ON THE INNOVATIONS OF MR. SOSONKIN REGARDING CARCINOGENICITY AND ALLERGIC REACTIONS TO STAINLESS STEEL

Published as a slightly shorter version in Medicine and Health (Weekly Russian-American newspaper, New York), vol. 2, No. 48, March
ABOUT THE AUTHOR

Anatole A. Klyosov, PhD, Sc.D., Professor of Biochemistry at Harvard University (Center for Biochemical and Biophysical Sciences and Medicine, Harvard Medical School) from 1987 to 1998, R&D Manager at Thermo Fibergen, Inc. (Bedford, MA) since 1996. A graduate of Moscow State University (MS, Chemical Kinetics, 1969; PhD, Biochemistry/Enzymology, 1972; Sc.D., Physical Chemistry, 1977), Visiting Lecturer in Biochemistry at Harvard University (1974-1975), Professor of Chemistry (Moscow State University, 1979-), Professor of Biochemistry (Institute of Biochemistry, USSR Academy of Sciences, 1982-); Laureate, National Prize for Young Scientists (1978), USSR National Prize in Science (1984). Both prizes were awarded for studies into biological catalysis, and role of metals in biological systems. Fellow, the World Academy of Art and Science (1989). Author of nearly 300 peer review publications (journal papers, patents, books).
Let us briefly revisit a recent turmoil in the Russian-American community. Isaak Sosonkin, currently a Brooklyn resident and Professor and Doctor of Medical Sciences in his former Soviet life, has accused ZEPTER International Inc. of a mortal sin. He did it publicly, in a series of statements on the Russian radio in New York City and on pages of Novoye Russkoye Slovo, the largest Russian newspaper circulating in the United States. To be specific, Mr. Sosonkin has stated that ZEPTER's cookware, made of fine 18/10 stainless steel, could cause allergic reactions and cancer. In letters that Sosonkin has forwarded to various offices, newspapers, and "to all the Russian-speaking media," he significantly extended the list of diseases that, in his words, could be caused by ZEPTER's cookware - from Alzheimer's disease to heart attack, and everything in between. He was not kidding. A large number of his listeners and readers have been stirred into shock and panic. Some scared owners of the elegant stackable cookware were quick to claim that they were going to bring it back to ZEPTER. Even in the former Soviet Union, where life was distinctly marked with a general disbelief of statements from the media, comments like these would cause a visible agitation among citizens. Naturally, in the United States, where there are much fewer problems to worry about, Sosonkin's warnings have been taken as a bombshell. He is a Professor of Medicine, after all. Whom to believe, if not him?

Discussions about ZEPTER and its "deadly" cookware, printed in Novoye Russkoye Slovo, might have easily impressed an ordinary reader that the only expert in the field - among those who have argued over the medical issues and their implications - was Sosonkin himself, self-described as Medical Doctor, Professor, Academician, bearer of sound American ranks and titles. Everyone else, who has tried to rebut his claims, were amateurs or dilettantes, and clearly knew nothing about the issue. Moreover, those very same people are putting themselves at risk by using ZEPTER's pans and everything.

Well, clearly it is a time for a professional to intervene. Better late than never, as they say both in the US and Russia.

People, please be calm. Using a scientific vocabulary - Sosonkin's claims have no material substance. They are unsubstantiated. In other words, he does not understand. Or he does not know, which is essentially the same as not understand. Or, he does understand, but he cannot stop. What he has started , he started with naming two diseases that could be caused by ZEPTER's cookware. Within a week he had identified two dozen more, each one scarier than the one before. He started with a statement that people should be "careful" using ZEPTER's cookware, but seven days later he has called the same very people to sue ZEPTER for deliberate and vicious damage of people's health.

To put things in order, I'll start with what Sosonkin has actually claimed, and then review what is actually known about effects of nickel and nickel-containing stainless steel on human health, particularly, 18/10 stainless steel, the principal material of which ZEPTER's is made. I'll conclude with the type of comments and general conclusions that can be drawn from this information, taking into account some other aspects, such as legal ones, of the situation.

