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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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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
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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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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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Analgesics / Anti-Inflammatories
• Acetaminophen• Codeine• Diclofenac• Ibuprofen• Indomethacin• Ketoprofen• Naproxen
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Antibiotics
• Chlortetracycline• Ciprofloxacin• Clarithromycin• Erythromycin• Lincomycin• Monensin
• Oxytetracycline• Roxithromycin• Sulfamethazine• Sulfamethoxazole• Tetracycline• Trimethoprim
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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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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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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
50
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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Contact Information
Judy MitchellNational Coordinator Phone: (250)-960-6708 Email: FNFNES@unbc.ca
WEB Site: www.fnfnes.ca
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