation2017-07-04T01:35:51Ztag:theconversation.com,2011:article/804032017-07-04T01:35:51Z2017-07-04T01:35:51ZNo, nanoparticles in baby formula will not harm your baby<figure><img src="https://images.theconversation.com/files/176674/original/file-20170704-12293-t2rt7k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The health scare surrounding nanoparticles might lead to people abandoning formula unnecessarily, with serious impacts on babies' health.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/392125570?size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>If you watched Channel 7 news this week, you would have learnt about a <a href="http://www.smh.com.au/business/consumer-affairs/study-finds-potentially-toxic-nanoparticles-in-australian-baby-formula-20170622-gwwb2j.html">study</a> commissioned by <a href="http://www.foe.org/projects/food-and-technology/nanotechnology/baby-formula">Friends of the Earth</a> that found “potentially toxic” <a href="https://theconversation.com/nanoparticles-and-nanosafety-the-big-picture-22061">nanoparticles</a> in Australian baby formula.</p>
<p>The study’s spokesperson said calcium phosphate nanoparticles (nano-hydroxyapatite, also known as nano-hydroxylapatite) caused kidney and liver damage. That claim was, how shall I put it kindly, just a little <em>misleading</em>.</p>
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<p>I have the <a href="http://pubs.rsc.org/en/content/articlepdf/2012/nr/c2nr00044j">study</a> the spokesperson mentioned before me, which was conducted in rats, not humans.</p>
<p>The researchers injected calcium phosphate nanoparticles directly into rats’ body cavities (instead of oral administration as happens with baby formula) at concentrations around a million times higher than found in the baby formula.</p>
<p>Let me quote from the study’s findings:</p>
<blockquote>
<p>The normal levels of AST, ALT and A/G [liver enzymes indicating liver damage] in the n-HA [nano-hydroxyapatite] group suggested no inflammation and necrosis induced by accumulation of 100 mg of n-HA particles. In the liver function there was almost no damage. Moreover, no significant change on values of BUN and CR [urea and creatine] than the control, which also suggested n-HA has no effect on renal function.</p>
</blockquote>
<p>In other words, there were <em>no</em> ill effects on liver or kidney function, the direct opposite of what the media reports were claiming.</p>
<p>Even <em>if</em> you injected 100 milligrams of pure nano-hydroxyapatite directly into a newborn baby’s body (equivalent in baby terms to the dose given to the rats) there would be <em>no</em> significant effect on liver or kidney function.</p>
<p>The spokesperson’s misleading message caused unwarranted concern. On a now deleted <a href="https://www.facebook.com/Sunrise">Sunrise Facebook</a> post discussing this report, the commentors’ concern and fear was palpable. Causing unreasonable fear is irresponsible.</p>
<h2>Nanoparticles occur naturally</h2>
<p>Nanoparticles have become the latest bogeyman, despite nanoparticles occurring naturally. The <a href="http://www.smh.com.au/business/consumer-affairs/study-finds-potentially-toxic-nanoparticles-in-australian-baby-formula-20170622-gwwb2j.html">media report</a> that fuelled the controversy failed to put nanoparticles in their natural biological context, provide any significant support that particles detected in milk are engineered nanomaterials, nor provide evidence of harm for the levels found.</p>
<p>Infant formula is based on milk, which naturally contains calcium and phosphorus (as calcium phosphates). Milk is an important source of calcium, which forms the basis of bones and teeth. The calcium and phosphates are in a complex balance between soluble and protein-bound forms.</p>
<p>One of the forms of calcium phosphate in milk is <a href="https://hal.archives-ouvertes.fr/hal-00900570/document">hydroxyapatite</a> (also found in <a href="https://en.wikipedia.org/wiki/Hydroxylapatite">tooth enamel</a>). So it is unsurprising that hydroxyapatite is found in dried infant formula, which is mainly dried milk powder. </p>
<p>Nanometre-sized particles of calcium phosphate also <a href="https://www.ncbi.nlm.nih.gov/pubmed/6626580">form naturally</a> in drying milk.</p>
<h2>Other studies have found no effect</h2>
<p>Researchers have studied the safety of consuming hydroxyapatite nanoparticles before.</p>
<p>Animals who ate the nanoparticles (added to their food, as opposed to having them injected) showed <a href="http://www.sciencedirect.com/science/article/pii/S0928493116315703">no toxicity</a> at levels well above those present in milk (up to 100 milligrams per kilogram of body weight a day for a year). </p>