To begin, we have to list ALL the published statements made by Mr. Sosonkin on this issue. The first five passages are quoted from an article by Alexander Grant, published in NRS of February 24, 1999; the last nine - from an article by Valery Sandler, printed in NRS of February 26. To wit:


1. … long ago, when I worked in Karaganda (former Kazah Republic in Central Asia - AAK), we observed lung cancer in some miners, who worked at a local nickel mine. We also found there some miners with leukemia. On the same time the miners possessed an elevated blood level of nickel. Therefore, I view nickel and chromium with a well-justified suspicion.
2. … publications on carcinogenicity of nickel have appeared. Therefore, Europe is moving towards nickel-free cookware.
3. [a quotation from a Russian magazine "Zdorovie" ("Health"), given by Alexander Grant in his article in NRS; according to Grant, Mr. Sosonkin had repeated those words in his radio program] … the West has lost interest in cookware made from stainless steel; this happened after data published in the mid 1990s demonstrated that nickel, which is an ingredient of stainless steel, is a strong allergen, and also possesses carcinogenic properties. … the stainless steel which is ZEPTER's cookware, contains chromium and nickel in the same ratio as that in a common stainless steel. Therefore, this should be viewed with concern.
4. … I have serious scientific works that prove malignity of nickel and chromium.
5. … nickel can cause cancer.
6. … this (apparently, nickel - AAK) is a strong allergen, it causes asthma, peptic ulcer and eczemas.
7. During the last six to eight years scientists in the USA, Germany, France, China, Singapore, India and Spain have studied the subject [it is not clear from the text, what subject; apparently, Sosonkin talks about metal kitchenware in general - AAK]. The American Cancer Institute [apparently, National Cancer Institute at NIH - AAK] did not avoid the "Metals and Cancer" problem, and in 1997 it was finally concluded that there is - undoubtedly - carcinogenicity and tumorigenicity of chromium and nickel. The Institute considers carcinogenicity of hexavalent chromium and nickel to be proved.
8. Science of the advanced countries of Europe and the Americas has proved that chromium and nickel are carcinogenic; these countries already use kitchenware that does not contain nickel.
9. Scientific investigations do show exactly, which (food) product takes how much nickel and how much chromium from a kitchen pan. There is high risk.
10. Hexavalent chromium is a component of this very steel, it is aggressive for human tissues and it is carcinogenic.
11. … there are a lot of works of leading world scientists, which consider chromium and nickel to be tumorigenic, and demonstrate transfer of these elements from kitchenware into food.
12. The company (ZEPTER - AAK) lies that this steel is a medicinal one. There are no medicinal steels!
13. … I am against chromium-nickel alloys 1810, which are used to make this cookware.
14. … all world … is moving towards nickel-free kitchenware, because nickel is a catalyst and thus it accelerates all processes.

My first reaction: amazingly striking ambitions, hand in hand with complete absence (or crude distortions) of facts. Some passages are just flatly absurd. It causes me almost a physical pain, to read these words.

Last, but not least: almost all the above statements are related to INDIVIDUAL nickel and/or chromium. Sosonkin, apparently, takes for granted that all the health-related features of individual nickel and chromium can be automatically assumed for stainless steel, since both nickel and chromium are components of that steel. This assumption is erroneous. It is hard to imagine that doctor Sosonkin would fail to know that nickel and chromium, on one hand, and steel, on the other, are totally different things. As different as, say, water is different from oxygen (which chemically is a component of water). One breathes oxygen, but drowns in water. It is very hard to split molecular oxygen from water. It is equally hard to split nickel from other components of stainless steel, particularly iron. To split atoms of nickel from pure nickel is easy. To split atoms of nickel from stainless steel is much more difficult. This is precisely why stainless steel is good as a structural material.

Let us take a closer look at the statements by Sosonkin. Indeed, almost all of them are about nickel or chromium, not about steel. Again and again repeats Sosonkin that nickel is carcinogenic and that it is an allergen. O.K., but this statement is not about steel. It is not about ZEPTER's cookware, which is made not of nickel, and which is not nickel-plated. Hexavalent chromium may be carcinogenic and it may be harmful for human tissues, but - again - why steel? "The Cancer Institute considers carcinogenicity of hexavalent chromium and nickel proven" reports Sosonkin. Fine. Apples and oranges again. If there were data on carcinogenic effects of stainless steel, that would be a different story. But there are no such data, and there is no such a story.

