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BVO and the Right Dose of Worry

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Colleagues at ShareCare.com, an online platform of health information launched by my friend, Dr. Mehmet Oz, asked me this week to comment on the risks associated with brominated vegetable oil (BVO). I did so, and my assessment is, as of the time I write this at least, featured on their home page.

The reason for the request is because BVO is much in the news of late. This is the ingredient a teenage girl noticed in her Gatorade, prompting her to find out what it was. Sara Kavanagh is reportedly a vegan, and thus allegedly more particular about what she eats than some. We'll come back to that.

Her investigation revealed potential health risks associated with BVO, and she started an online petition to get this apparently alarming ingredient out of her sports drink. Pepsico, which owns Gatorade, is in fact doing so -- although they contend that had been in the works for some time, and has nothing particularly to do with the petition.

Brominated vegetable oil has been used in the making of soft drinks in the U.S. since the 1930s. It received the designation "generally recognized as safe" from the U.S. FDA in 1958, but this was revised in 1970, at which time restrictions were placed on the amount that can be used in food. The ingredient is now found in a variety of citrus-flavored beverages, including, but not limited to: Gatorade, Mountain Dew, Powerade, Fanta, and Fresca.

Bromine is used to increase the weight of the oil so it doesn't rise to the top, and the oil then serves to keep fat-soluble citrus flavors in suspension. The result is probably an enhancement of both the appearance of the drink, and perhaps the taste.

BVO has made headlines in part because Ms. Kavanagh found that the same ingredient is used in a flame retardant. The idea that a compound found in a beverage could be used to battle fires was, apparently, alarming.

It's true that BVO can be used in a flame retardant, but I'm not sure how relevant that really is. Elements that are an essential part of the human body can be mixed in some pretty toxic combinations as well. Some of what we are made of can be used to make pesticides, for instance, all depending on doses and what else is in the mix. The human body contains quite a bit of chloride -- derived from the same element used to disinfect our swimming pools.

Is BVO actually dangerous? Possibly. Reviewing the relevant literature, I could find only one case of harm linked to bromine in soft drinks, reported in 1997. A man consuming two to four liters a day of citrus-flavored soft drinks developed a neurological condition due to bromine excess. He was eventually diagnosed, treated, and recovered.

I could find no other evidence of documented harm in people, although that of course does not rule it out. But since the ingredient has been in our beverages for nearly 100 years, we've had plenty of time to see harmful effects if they were occurring at a meaningful level. If they are occurring, they are subtle enough to fly mostly under the radar.

The other cases of bromine-related harm I could find were all associated with the use of medication providing the substance in more concentrated doses. Speaking of dose, BVO is used in fruit-flavored soft drinks in amounts so tiny it often need not even be listed among the ingredients. Whereas most ingredients are measured in grams or milligrams, BVO is measured in the vanishingly smaller "parts per million."

Since much of the focus has been on Gatorade, which is taking BVO out of its mix, I checked on the overall composition of their original "Perform" series drink. In 12 ounces, it has 80 calories, 160 mg of sodium, and 21 grams of sugar.

Which leads to the moral of this story. If that composition is the forest, then BVO has us all barking up the wrong tree.

Animal studies suggest some possibility of harm from BVO. Bromine toxicity is known to occur in people, but as noted, generally resulting from medications that contain bromine in much higher concentrations than soft drinks. So the case can be made for "why take a chance?" If we can get rid of the BVO, we might as well. I support its removal from the Gatorade recipe.

But while any harms of BVO are speculative, the public health toll of excess calories and sugar is well established. The question for the teenage girl concerned enough about ingredients to investigate BVO is: Why was she drinking a sugar-sweetened, artificially-flavored beverage in the first place? There is no BVO added to water -- so we are not dependent on any company to take it out.

I suppose Ms. Kavanagh might work out so intensely that water cannot satisfy her rehydration needs. But I work out quite hard myself, and have never encountered that problem. And, of course, our Stone Age ancestors muddled along somehow without sports drinks.

I have long noted that we distort risks -- trivializing those we feel we can control (such as our sugar intake, or driving too fast, or texting while driving), and exaggerating those we feel we cannot (such as BVO). The Pulitzer-prize winning author Jared Diamond made that same point in this week's New York Times.

The harms attached to our excess intake of sugar and calories, and sugar-sweetened beverages specifically, are emphatically clear, and decisively established. I really don't think we need BVO in the mix to raise concerns about such products.

As for mucking about with vegetable oils, we have a long history of such mischief. The best known, and deservedly most notorious example to date is partial hydrogenation.

Partially-hydrogenated vegetable oils are formed when normally unsaturated oils are bombarded with hydrogen so that some but not all of those available bonds are "saturated" with it. The result is trans fat, which we now know to be, in essence, a slow poison, contributing to the risk of heart disease in particular.

Partially-hydrogenated oils became widespread in the food supply because they are inexpensive to make and act much like saturated fats, providing stability and heat tolerance. With time, we have come to learn that partially-hydrogenated oils lengthen the shelf life of foods, but are apt to shorten the shelf lives of people eating the food. They are still out there, but have gone from nearly ubiquitous to increasingly rare. Good riddance to them.

Is brominated vegetable oil the new trans fat? No. Trans fat has long been used in many products with a significant amount of oil in the mix. Exposure to trans fat has come in amounts of hundreds of milligrams, and even grams. Paracelsus, considered the father of toxicology, famously told us "the dose makes the poison." Our exposure to trans fat was, and still is, at dose levels clearly linked to bad health outcomes. With BVO, the prevailing dose of worry seems to far outweigh that of the ingredient.

I don't drink any of the products that contain BVO -- and wouldn't drink them if they didn't, either. If you are really drinking enough of the sugar (or artificially) sweetened, citrus-flavored beverages in question to be at any genuine risk of harm from BVO, then my view is: You've got bigger, far better documented things to worry about!

-fin

Dr. David L. Katz; www.davidkatzmd.com

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