<p>Even if you inject them (into veins or into body cavities), you need levels well above those found in infant formulas to <a href="http://onlinelibrary.wiley.com/doi/10.1002/jat.3073/full">cause damage</a> (50 milligrams nano-hydroxyapatite per kilogram body weight in rats).</p>
<p>To give you an idea of how much higher this is with respect to infant formula, the highest levels of hydroxyapatite nanoparticles in any formula is 287 particles in 10 grams of formula.</p>
<p>Yes, that’s <em>particles</em> not milligrams, not micrograms but actual particles. We are talking nano- to femtograms here, amounts so small it is hard to visualise. These levels are a million times or more less than levels found to have produced no effects in animals (and even lower than levels that do cause damage).</p>
<p>Hydroxyapatite nanoparticles have been widely developed to aid bone repair, deliver drugs and have been extensively tested. All results suggest that even <a href="http://onlinelibrary.wiley.com/doi/10.1002/cphc.201200080/full">levels required to be drug delivery agents</a>, well above those found in baby formula, have no significant adverse effects.</p>
<h2>The body dissolves the nanoparticles anyway</h2>
<p>These nanoparticles will also not stay nanoparticles: they dissolve in the stomach fluids, allowing their calcium to be absorbed. </p>
<p>Newborns and very young babies’ stomach fluids are less acidic than older babies and young children (pH5), but <a href="http://www.sciencedirect.com/science/article/pii/S0003996997000447">still acidic enough to dissolve hydroxyapatite</a>. </p>
<p>And particles are more easily dissolved the smaller they are. So, nanoparticles are likely to be even more rapidly dissolved into their component calcium and phosphate ions than larger particles.</p>
<h2>What’s the take-home message?</h2>
<p>There are no significant public health implications for these small crystals of naturally occurring calcium phosphates in milk-based baby formula. </p>
<p>The way the Friends of the Earth study results have been presented, with misleading references to irrelevant studies, has caused unnecessary fear and concern, and may lead some to abandon formula unnecessarily, with negative impacts on baby health.</p><img src="https://counter.theconversation.com/content/80403/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>Ian Musgrave receives funding from the National Health and Medical Research Council to study adverse reaction to herbal medicines, and has previously been funded by the Australian Research Council to study potential natural product treatments for Alzheimer's disease. In previous years he has collaborated on work on the formation of amyloids from milk proteins. </span></em></p>A widely publicised study that cast doubt on the safety of milk formula was misleading, based on dubiously reported studies and may have serious consequences.Ian Musgrave, Senior lecturer in Pharmacology, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/40542012-02-23T19:29:53Z2012-02-23T19:29:53ZFor love, not money: kidney exchange encourages social contract<figure><img src="https://images.theconversation.com/files/8029/original/bbgzqw36-1329976778.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">How do we encourage more Australians to become live kidney donors?</span> <span class="attribution"><span class="source">CarbonNYC</span></span></figcaption></figure><p>Many readers will have seen <a href="http://www.donatelife.gov.au/">advertisements encouraging people to talk to their loved ones about organ donation</a>. This is part of the government’s latest set of initiatives to increase Australia’s organ donation rate, but it fails in one important respect. </p>
<p>The government’s plan is to optimise the system for procuring organs from deceased individuals and its reform package is the best way to get more organs such as hearts and lungs, which cannot be procured from live donors. But for kidneys, an organ in critically short supply and available from live donors, the package is going to fall well short of what’s required. </p>
<p>Australia, unlike Spain and other countries with high rates deceased organ donation, has relatively few people dying while connected to a respirator. And only individuals who die in this manner are suitable for organ donation because organs tend to expire from lack of oxygen long before they can be transplanted. </p>
<p>Typically, only individuals who suffer death by <a href="http://emedicine.medscape.com/article/433855-overview">cerebral trauma</a>, such as car accident victims, end up (brain) dead on a respirator. Such deaths account for less than 1% of hospital deaths in Australia. </p>