"I am against chromium-nickel alloys 1810", says Sosonkin. Why against? And why against this particular alloy (18/10 is the proper brand)? No comments. Maybe because ZEPTER's cookware is made from this particular alloy? No comments.

Well, it looks like the discussion is over. How disappointing. There is no ground for the discussion. I tried to call Sosonkin, thanks to the Internet that provided Sosonkin's home phone number. Called, introduced himself, assured that we would not touch other questions besides those directly related to the matter at hand. Politely asked a couple of questions related to expected (or experimentally measured?) concentrations of nickel coming out of stainless steel. Sosonkin decided not to enter into the discussion and simply hang up. Thus the level of Sosonkin's expertise became a little bit clearer. He may be an expert, but not in the areas of carcinogenicity and allergic reactions of stainless steel.

However, something else does not allow me to consider the matter closed. Many people are still disturbed with their emotions still at a high level. In this situation to just announce that Sosonkin is not an expert in the area, that he does not understand, or that he understands but has his own agenda - this is not a solution to the problem. Many related questions are left unanswered. There is a need for more detailed answers, at least for readers who want first-hand information. Information that is based on solid facts and figures, with proper references.

For example, is nickel allergic? Not just in ZEPTER's cookware (it is not, see below), but what about nickel or nickel-plated earrings? Or nickel-plated bracelets? Watches? What if nickel, even a tiny amount, could come out of stainless steel? What then? Do foodstuffs truly contain no traces of nickel and/or chromium? What if it does? What then? And if it does, where did the nickel come from? Still from kitchenware, or from elsewhere? Where? Is it truly that dangerous, to get some nickel in foodstuffs? And how much nickel in food is a problem? What do professional dieticians say about this?

Should one really be careful regarding kitchenware from stainless steel, even from the best brands of steel, such as 18/10? Also, why is nickel dust believed to be carcinogenic? Sosonkin spoke about it, and he should have known the facts, since he used to work in the area. Is only nickel dust carcinogenic? Likewise, is it true that stainless steel is ABSOLUTELY not carcinogenic? If so, why Sosonkin has claimed the opposite? Is he really that irresponsible, and brought stress to many people for no reason whatsoever? Or is there something right in his statements, that stainless steel and food should not mix? Is it true that there is a legal document in the USA and/or Europe that restricts manufacturing and/or use of cookware (or other kitchenware) from nickel-containing stainless steel? Or did Sosonkin just lie when he stated that Europe is dumping stainless steel cookware and switching over to nickel-free kitchenware instead? Where is the truth?

There are many questions and all of them are completely justified. Let's move to answers. To answer all of them in detail, we would need to write a book, or a series of articles. Given that, we will answer them briefly, but with facts and figures in hand. Item by item. A list of references is attached.

Let us begin, again:

1. Dusts of metals (zinc, nickel, chromium, cobalt, etc.), as well as all other dusts, such as that of coal or cotton, can affect one's health when inhaled. Lung allergy occasionally occurs with asthma-type effects. Overexposure to dusts by inhalation may lead to histologic fibrosis of the lungs, and occasionally to cancer of the lungs. All of this has nothing to do with metal cookware, including that made of stainless steel. In other words, the basic statement by Sosonkin that implies a connection between a miner's cancer of the lungs and possible health effects of ZEPTER's cookware is truly ridiculous. Undoubtedly, he does understand this himself. He simply wanted to impress his audience with his knowledge and great medical experience, and picked something shocking to deliver the message. The example picked was clearly wrong, but by then it was too late. Unfortunately, Sosonkin has refused to acknowledge the mistake. Any dust, including nickel dusts, when inhaled into the lungs, causes mechanical irritation of the lung tissue. Dusts are tiny particles of an abrasive material. As a response, the lung tissues attempt to encapsulate the intruding particles, which in turn may lead to a pathological growth, and which - again occasionally may spread, causing, - rarely - malignant tumor formations. Typically, this has nothing to do with the individual nickel as a metal or a chemical element. And, of course, it has nothing to do with ZEPTER's (or any) cookware, whether it contains nickel or not.

