Angelon-Gaetz et al. 2018 — Lead in spices, herbal remedies, and ceremonial powders, North Carolina
This MMWR report from the North Carolina Childhood Lead Poisoning Prevention Program (NCCLPPP) describes seven years of environmental lead investigations in homes of children with confirmed elevated blood lead levels (BLLs), in which spices, herbal remedies, and ceremonial powders were sampled. Of 386 samples collected from 59 properties, 28.8% contained lead at or above 1 mg/kg, identifying these products as an important and underrecognized source of childhood lead exposure. Among edible items, turmeric had the highest average lead concentration at 66 mg/kg (range 0.1–740 mg/kg, n = 34 samples), while among nonfood items, traditional cosmetic and ceremonial powders (kumkum, sindoor, surma) showed extraordinary contamination, with sindoor averaging 41,401 mg/kg. The affected children were predominantly of Asian descent (67%), reflecting the overlap between high spice consumption, South Asian cultural practices, and lead exposure pathways. The report directly called for a national maximum allowable limit for lead in spices and herbal remedies, which did not exist at the time of publication.
Key numbers
Study scope: 59 properties, 61 children with confirmed elevated BLLs; average screening BLL 17.0 µg/dL (±9.6), average diagnostic BLL 15.2 µg/dL (±7.0); average child age at investigation 2.3 years (range 0.9–6.6 years).
Overall: 386 samples analyzed; 111/386 (28.8%) contained ≥ 1 mg/kg Pb; 344 samples were food items, 42 were nonfood.
Contamination by nonfood items (ceremonial powders, topical remedies):
- Kumkum: average 12,185 mg/kg, range 0.4–140,000 mg/kg (n = 12)
- Sindoor: average 41,401 mg/kg, range 0.1–130,000 mg/kg (n = 8)
- Surma: average 68,000 mg/kg (n = 1)
- Vibhuti: average 80.3 mg/kg, range 2.9–140.0 mg/kg (n = 3)
- 35/42 nonfood items (83.3%) were ≥ 1 mg/kg Pb
Key food item lead concentrations (categories with average ≥ 1 mg/kg):
- Turmeric: average 66.4 mg/kg (SD 206.6), range 0.1–740.0 mg/kg (n = 34) — highest edible spice
- Chili powder/red pepper: average 12.6 mg/kg (SD 41.2), range 0.1–170.0 mg/kg (n = 23)
- Kabsa spice: average 19.0 mg/kg (n = 1)
- Coriander: average 4.8 mg/kg (SD 12.8), range 0.1–39.0 mg/kg (n = 9)
- Saffron supplement: average 2,764 mg/kg (n = 1)
- Balguti Kesaria (Ayurvedic medicine): average 220 mg/kg (n = 1)
- Vanilla: average 8.5 mg/kg (n = 1)
- Baby cereal: average 17.6 mg/kg (SD 23.2), range 1.2–34.0 mg/kg (n = 2)
- Rice flour: average 4.1 mg/kg (SD 5.7), range 0.1–10.6 mg/kg (n = 3)
- Cumin: average 1.1 mg/kg (SD 1.5), range 0.1–6.4 mg/kg (n = 17)
- Cinnamon: average 2.6 mg/kg (SD 0.1), range 2.5–2.7 mg/kg (n = 2)
Regulatory context (at time of publication): No US national limit for Pb in spices. FDA limit for lead in natural-source food color additives (paprika, saffron, turmeric) was 10 mg/kg. FDA action levels for products consumed by children: 0.1 mg/kg (candy), 0.5 mg/kg (other foods); spices not classified as intended for children. Codex Standard 193–1995 did not specifically limit Pb in spices.
Demographics of affected children: 67.2% Asian (including Indian and Pakistani descent); 13% Black/African American; majority living in housing built after 1978, ruling out lead paint as primary source; in 32 of 42 newer-built homes, no lead found in paint, dust, or fixtures.
Methods (brief)
Environmental samples collected during home lead investigations by state and local health department investigators. Screening by atomic absorption mass spectrometry by NC State Laboratory of Public Health; samples < 15 mg/kg Pb subsequently analyzed by ICP-MS (starting 2011). Results below LOD replaced with LOD/√2. Retrospective cross-sectional design; 7-year data window January 2011–January 2018. Blood lead data from North Carolina childhood lead surveillance system. This is a surveillance and case-series report, not a market basket study; samples were collected from homes where children had already been identified with elevated BLLs, so this does not represent a random sample of the spice market.
Implications
Certification: This is among the most important US surveillance papers documenting the spice-lead pathway in a real-world child health context. Turmeric reaching 740 mg/kg Pb in a single home sample, and 66 mg/kg average across 34 samples, provides stark evidence of the adulteration scale (consistent with lead chromate added for color). The report also documents that rice flour, baby cereal, and other pantry staples in these same homes were lead-contaminated, suggesting household-level contamination spread from spice handling. HMT&C standards for spice-adjacent products (spice blends, curry powders, turmeric powder) should treat lead as the primary concern and benchmark against the 10 mg/kg FDA color additive limit as a minimum floor, not a safety level.
Courses: Strong anchor case for the public health and regulatory gap around spice lead contamination. Documents the regulatory vacuum at the federal level (no national limit existed at time of publication), the cultural and demographic concentration of risk in immigrant households with high spice use, and the failure of standard childhood lead risk assessment protocols to capture spice-related exposure. The NCCLPPP survey tool developed for systematic spice exposure documentation is a model for HMT&C investigation frameworks.
App: The turmeric Pb distribution (n = 34, range 0.1–740 mg/kg, average 66 mg/kg) and the chili powder/red pepper data (n = 23, range 0.1–170 mg/kg, average 12.6 mg/kg) contribute to contamination profiles for these spice ingredients, though this is a clinically-ascertained sample rather than a market basket, so values represent a selected high-contamination tail. Use as upper-bound context, not population-representative means.