Tainted paint or water remain the most likely sources of lead contaminating a child’s blood in North Carolina.

But evidence is growing that some imported spices, ceremonial powders, herbal remedies and other products pose an increasing hazard. Children of immigrants may especially be at risk.

So state and county health officials are ramping up efforts with other child advocates to better assess the scale of this problem and how to help families better protect their kids.

“We are most concerned about spices,“ said Kim Gaetz, a public health epidemiologist at the children’s environmental health branch in the N.C. Division of Public Health. “People don’t think of them as something you should be cautious of.”

In one case that Gaetz described only generally, laboratory testing detected high levels of lead in a spice found in a child’s home. A relative obtained the spice in India where she lives, ground it up and sent it to loved ones in North Carolina.

Unknown to the relative, the way she processed the spice added lead to it. “It was in the hammer she was using,” Gaetz said.

In another example, the U.S. Food and Drug Administration this summer warned parents nationwide not to use an Ayurvedic medicine available online called Balguti Kesaria after testing here and in Michigan detected lead in it.

The product, marketed as a treatment for cough, cold, worms, teething and other things, was given to a child, part of the ancient Ayurvedic medical practice originating in East India. Testing revealed that the child had both high levels of blood lead and developmental delays.

Incomplete picture

The true scale of this problem in North Carolina is unknown. In a records review of elevated blood lead investigations here since 2011, Gaetz so far has found only 35 cases where spices, ceremonial powders or supplements have been identified as the sole source (or one combined with tainted paint or water) of lead exposure during a home inspection. Some were purchased in the United States. Some were not.

But that doesn’t capture the many likely cases where these imported materials were not even suspected, never mind tested, Gaetz said. Nor does it take into account that a large number of children in North Carolina never have their blood screened for lead at all.

“This is an emerging issue for North Carolina,” she said. “In some cases where we did not find a source, this may have been the source.”

Children with elevated blood levels have few obvious symptoms. Instead they may be listless or lose their appetites. So, testing is vital. Federal, state and county public health experts encourage providers to test blood lead levels for all children at 12 months and again at 24 months of age.

But in North Carolina, only young babies enrolled in government programs such as Medicaid, or the nutrition supplementing program called WIC — along with refugee children — are required to be tested.

State legislators just this year beefed up mandates for how aggressively public health staff should investigate the source of lead in a child’s blood once it is detected.

They lowered the designation of “confirmed” lead poisoning from 20 to 10 micrograms per deciliter in the blood of a child younger than six and in pregnant women. Remediation of exposure sources will be required when two tests within a 12-month period confirm poisoning.

More diversity

Also extremely relevant here is North Carolina’s changed demographics. This state’s foreign-born population grew more than eightfold over the past 35 years.

In 1980, fewer than 80,000 North Carolina residents were born outside the United States. By 2014, more than 750,000 North Carolina residents were foreign-born, with the majority of newcomers hailing from Latin America and Asia.

Families with roots in South Asia, where spices such as turmeric are known to sometimes be tainted by the metal, and Latin America, where chiles can be contaminated by lead-bearing dust, seem to be among the people at highest risk of this exposure, Gaetz said.

“Right now we recommend that if people are regularly eating these spices to have their children tested,” Gaetz said.

In the past, some low levels of lead in children’s blood were deemed acceptable, but now lead is considered unsafe at any level in a child’s blood. Even low levels in a child’s blood can affect IQ, a child’s ability to pay attention, and her academic achievement, according to the Centers for Disease Control and Prevention.

Yet it can sneak into many products, Gaetz said. Sometimes lead exists in soils where a plant used as spice is grown. Or processing a plant either with a grinding device or hammer containing lead can cause the contamination.

In some cases, lead may be added intentionally to brighten a spice’s color or to create a special taste. Lead has sometimes been added to spice containers to boost their weight at the checkout counter.

Knowing all this has motivated many people engaged in public health to get a firmer handle on where contamination exists here.

Gaetz is developing English- and Spanish-language surveys to give families at risk to better understand what children consume in the their homes.

“That is important families that have a background from another culture may have different spice eating consumption patterns compared to average American family,” said Gaetz, who hopes to publish the survey once it’s developed so other states can use it as well.

Some county public health workers, including Doris Hogan, environmental health specialist in Forsyth County, have very recently developed educational materials to give families to help them learn more about potential risks. Tom Vitaglione, a senior fellow at the advocacy group NC Child, visited a range of stores selling imported spices this summer that he brought to a state laboratory for testing.

Getting advice

A Pakistani-born college student helped Gaetz collect advice from women of South Asian descent in order to improve her survey. Ezan Ahmed Chaudhry, a UNC-Chapel Hill sophomore, recruited the women to focus groups with flyers in doctors’ offices, child care centers and libraries in Wake County.

The women recommended that health workers use multiple names for golden milk, also associated with Ayurvedic medicine, which some families call turmeric milk, Chaudhry said. And they pointed out that some traditional food cooks will not use measuring units such as tablespoons and cups, prompting a plan to ask people to show public health staff how much spice they put in a dish rather than write it down.

Chaudhry said the women were concerned about what they learned at the meetings and clearly wanted to know more about how to prevent any potential risks at home.

“If I told my grandma to use less spice in her cooking, she’d shrug it off. But a lot of the younger parents are open to change if there is a solution,” Chaudhry said.

All involved with this effort to protect children from emerging lead exposures are aware that asking families to alter practices at home, if that becomes necessary, can be sensitive work, said Andre Pierce, Wake County’s Environmental Health and Safety Director.

Once a fuller understanding of the real risks are known, he said, public health advocates will likely reach out to leaders in affected communities for guidance on how best to communicate risks and ways to reduce them.

“These things have cultural value,” Pierce said. “You need to be careful.”

This article was originally published on Getting the Lead Out of Spices, Powders, Supplements