In any case, regardless the mechanism of its action on human health, industrial nickel dusts and fumes are the subjects of a great concern. They are on the Hazardous Substance List, and are regulated by OSHA and cited by ACGIH, DOT, NIOSH, IARC, NTP, DEP, NFPA and EPA. Furthermore, they are on the Special Health Hazard Substance List , since reasonably anticipated to be carcinogens. This is an issue of work-related health problems, or occupational diseases, and, again, does not have the slightest relation to ZEPTER's cookware. Period.

2. It does not make much sense to seriously discuss the subject "metals as allergens" without a clear indication of which form those metals are present. Are they metal chunks or other metallic items, or metal dusts, or alloys, containing the metals in question, or, say, water-soluble chemical derivatives of the metals? In those and other various forms, the metals, as possible allergens, are characterized with quite different threshold concentrations. They act, as possible allergic compounds, on quite different body organs and follow quite different mechanisms in their biological action. They differ on delivery routes of the metals, or their chemical derivatives, to target organs or tissues. Without being as specific as possible, an expert would not even discuss the problem, let alone offer advice. Consider this simple example. Cupric sulfate is a poison, a rather strong one. Copper cookware, however, has been in use for hundreds, perhaps thousands of years, and is regarded as safe. Industrial copper dusts are generally harmful. Three kinds of the metal, three quite different situations. Mr. Sosonkin is clearly bluffing (or just does not understand, though that is hard to believe) when he talks of "serious works that prove malignancy of nickel and chromium." Generally it maybe safe to say so (e.g., talking about occupational diseases), but he was speaking on a very specific case, namely about some amounts of the metals that, in his belief, may leave stainless steel and get into food. Later we will consider this subject of "leaving". But, coming back to his statement: a specialist just cannot speak in such general terms, when discussing a specific problem. Even arsenic, widely known as a deadly poison, is in fact an essential element in the human diet, albeit in small amounts, namely between 12 and 60 micrograms a day. The same is also true for chromium and nickel, with a typical human daily dietary intake of 50-200 and 70-260 micrograms, respectively. This is described in detail in a recent thorough article "Ultratrace Elements in Nutrition: Current Knowledge and Speculation" (1998), and is discussed later in this paper.

3. Now, a few words about nickel and nickel allergies in general. Nickel is a lustrous silvery-white hard metal that is found in nature. It is usually mixed with other metals to produce alloys. The most common nickel-containing alloy is stainless steel. Other nickel alloys are used to make coins, costume jewelry, buttons, zippers, keys, paper clips, pens, and so on. Nickel is found in many common, everyday items, many of which are likely to come into direct contact with the skin.

Nickel has been shown to be a common case of allergic skin rashes. Recent studies have revealed that about 11% of women and 2% of men are allergic to nickel, and the figures are growing annually, particularly among men (apparently, due to the increasing popularity of ear piercing in men). It has been shown that ear piercing, and probably any body piercing in general, puts susceptible individuals at greater risk to become more easily sensitized to nickel. The mechanism for developing nickel sensitivity is not clearly understood. However, nickel is recognized as the most common form of contact allergy in the industrialized world. Note that it is NICKEL, not stainless steel, including 18/10 stainless steel, which coincidentally ZEPTER's cookware is made from!

A typical way to acquire nickel sensitivity is to pierce ears with a nickel-coated needle, and/or to wear nickel or nickel-plated earrings right after the ears are pierced. Doctors recommend, that when ears are pierced, it is best to use stainless steel or 14K gold earrings, and keep them in at least three-four weeks or until the holes are completely healed. Note: the recommendation is to use STAINLESS STEEL needles to pierce the ears, and to wear STAINLESS STEEL earrings to avoid nickel allergy. Stainless steel, which normally contains from about 4% to 13%, and as high as 25% nickel, depending on the alloy.

