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Effects of Environmental Pollutants on Human Health With EFFECTS OF ENVIRONMENTAL POLLUTANTS ON HUMAN HEALTH WITH SPECIAL REFERENCE TO LEAD By JAMAL ALI FAOUR B.S. (Environmental Health Sciences, American University of Beirut, Lebanon) P.G.DIP.E.S & T. (Environmental Science and Technology, International Institute for Hydraulics and Environmental Engineering, Delft, The Netherlands) M.Sc. (Environmental Pollution Control, University of Leeds, England) A Thesis Submitted for the degree of fa ste r of Philosophy of the University of London and the Diploma of Imperial College. Imperial College of Science Technology and Medicine Department of Mathematics (Environmental Technology Research) London, February 1989 ABSTRACT Exposure to lead and its possible effects on health has long been a topic of public and scientific concern. Much of the concern about lead exposure of the general population comes from non-medical scientists and journalists who consider lead from petrol the chief source. The overgrowth of medical and scientific journals has reached such proportions as to become a sort of literary pollution. Undoubtedly the issue which has generated the most widespread interest is whether lead in the environment affects the intelligence or behaviour of young children. Challenged by the lack of a common point of view as to whether or not this phenomenon exists, I have scrutinized most of the scientific information available with respect to methodological, design and interpretation aspects of the studies by exercising critical faculty in assessing these publications and attempting to identify the most serious contributor. It is concluded with great certainty that the blood-lead level is governed to a large extent by a multiplicity of factors, which are independent of inhaled lead. Blood-lead level depends significantly on nutritional intake and high blood-lead levels do not necessarily reflect lead absorption, but also signal slow excretion mechanisms due to the overriding importance of dietary and physiological factors. It is postulated that diet is the main determinant of population differences in blood-lead levels. As the world food supply dwindles, much attention is to be focussed on elevating the level of nutritional thinking among the public. Brain function depends on the correct balance of nutrients reaching it, and the claimed effect of lead on IQ is found illusory. The notion that lowering lead levels in petrol confers benefits on inner city school children denies the association of social, cultural and economic disadvantages with depressed levels of intellect and its profound effect on elevated rates of school failure. CONTENTS Page A B ST R A C T 1 TABLE OF CONTENTS 2 LIST OF TABLES 5 LIST OF FIGURES 6 ABBREVIATIONS 7 REFERENCES ACKNOWLEDGEMENTS CHAPTER 1: Environmental Pollution and Assessment of Health Risks 12 CHAPTER 2: Lead in the Environment 28 CHAPTER 3: Blood-Lead Level : A biomonitoring Index of Exposure 31 CHAPTER 4: Human Exposure and Blood-Lead Level Trends 40 4.1: Lead in Petrol as a Potential Pathway of Exposure 40 4.2: Lead in Air as a Potential Pathway of Exposure 54 4.3: Lead in Paint as a Potential Pathway of Exposure 62 4.4: Lead in Water as a .Potential Pathway of Exposure 69 4.5: Lead in Food as a Potential Pathway of Exposure 80 4.6: Urban-Rural Blood-Lead Levels Comparison 83 CHAPTER 5: Blood-Lead Levels Decline 85 5.1: Changes in Blood-Lead Levels 85 5.2: Epidemiological Observations 87 5.3: U.K. Blood-Lead Levels Monitoring Programme 90 (Discussion of Results) 5.4: Conclusion 101 2 Page CHAPTER 6: Diet, Excretion and Body-Lead Content 103 6.1: Intestinal Uptake of Lead 103 6.2: Classification of Lead: An Essential Metal 107 or Contaminant Metal? 6.3: NutritionalFdCtorSand Susceptibility to 115 Lead Toxicity 6.4: The Intake and Excretion of Lead by the 121 Elderly 6.5: Dietary Intake of Lead 123 6.6: The Kinetics and Pathways of Lead Excretion 130 6.7: Sweat as a Significant Pathway of Lead 137 Excretion 6.8: Populations with Low Blood-Lead Levels 141 6.9: Interactions between Lead and Selenium 149 6.10: The Effects of Vitamin B Complex on 152 Lead Toxicity 6.11: Blood-Lead Levels of Greenlanders 155 6.12: Biliary Excretion of Lead and the Protective 160 Effects of Glutathione 6.13: High Blood-Lead Levels Signal Slow 165 Excretion Mechanism 6.14: The Influence of Iron Deficiency on 170 Lead Absorption 6.15: Enhancement of Lead Absorption by 177 Low Dietary Calcium 6.16: Effects of Malnutrition on Susceptibility 181 to Lead Poisoning 6.17: Conclusion 189 3 Page CHAPTER 7: Low Level Lead Exposure and the Evaluation 191 of Mental Skills in Children 7.1: What is IQ and What Do IQ Tests Measure? 