Arsenic in Food
A Resource for Health Professionals
Health professionals are encouraged to follow the guidance below to help navigate discussions
with patients and families who are concerned about arsenic exposure in children.
Key Points posted on Jun 23, 2021
- For children, there is no known safe level of arsenic in food.
- Arsenic can cross the placenta, increasing the likelihood of exposure to the fetus. There is minimal exposure from breast milk.
- Recent reports have described inorganic arsenic levels in a variety of foods, including rice and rice milk; cereal and energy bars sweetened with rice syrup; and apple juice and baby food.
- Low-level inorganic arsenic exposure from food products may be associated with learning development and neuromotor function delays in children.
- Health care providers can encourage families to consume a varied diet.
Arsenic Exposure and Risk Factors posted on Jun 23, 2021
Arsenic occurs naturally in both organic (typically non-toxic) and inorganic forms. Inorganic arsenic is toxic and carcinogenic (cancer-causing). Arsenic is a naturally occurring element, found widely in the environment as an inorganic salt. Groundwater may flow through arsenic-containing bedrock or soil, contaminating drinking water drawn from wells. Past use of arsenic-containing pesticides and fertilizers may also contaminate fields where rice (which selectively absorbs arsenic) and apples are grown.1,2
In addition to being naturally present in the environment, it has also been used for many years for industrial purposes, including pest control, animal antimicrobial treatment, wood preservation, petroleum refining, and in the mining/smelting industries. Most industrial uses of arsenic employ the more toxic inorganic forms. Release of arsenic through these processes can lead to increased inorganic arsenic in the atmosphere, in water, and in soil. Workers in industrial processes and communities near these industries may be exposed to arsenic from coal-fired power plants, hardening metal alloys, purifying industrial gases, and in the electronics industry in the form of gallium arsenide and arsine gas as components in semiconductor devices. Arsenic has been reported in imported folk or homeopathic remedies.3
Although inorganic arsenic can cross the placenta, increasing the likelihood of exposure to the fetus, arsenic may be found, as noted above, in water and food. In addition to inorganic forms of arsenic, there are organic forms found in seafood (farm-raised and wild) that are generally
Health Effects and State of the Science posted on Jun 23, 2021
There is no level of inorganic arsenic in food that is safe. An ingestion of a very high amount of arsenic-containing product can cause a serious sudden illness. Chronic high-level inorganic arsenic exposure, as from elevated water levels, has been associated with chronic skin problems and future development of a variety of adult cancers of the bladder, lungs, skin, kidney, nasal passages, liver, and prostate, as well as respiratory and cardiovascular disease, but patients are unlikely to complain of specific symptoms or signs. Low-level exposure, more typical of some well water or food products, has possible health effects on learning and neuromotor function in children. It is important for health care providers to have an index of suspicion for arsenic-based on suspected or confirmed exposure to some well water or food.
Medical Management posted on Jun 23, 2021
Most arsenic exposures are chronic, without obvious symptoms or signs, and so medical management shifts to prevention, mitigation, and risk assessment. If, despite avoidance of arsenic (primarily in water and food), there is remaining concern or clinical suspicion for potential ongoing arsenic exposure; a quantitative timed urine specimen (8 or 12 hours in children 24 hours in adults; a first morning “spot” urine, along with a urine creatinine to correct for concentration, is less accurate). An acid-washed container should be used to avoid sample contamination. If the laboratory reports total arsenic, it should be “speciated” or fractionated to distinguish between the toxic inorganic species (if present) as well as the organic species (currently considered non-toxic) typically found in seafood. Consultation with laboratory staff is recommended before ordering the test. For more information, visit Agency for Toxic Substances and Disease Registry (ATSDR) Arsenic Toxicity website.