No one is born allergic to nickel. There must be an initial exposure for sensitization to occur. For sensitization to be acquired, this exposure to nickel or nickel-containing items can be just initial, or brief, or repeated, or prolonged, depending on the individual's susceptibility. The degree of allergic response varies by person, and typically manifests as eczema (allergic contact dermatitis), which appears as redness, itching, swelling and a crusting pigmented skin rash with watery blisters. Nickel allergy can occur at any age, but once it has developed, it is usually a chronic condition and often life-long. Besides nickel earrings, the allergy can be caused by nickel and nickel-containing buttons, eyeglass frames, watchbands, rings, bracelets, and coins. The subject is described in detail on the Internet. For example, a well-written medical paper "Nickel-Containing Alloys and Platings and Their Ability to Cause Dermatitis" can be found at http://www.mediconsult.com/mc/mcsite.nsf/condition/allergies~Journal+Articles~GYCG-47TSSS; "Nickel Allergy" (www.goaskalice.columbia.edu/1083) is another useful resource. These articles also describe how to get tested for a possible nickel or other contact allergy. If you are interested, ask your dermatologist about patch testing, which is done on the back and ear lobe.

From a wide variety of nickel-containing metal materials commonly used in jewelry and clothing accessories, only about ten produced a noticeable response among a statistically significant number of individuals using patch testing. Redness and infiltration of the skin by the metal were used as signs of a positive reaction. These ten included brass and sterling silver alloys that were gold-, silver- or chromium-plated; nickel-silver; and white gold with more than 6% nickel content. It was found that some of these alloys can release nickel when in contact with human sweat and cause reactions in sensitive persons. In the process used to make costume jewelry, a very thin layer of gold (usually 1-millionth to 200-millionth-of-an-inch-thick) is electroplated over a base of nickel or other alloys. When this layer becomes scratched or corroded, even small amounts of moisture from the body react with the nickel, causing it to leach out.

Again, please note: of the many stainless steel materials tested, NONE produced a dermatitis reaction. Stainless steel is therefore considered safe, despite the presence of nickel. The reason is simple: nickel is so firmly bound in the alloy, that the binding (particularly with iron) is practically irreversible. Reuters Health agency announced at the end of 1998: "Surgical-grade stainless steel and titanium probably represent safer materials" to avoid contact allergy. In the beginning of this year (1999), Reuters News again returns to this question in the article "Nickel Allergies on the Rise". They state: "So how can individuals avoid developing a nickel allergy? For those considering piercing, it is very important … to have nickel so tightly bound to another metal it will not leach. For example, when having ears pierced, it is best to use stainless steel earrings."

4. According to the American Academy of Dermatology, "although stainless steel contains nickel, the nickel is so firmly bound in the alloy that stainless steel is safe for most nickel-sensitive people" (from the paper "Nickel Allergy: When Your Jewelry Makes You Sick", www.bewell.com/healthy/woman/1998/LATnickel).

Enough, it seems. Any comments regarding the relevant statements by Sosonkin - remember, "nickel, which is an ingredient of stainless steel, is a strong allergen", "… I have serious scientific works" - are unnecessary.

5. Now, to "medicinal steel." Indeed, in the Russian technical nomenclature there is no such term. Steels differ on their composition and intended application (such as general usage steels, rifle steels, construction steels, tool steels, fast-cutting steels, stainless steels, etc.). However, in the English language there is such a term, and a series of stainless steels are named as "surgical steels," or " food grade steels", such as steels 18/10, 17-4, 304, 316L and others. Sosonkin apparently does not know this.

The popularity of surgical stainless steel is due to its gleaming appearance which lasts for the life of a product with just an occasional cleaning. The excellent corrosion resistance of stainless steel is due to an invisible, passive oxide film that forms on the metal's surface in air, and effectively "seals" it. The passive oxide film also does not allow components of the alloy to leak. Hospitals use surgical stainless steel because it can be kept clean and sterile. Hence, the name.

Surgical steel 18/10 is often described in the highest terms - finest, mirror-finish, gleaming, superior quality, and so on. Besides surgical instruments, many other high quality household (and other) items are manufactured from this steel: elegant - and fairly expensive - cookware, cartridges for water filter systems, kitchen sinks, etc. ZEPTER makes its cookware from this very steel. Thus, Sosonkin's public exclamation on the radio "The company (ZEPTER) lies that this steel is a medicinal (surgical) one. There are no medicinal steels!" we will leave without comment.

