Ask the Doctors by Eve Glazier, M.D. and Elizabeth Ko, M.D

Recent News About Mac and Cheese Worries Parent

Dear Doctor: Could boxed macaroni and cheese really be as bad for you as news reports suggest? Sometimes, that's all my kids will eat.

Dear Reader: The recent news about the presence of chemicals called phthalates in boxed macaroni and cheese sent a shockwave through many American kitchens. Affordable, easy to prepare and beloved by the younger (and let's face it, more than a few of the older) members of the family, pre-packaged mac and cheese has become a mealtime staple.

However, a study funded by an advocacy group called the Coalition for Safer Food Processing and Packaging raised an alarm earlier this year. Testing for phthalates -- a family of chemicals used, among other things, to make plastics flexible -- the group reported measurable amounts in 29 of the 30 cheese products. These include boxed macaroni and cheese, as well as soft, hard and natural cheeses.

Concentrations ranged from 0.6 parts per billion to 295 parts per billion, with the lowest in natural cheeses. The highest were found in cheese packets in boxed mac and cheese. In all cases the phthalates migrated into the food via the packaging.

The chemicals, many of which were banned from use in infants' and children's products in 2008, are known as endocrine disrupters. That is, they interfere with the working of the body's hormonal system. Exposure in high amounts can affect fertility in adults, and is associated with disruptive behavior in children.

All of this sounds quite alarming. But before you banish all cheese products from your home, let's take a closer look. The concentration at which phthalates begins to cause problems is not known. Yet the study labels the 0.6 parts per billion to 295 parts per billion of phthalates that were found in the tested products as a "high amount." Additionally, the Centers for Disease Control and Prevention have found that, although we encounter phthalates in a variety of products, combined exposure remains extremely low.

To be honest, we think if you're going to be worried about the health effects of boxed mac and cheese, all you really need to do is read the sodium level on the nutrition label. And while mac and cheese out of a box is easy, sooner or later, for your children's long-term health, you'll have to bring fruit, veggies and other building blocks of a healthful diet into the mix.

Maybe start by making the boxed mac and cheese a special treat on a certain day of the week. Or find a recipe the family likes and make mac and cheese from scratch. It may not be as fast, but it's far more healthful. And, yes, we know these changes aren't easy. As parents ourselves, we face the same challenges of pleasing a picky eater's palate.

A final word: If the mac and cheese study has you worried about phthalates in general, take steps to cut them out of your food chain. Never use plastic in the microwave, as the heat can cause the chemical to move into your food. The same goes for the dishwasher -- wash any plastic ware by hand. For the greatest peace of mind, skip the plastic ware altogether and switch your food storage to glass or stainless steel.

(Send your questions to, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)