Prevention and Risk-Reduction Communication posted on Jun 23, 2021
United States (US) Environmental Protection Agency (EPA) has an enforceable maximum contaminant level (MCL) for municipal water supplies of less than or equal to 10 micrograms of arsenic per kg of water (10 parts per billion, or ppb), to protect from chronic arsenic exposures, and a non-enforceable MCL goal of 0 ppb, which reflects the level at which no adverse health effects are expected.5 Some states have lowered the level to 5 ppb. The US Food and Drug Administration (FDA) has tested various foods for arsenic, finding, for example, elevated levels in rice6, and proposed a limit for inorganic arsenic of 100 ppb in infant rice cereals in 20167; this action level was adopted in 2020.8
The risk of chronic exposure to low-level arsenic can be mitigated through a varied diet. Infants
who have a restricted diet (e.g., rice cereal as a first solid food and juice) may have arsenic
exposures that are proportionately higher than those in older children and adults. FDA conducts
routine surveillance for arsenic in apple juice and generally levels have been below 10 ppb, the
same level allowable in drinking water.9 Children’s toys are tested and must demonstrate compliance with Consumer Product Safety Commission (CPSC) regulations that limit arsenic in toys that may be mouthed. Until more is known, providers can advise families to:
- Encourage breast milk for the first 6 months of life, as it has little to no arsenic.10
- Test well water for arsenic, and consider bottled water if results exceed EPA recommendations, particularly if water is used to reconstitute formula.11 Reverse-osmosis filters can mitigate arsenic in water but must be maintained regularly; an iron-
impregnated biochar has been shown to perform as a low-cost arsenic sorbent.12
- Consult with local or state environmental health agencies to determine the potential
for arsenic in drinking water, especially important for private well users, as these
systems are not regulated by EPA.
- Choose rice products, including baby food, that are lower in inorganic arsenic.13
- As part of a varied diet, limit the serving size and frequency of foods that may have
higher inorganic arsenic content, such as rice. Manage fruit juice consumption as part
of a healthy diet per the recommendations for children from the American Academy of
- Avoid rice milk for younger children.
- Avoid products sweetened with brown rice syrup.
- Parboil rice (brown or white) before cooking, or wash and pre-soak rice (effective only for white) before cooking to reduce inorganic arsenic.15
- Avoid smoking, as cigarette smoke contains arsenic.
- Do not use older, arsenic-containing pesticides (now banned in the US).
- Do not allow children to play in areas or structures known to have arsenic contamination. Avoid sawing, sanding, or burning “pressure-treated” chromated copper arsenate (CCA)-containing lumber; do not grow vegetables in planters made of CCA-containing lumber
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Additional Resources for Health Professionals
Grand Rounds: Old Poison, New Findings: Arsenic’s effect on maternal and child health - June 29, 2016 posted on Mar 18, 2020
By the end of this module, participants should be able to:
- Describe how people can be exposed to arsenic
- Evaluate the epidemiological evidence linking in utero and early life exposures to adverse pregnancy outcomes and children's health
- Recommend ways to reduce exposure to arsenic
Molly Kile, ScD
College of Public Health and Human Sciences
Oregon State University
Region 10 PEHSU
Case Conference: Childhood Diet and Arsenic Exposure: Interesting Clinical Cases - December 16, 2015 posted on Mar 17, 2020
At the conclusion of this activity, attendees should be able to:
- Order and interpret the most appropriate laboratory tests to workup arsenic exposure.
- Describe the differences in health risks between inorganic and organic arsenic.
- List common dietary sources of both inorganic and organic arsenic.
- Identify at least two national or local-level resources to help guide safe seafood consumption.
The speaker will begin by presenting several clinical cases/case presentations. The cases to be presented will be provided in final proposal. This will be followed by a discussion of the outcome of the case with consideration and implications for current and future clinical and public health practice. The presenter will conclude by discussing preventive steps that can be taken to decrease exposure to environmental hazards and improve patient care.
The parents of a 6-year old boy with learning and motor delays present to the child’s primary care provider. There have been no recent changes, and vital signs are normal. A developmentally delayed cousin was recently “tested for heavy metals”, so the parents request that these labs be checked for their child as well. In addition to basic labs, heavy metal blood and urine tests are ordered. All results are WNL, except for a random urine arsenic of 93 mcg/gm Cr.
Ada Otter, DNP, ARNP
University of Washington
Region 10 PEHSU
Regional PEHSU Websites
- Carignan CC, Punshon T, Karagas MR, Cottingham KL. Potential exposure to arsenic from infant rice cereal. Ann Glob Health 2016;82:221-4.
- Gonzalez N, Calderon J, Rubies A, et al. Dietary exposure to total and inorganic arsenic via rice and rice-based product consumption. Food Chem Toxicol 2020;141:111420.