6. There are a fair amount of data on carcinogenic effects of individual (pure or partially pure) nickel. There are NO data on carcinogenic effects of stainless steel. Practically all indications on carcinogenicity of nickel are related to industrial mining, refining, or welding processes of the metal (see, e.g., IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol.49, IARC 1990, 677 pp), and have nothing to do with stainless steel cookware of any kind. Federal and other documents regulating storing, transporting, industrial processing of nickel, and otherwise exposure to nickel and its dusts and fumes, set the respective limits and other restrictions. They also maintain an infrastructure for monitoring, reporting, and taking care of the issues. None of those documents provides citations regarding cookware made of nickel- containing stainless steel. A review of these documents can be find on the Internet (www.rtk.net).

7. Wait a minute - a skeptical reader would intervene. What does it mean, "there are no data on carcinogenic effects of stainless steel." How do you know? What if the author just missed them? Could not find the relevant citations? This is not a terribly convincing statement. O.K., this is a good and legitimate point. Let us explain.

The Net stores an interesting, useful, and fairly wide network, containing many thousands of documents. The name of this system is RTK NET, or The Right-to-Know Network (www.rtk.net). It provides free access to databases, documents, and conferences on the environment, health hazards, housing, and sustainable development. From information on RTK NET one can identify specific factories and their environmental effects; assess communities affected; it also provides public access to the Toxic Release Inventory. RTK NET is funded by government agencies. The data are furnished by the manufacturers (under threat of sizeable fees for withholding or underreporting), by multiple occupational, hygienic, and the like federal and state bodies, by medical personnel, researchers, and by customers themselves. Data listed in the NET are fairly detailed; for instance, a single "Nickel" document takes up seven pages of fine print.

Now, all attempts of this author to retrieve ANY information on the present or potential health hazard that would be caused by ZEPTER's cookware turned out to be fruitless, so to speak: zero documents. Searching for stainless steel 18/10 gave the same result: zero documents. Is stainless steel in general harmful by any means (without counting, of course, things like knives and guns)? Not a single relevant reference. Likewise, kitchenware did not produce any references. This does not mean that there were no references at all. "Stainless steel" produced 28 documents, "steel" resulted in 152 documents, but all of them turned out to be completely irrelevant. That means, all of them were about health hazard either of individual components of steels (such as nickel, chromium, etc.), and were related to the steel-making processes, or about their chemical derivatives and relevant mineral acids (sulfuric acid, nitric acid, and so forth).

Hence, there were no data found regarding health hazards caused by stainless steel cookware. Except, of course, those announced by Sosonkin. But we already know their value.

8. Let us move to yet another question: what if a small amount of nickel, despite all known data, still leaves the stainless steel matrix of the cookware, and in tiny amounts enters the food? What then?

In fact, nothing. It looks like there might be some health benefits. So let us consider that surprising situation being armed with facts and figures.

As we have noted earlier, and will provide more detail later, typical human dietary intake of nickel is between 70 and 260 microgram/day (0.07-0.26 mg). This amount would translate to a yearly requirement of 25 to 95 milligram of nickel per individual. Obviously, if THIS amount could leave the mirror-finish inner walls of a ZEPTER pan, they would quickly cease to be mirror-like! And this, we repeat, are still the amounts of nickel that satisfy the daily dietary requirements for average people. One can only imagine how the cookware would look if the amounts of nickel leaving are more excessive!