193 7.2: Verbal or Performance Effects of Lead 204 7.3: Confirmation of a Lead-IQ Hypothesis 212 7.4: Social Factopsand Lead 222 7.5: Undernutrition and the Intellectual Impairment 225 7.6: Lead in Teeth as an Index of Body Burden 230 7.7: Recent Findings on Lead Exposure and 237 Children’s Intelligence CHAPTER 8: Concluding Comments 242 FIGURES 248 REFERENCES 257 ACKNOWLEDGEMENTS 308 4 LIST OF TABLES Blood-lead levels Categories of Absorption 38 Pb-B levels in Japan 1965 46 Pb-B levels in Japan 1983 47 Blood Lead Concentrations in Adults and Pre-school children 56 in Birmingham Blood Lead and Water Lead in 24 British towns 70 Trend of Dietary Intakes of Lead 124 Relation between Intake and Output of Lead in Man 137 Comparison of Food Consumption in Japan and Other 144 Industrial Countries 6-ALA-D Activities in Different Populations 146 Average Daily Contents of Nutritional Intake among the Nepalese 148 IQ Scores Classification 195 Occupational Classification by IQ Scores 196 IQ Scores of Ethnic Minorities in UK — Child Health 247 and Education Study, 1980. 5 LIST OF FIGURES Page 1. Emission Trends of hydrocarbons, carbon monoxide, 24$ nitrogen oxides and lead in U.K. 2. Fate of Lead Added to Petrol in the U.K. 24*) 3. Variation of Airborne Lead Concentrations with Voo Distance from Motorway 4. Principal Pathways of Lead from the Environment 251. to Human Comsumption 5. Location of Surveys in U.K. Blood-Lead Monitoring 252. Programme 1984-1987 6. A Schematic Diagram of the Pathway of Bioynthesis 253 of Haemoglobin 7. A Schematic Diagram of the Pathway of Glucose 25^- Metabolism in the Red Cell 8. The Principal Tissues of Human Tooth. 25S 6 ABBREVIATIONS, SYMBOLS AND UNITS ALA-D = (6-ALA-D), amino laevulinic acid dehydratase enzyme ALA-S = (<5-ALA-S), am ino laevulinic acid synthetase enzyme n AM = Arithmetic mean = -—^— As = Arsenic ASD = Arithmetic standard deviation BAD = British Ability Scales BBB = Blood Brain Barrier BUN = Blood Urea nitrogen Ca = Calcium CaBP = Calcium binding protein CaCOg = Calcium carbonate C a(O H ) 2 = Calcium hydroxide, lime C aN a 2 EDTA = Calcium disodium ethylene diamine tetraacetic acid (Chelating agent) Cd = Cadmium CDTA = Cyclohexylene diaminetetraacetic acid (Chelating agent) CLEAR = Campaign for lead-free air CO M A RE = Committee on Medical Aspects of Radiation in the Environment Cu = Copper Cysteine = Sulphur-containing amino acid: COOH h 2n - C - H c h 2s h 7 Cystine = Dipeptide formed when two molecules of cysteine are oxidized by very gentle means | -SH HS-| — |-S - S-| DDC = Diethyldithiocarbamate (Chelating agent) DHSS = Department of Health and Social Security — UK DTPA = Diethylenetriaminepentaacetic acid (chelating agent) ECD = European Community Directive EDTA = Ethylene diamine tetraacetic acid (Chelating agent) EEC = European Economic Community EPA = Environmental Protection Agency = U.S.E.P.A. FAO = Food and Agriculture Organization Fe = Iron Ft = foot = 0.3 metres gallon(U.S) = 3.8 litres g/i = Grams of lead per litre of petrol (Maximum permissible level of lead additives in petrol = 0.15 g/£ — end of 1985) GLC = Greater London Council GM = Geometric mean = n^Jxi X 2 x^ ... xn G .-6 -P.D. = Glucose- 6 -phosphate dehydrogenase enzyme GSD = Geometric standard deviation GSH = Reduced glutathione, a tripeptide: 7 -L-glutamyl-L-cysteinyl glycine GSSH = Oxidized glutathione GSH-Px = Glutathione peroxidase, a selenium-containing enzyme Hb = Haemoglobin concentration, expressed in g/lOOml ICRF = Imperial Cancer Research Fund, a lipophylic chelating agent derived from EDTA ILE = Isotopic Lead Experiment ILO = International Labour Organization 8 IQ = Intelligence Quotient IU = International unit; vitamin D requirement is expressed in International units Km = Kilometre LET = Linear Energy Transfer Radiation m = m etre MAFF = Ministry of Agriculture, Fisheries and Food MCV = Mean Corpuscular volume = fl(femto litre = 10 litres) Mg = Magnesium MRC = Medical Research Council mSv = Millisievert, unit of expressing radiation dose fi = micron = 1 0 metres fig = microgram fig/dt = micrograms per decilitre = ^g/1 0 0 m£ = //g1 / 0 0 g = fig% = ppm x 100 = 0.048/z mol/£ fig/g = micrograms of lead per gram = mg/Kg = ppm (it is the unit used for expressing the concentration of lead in food) Current recommended maximum safe level = 1 fig/g = lp p m fig/d = micrograms per litre (It is the unit used for expressing the concentration of lead in water) Current recommended maximum safe level = 50 fig/1 o /ig/m° = micrograms of lead per cubic metres of air (It is the unit of expressing the concentration of lead in air) Current recommended maximum safe level for community exposure = 2 fig/rc? /ig/100ml = micrograms of lead per 100 millilitres of whole blood (It is the most commonly used unit of expressing the concentration of lead in blood) fimo\/d = micromoles of lead per litre of whole blood (It is the unit of expressing the concentration
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