<p>What this effectively means is that we could get the whole country to sign up as organ donors and it would have little-to-no effect on donation rates, because it wouldn’t affect how many people die in hospital on a respirator.</p>
<h2>For love or money?</h2>
<p>So why did the government go ahead with advertisements about talking to your loved ones about organ donation despite its obvious inadequacy?</p>
<p>Policy in this area remains hopelessly mired in the gift of life doctrine, which holds that donating an organ should be uncompromised by incentives. Note, for instance, the Australian and New Zealand Intensive Care Society <a href="http://www.anzics.com.au/death-and-organ-donation">(ANZICS) guidelines on organ donation</a> – that state organ and tissue donation is “an unconditional, altruistic, non commercial act”. </p>
<p>The doctrine claims that having individuals receive life-saving organs from anonymous individuals reaffirms the social contract — the notion that we look out for each other because we are all part of the same society and so we care about each other. </p>
<p>In contrast, commercial systems encourage people to donate only when it’s in their interest. In such systems, the primary motivation for saving a life is selfishness – and this leads to social atomisation.</p>
<p>Advocates of commercial approaches to kidney acquisition generally acknowledge that this is all well and good, but that any positive gains derived from social solidarity are offset by the suffering of individuals on dialysis. They want to see a system that gets more transplantable kidneys.</p>
<p>The debate between the commercial and gift of life camps is currently at an impasse in Australia. Until there’s a major breakthrough, any policy proposals must secure more kidneys while maintaining social solidarity.</p>
<h2>Bartering and the social contract</h2>
<p>One option to break the impasse is kidney exchange: say you have kidney failure and I offer to donate you one, but our tissue or blood type are mismatched. Both our details are placed on a database, which matches us to other people who may be in a similar situation. </p>
<p>My kidney is found to be compatible with another recipient and their donor is compatible with yours. A swap ensues in which both people in need of a kidney receive one. A sufficiently large database ensures the possibility of five-way swaps, which maximises efficient distribution. </p>
<p>Kidney exchange means that all kidneys are good, including old donors for young recipients and other similarly compromised cases. It allows recipients to tap into extended social networks, such as sports clubs, workplaces and unions, to try and find someone willing to donate, and then be matched with the most suitable donor. </p>
<p>The involvement of broad social networks and directed donation facilitates altruism and builds community solidarity on a micro level, satisfying the gift of life principle. The unpaid live donor system is optimised, and a great deal of publicity pertaining to the kidney shortage is achieved on an intimate level, rather than through impersonal national advertising campaigns. </p>
<p>In places where it has been implemented, kidney exchange has led to modest improvements in kidney supply. This includes Japan, where, due to a scandal at the time of the country’s first heart transplant (there were allegations that the donor was not quite dead), there’s strong opposition to both commercial and cadaveric procurement. </p>
<p>A similar system for blood procurement in the post-war years worked by requiring recipients of blood transfusions to pay back the blood, often in quantities they were unable to provide themselves (in the case of haemophiliacs, for instance). So people would activate their social networks to donate blood on their behalf, entrenching community bonds and publicising blood shortages. </p>
<p>It’s important to acknowledge the complexity of the kidney supply issue and not dismiss aspects of it as unethical or because it makes us squeamish. At a time when many people are experiencing very real suffering, we need to look for possible ways forward, and the introduction of a kidney exchange program seems a matter of routine prudence. It’s not a silver bullet but does produce increases so there’s no reason not to use it. </p><img src="https://counter.theconversation.com/content/4054/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Fabian does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many readers will have seen advertisements encouraging people to talk to their loved ones about organ donation. This is part of the government’s latest set of initiatives to increase Australia’s organ…Mark Fabian, Researcher Political Science and International Relations, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.