However, alas, nickel does not split off from stainless steel, including ZEPTER's cookware. We get it from other sources. We must ingest it, since nickel, as well as chromium, are essential for nutrition. This is well documented in the medical and nutritional literature (a list of relevant references is attached). These papers are published in leading peer reviewed US and international scientific journals, such as Metabolism, Biological Trace Elements Research, Journal of Trace Elements in Experimental Medicine, Biochemistry, Archives of Biochemistry and Biophysics, Endocrinology, Journal of Cellular Physiology, American Journal of Clinical Nutrition, Journal of Nutrition, and others. Titles of some articles speak for themselves: "Nickel -- an essential element" (in the book "Nickel in the Human Environment"); "Beneficial metal ions. Nickel"; "Nickel content of food and estimation of dietary intake"; "Nutritional requirements for boron, silicon, vanadium, nickel and arsenic"; "Recent advances in the clinical and biochemical manifestation of chromium deficiency in human and animal nutrition"; "Recent advances in the biochemical effects of chromium deficiency"; "Chromium in human nutrition"; "Urease -- a Ni (II) metalloenzyme"; "Structure- function relationships among the nickel-containing hydrogenases"; "Nickel enzymes". This is less than a quarter of the provided references.

What these papers are about is easy to see from their titles. Let us go a bit deeper, that is, we will list a selection of proven facts, documented in the cited articles. Item by item:

(a) Chromium and nickel are essential nutrients for humans. Typical human daily dietary intake is between 50 and 200 micrograms for chromium and between 70 and 260 micrograms for nickel (from 1998). ESADDI (Estimated Safe and Adequate Daily Dietary Intake) was established for chromium in 1980, and the current ESADDIs for this element are: infants aged 0 to 6 months, 10 to 40 mg, and aged 6 months to 1 year, 20 to 60 mg; children and adolescents aged 1to 3 years, 20 to 80 mg, aged 4 to 6 years, 30 to 120 mg, aged 7 years and older, 50 to 200 mg; and adults, 50 to 200 mg ("Recommended Dietary Allowances", 9th Revised Ed., National Research Council, Food and Nutrition Board).

(b) Humans on long-term parenteral nutrition containing a low amount of chromium developed impaired glucose tolerance, or hyperglycemia, with glucose spilling into the urine, and a resistance to insulin action. These abnormalities were reversed with a relatively large infusion of chromium (published in American Journal of Clinical Nutrition).

(c) Chromium has an essential function in potentiating insulin action in the metabolism of glucose, and provides a beneficial effect on diabetes resulting from inadequate synthesis of insulin. A large number of reports from numerous research groups have described beneficial effects from chromium supplements in subjects with degree of glucose intolerance ranging from hyperglycemia to insulin-dependent diabetes. It has been shown that chromium-deprived humans have decreased insulin binding to red blood cells and insulin receptor number (published in Journal of Nutrition; Metabolism).

(d) Beneficial effects of chromium supplementation on blood lipid profiles have been reported (Published in Metabolism).

(e) Chromium is bound to DNA in chromatin and increases the number of initiation sites, which enhances RNA synthesis (see "Present Knowledge in Nutrition", 7th Ed., 1996).

(f) Nickel deprivation results in depressed growth, reproductive performance, and plasma glucose content, and alters the distribution of other elements in the body, including calcium, iron, and zinc (these data were published in 1995).

(g) Some enzymes (such as urease, carbon monoxide hydrogenase, acetyl-CoA synthase and others) contain nickel in their catalytic centers. Nickel deprivation results in a complete slowing down of the catalytic activity of these enzymes. As a consequence, the respective biological processes catalyzed by the enzymes cease (this overview was published in 1998) .

(h) The function of nickel involves a biological pathway using vitamin B-12 (Published in the Journal of Trace Elements Experimental Medicine, and Biological Trace Elements Research, in 1989-1993).

(i) Nickel has a very basic function at a molecular level in the body, since it has been shown that nickel is a calcium channel blocker and can activate calcium receptors to elicit calcium signals. Therefore, nickel may play a certain role in signal transduction in the body, a fundamental life function (Published in Endocrinology; and the Journal of Cell Biology).

Consideration of the above data, among many others, has led Professor Forrest Nielsen (U.S. Department of Agriculture), author of the recent detailed review "Ultratrace Elements in Nutrition" (1998) to the following conclusion:

There is "almost overwhelming…evidence that this element [nickel] has an essential function in higher forms of life, including humans."

So, when Sosonkin tries to scare his audience by discussing nickel, splitting off from stainless steel cookware without bothering to mention its amounts or concentrations, a professional would just shrug.

