To: richardred who wrote (998 ) 9/17/2007 1:23:30 PM From: richardred Respond to of 3363 Health Blog Q&A: Microwave Popcorn and Lung Disease Posted by Jacob Goldstein Did a furniture salesman’s love of microwave popcorn give him a debilitating lung disease? It’s possible, according to Cecile Rose (pictured), a pulmonologist who is an expert on the condition known as bronchiolitis obliterans. A few years back, public health officials realized that diacetyl, a chemical used in the ersatz butter flavoring on microwave popcorn, probably caused the disease in people who worked in popcorn and food-flavoring factories. Rose saw a man earlier this year who had similar signs and symptoms — and who’d eaten a lot of microwave popcorn every day. Last month she sent a letter about the case to the FDA, alerting them to a possible connection. That letter was published yesterday on a blog called the Pump Handle and reported by the Associated Press. Today, the food giant ConAgra said it would phase out the use of diacetyl in its Orville Redenbacher and Act II popcorn. The company said the move was to protect workers, and that the chemical doesn’t pose a risk for consumers. The Health Blog spoke this afternoon with Rose, who works at National Jewish Medical and Research Center in Denver and has been a consultant through her hospital to the food-flavoring industry. Here are the highlights. Tell us about the patient described in your letter to the FDA He’s in furniture sales — a place you go to buy a couch. At the end of the clinical evaluation I had done this careful detailed history and a physical evaluation, and I took a look at his breathing test, his CT scan and his biopsy report. And it appeared to me to be very similar to the disease in the microwave-popcorn workers and in the flavoring workers. So on a real whim I turned to the patient and said, “This is a very strange question, and I apologize, but are you around a lot of popcorn?” To my complete surprise, he said, “How would you know that about me?” He said, “I am popcorn. It is my exclusive snack-food choice. I have been eating two to three bags a day for 10 years.” I was floored. I asked for an independent review of my work by my colleagues, and they concurred. We felt that it would be appropriate to contact the public health agencies . [In July] I contacted FDA, CDC, EPA and OSHA. I received a letter from EPA in which they indicated that they would be placing my letter under something called an FYI submission to notify the public. From OSHA I received a letter thanking me and saying this case report does not appear to be related to a workplace exposure. I haven’t heard anything from CDC. The FDA asked me to submit the letter to their docket. I think I expected the agencies to contact me to find out more. I think I expected them to pick up the phone and say, “We really need to understand this.” Can you describe this disease? The very small airways called the bronchioles are inflamed and become blocked. Once a person gets it, if they continue to be exposed, then their lung function deteriorates. They have increased cough, shortness of breath and chest tightness. If they’re removed from exposure [to diacetyl], the lung function usually stabilizes. It does not continue to deteriorate. But it does not respond to medical treatment and typically does not improve. How does exposure when you make butter-flavored microwave popcorn at home compare to what factory workers are exposed to? We did some testing in this man’s home. The peaks of exposures to diacetyl were similar to the levels that were described in the microwave popcorn production plants. But it goes away very fast. We don’t think for a minute that even for this patient his exposure is comparable to what the workers are exposed to. So what can you say about the risk of making butter-flavored microwave popcorn at home? You have to be very careful about inferring a causal connection on the basis of a single case report. It may not be correct. We don’t know what the risk is to the occasional consumer of microwave popcorn. More work needs to be done to try to understand the exposures. I have not banned the use of butter-flavored microwave popcorn from my home, but we certainly don’t use it every day. That’s just our habit — we were never big consumers of butter-flavored microwave popcorn. Update: Rose’s patient talks with the press about his experience. See this Health Blog post for more.blogs.wsj.com