- Course WB 1576: Arsenic toxicity. Agency for Toxic Substances and Disease Registry. Available at https://www.atsdr.cdc.gov/csem/arsenic/docs/arsenic.pdf. Accessed April 29, 2021.
- Taylor V, Goodale B, Raab A, Schwerdtle T, Reimer K, Conklin S, Karagas MR, Francesconi KA. Human exposure to organic arsenic species from seafood. Sci Total Environ. 2017 Feb 15;580:266-282. doi: 10.1016/j.scitotenv.2016.12.113. Epub 2016 Dec 24. PMID: 28024743; PMCID: PMC5326596.
- Just the facts for consumers: Arsenic in your drinking water. Environmental Protection Agency. Available at https://nepis.epa.gov/Exe/ZyPDF.cgi?Dockey=60000E1E.txt. Accessed April 29, 2021.
- Arsenic in food and dietary supplements. U.S. Food & Drug Administration. Available at https://www.fda.gov/food/metals-and-your-food/arsenic-food-and-dietary-supplements. Accessed March 25, 2021.
- Proposed limit for inorganic arsenic in infant rice cereal, April 2016. U.S. Food & Drug Administration. Available at https://www.fda.gov/food/cfsan-constituent-updates/proposed-limit-inorganic-arsenic-infant-rice-cereal. Accessed March 25, 2021.
- Supporting document for action level for inorganic arsenic in rice cereals for infants, August 2020. U.S. Food & Drug Administration. Available at https://www.fda.gov/media/97121/download. Accessed March 25, 2021.
- Arsenic in Food and Dietary Supplements, August 2020. U.S. Food & Drug Administration. Available at https://www.fda.gov/food/metals-and-your-food/arsenic-food-and-dietary-supplements Accessed April 7, 2021.
- Carignan CC, Karagas MR, Punshon T, Gilbert-Diamond D, Cottingham KL. Contribution of breast milk and formula to arsenic exposure during the first year of life in a US prospective cohort. J Expo Sci Environ Epidemiol 2016;26(5):452-7.
- Arsenic rule compliance for community water system owners and operators. U.S. Environmental Protection Agency. Available at https://www.epa.gov/dwreginfo/arsenic-rule-compliance-community-water-system-owners-and-operators. Accessed March 25, 2021.
- Hu X, Ding Z, Zimmerman AR, Wang S, Gao B. Batch and column sorption of arsenic onto iron-impregnated biochar synthesized through hydrolysis. Water Res 2015;68:206-16.M
- Hirsch J. Heavy metals in baby food: what you need to know. Consumer Reports, August 16, 2018. Available at https://www.consumerreports.org/food-safety/heavy-metals-in-baby-food/?fbclid=IwAR02IZ22vz2opEfR7qlAAr-e8vxHVkXb11HPimJ-e_DBBKKRrOCbXsvJSCY. Accessed March 28, 2021.
- Heyman MB, Abrams SA, SECTION ON GASTROENTEROLOGY, HEPATOLOGY, AND
NUTRITION and COMMITTEE ON NUTRITION. Fruit Juice in Infants, Children, and Adolescents: Current Recommendations. Pediatrics 2017;139 (6):e20170967.
- Menon M, Dong W, Chen X, Hufton J, Rhodes EJ. Improved rice cooking approach to maximise arsenic removal while preserving nutrient elements. Sci Total Environ 2021;755(Pt 2):143341.
The Pediatric Environmental Health Specialty Units (PEHSUs) are supported by cooperative agreement FAIN: NU61TS000296 with the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry (CDC/ATSDR). The U.S. Environmental Protection Agency (EPA) also provides support through Inter-Agency Agreement DW-75-95877701 with CDC/ATSDR. The American Academy of Pediatrics supports the PEHSUs as the National Program Office. The content on this website has not been formally disseminated by CDC/ATSDR or the EPA and should not be construed to represent any agency determination or policy. Use of trade names that may be mentioned is for identification only and does not imply endorsement by the CDC/ATSDR or EPA.
The information contained on this website should not be used as a substitute for the medical care and advice of your/your child’s primary care provider. There may be variations in treatment that your provider may recommend based on individual facts and circumstances.
Last updated: July 30, 2021