9. From THE NUTRITION BIBLE (Jean Anderson and Barbara Deskins, William Morrow & Company, Inc., 1995): Nickel. One of the minerals the body needs in minute quantities to produce some of the enzymes required for efficient metabolism. Nickel interacts with more than a dozen other minerals in the body and too little of it can stunt growth and curtail blood formation and upset the balance of iron, copper and zinc in the liver. Good sources of nickel are dried peas and beans, whole grains, nuts and - hooray! - chocolate. As with other heavy metals, nickel can be toxic (too much of it damages all vital organs - brain, heart, kidneys, liver and lungs). But nickel buildup is more apt to come from industrial fallout (chemical pollutants) than from eating.

One can notice that cookware - as a likely source of excessive amounts of nickel - is not mentioned in the above paragraph. But we know why. It is not an issue.

10. Says Sosonkin (with a reference to the Russian popular medical magazine "Zdorovie"): "… publications on carcinogenicity of nickel have appeared. Therefore, Europe is moving towards nickel-free cookware."

This is not true. There is "The European Directive Restricting the Use of Nickel" No. 94/27/EC of 30 June 1994, with additions of February, 1997, that restricts marketing and use of nickel-made items. It says: "the presence of nickel in certain objects coming into direct and prolonged contact with the skin may cause sensitization of humans to nickel and may lead to allergic reactions; … for these reasons the use of nickel should be limited."

However, this is again all about nickel, not about stainless steel and not about cookware. In Annex, the Directive clearly lists products to be restricted ("May not be used"), all of them - either nickel, or nickel- coated:

· earrings,

· necklaces, bracelets and chains, anklets, finger rings,

· wrist-watch cases, watch straps and tighteners,

· rivet buttons, tighteners, rivets, zippers and metal marks, when these are used in garments.

That is all. Cookware made of stainless steel, and other kitchenware is not mentioned.

11. Sosonkin's statement that Europe and the Americas have already switched over to kitchenware that does not contain nickel is questionable. It seems that the opposite is true, and demand for nickel-containing stainless steel cookware, particularly made of top grade 18/10 stainless steel, is on the rise. This is not surprising, taking into account its elegance and high quality. Cookware of this kind is intended for upscale homes, and is rather expensive.

Among current manufacturers and distributors of cookware made of 18/10 stainless steel are the following European, Canadian, and U.S. companies: Eastern Home Products (EHP); Rosle; HJ Neumann - FRANKE; Cuisinart (Hanover Direct Pennsylvania, Inc.); Chefs Heaven; Fagor; Italian companies Evolve; Frabosk; G.A.T. (Gruppo Alternativo Technoindustriale); Paderno; Prodotti; Guido Bergna (as part of Crown House, England), French SITRAM, and others. Plus, of course, Zepter International (USA) as a part of the multinational Zepter family.

One more question, which is related not to the technical side of the story, but rather to the moral one. How come, that a professional medical doctor, knowing the principle "do not harm", has apparently deliberately - and repeatedly - misled his audience? Even if this misleading was based on a plain ignorance, Sosonkin should have known that he did not have data (or knowledge) to go ahead in order to actually accuse ZEPTER of a mortal sin, and to scare his attentive listeners and readers. One can only imagine how many people Sosonkin put into unnecessary stress.

Finally -- Sosonkin should have certainly known that in the USA he could not call himself Professor, PhD, Doctor of Medical Sciences, Doctor of Philosophy in Medicine (the last two titles do not apparently exist in this country), and Academic of the New York Academy of Science (there is no such a title). And, after all, the New York Academy of Science (NYAS) is a very different body compared to the former USSR Academy of Sciences. The New York Academy of Science is not an "Academy" in the former "soviet" meaning of the word Academy. It is also very different from the National Academy of Sciences of the USA. The informational leaflet of the NYAS states: "Your membership is the Academy recognizes your interest in science and technology." A similar leaflet notes that there are more than 40,000 members of NYAS. They are not "Academics", though it sounds impressive to anyone who used to live in the former Soviet Union, since there "Academic" was the highest distinction in science, the highest title in science, the highest respect.

Actually, it is not a bad idea - to join the New York Academy of Science and pay the annual fees of $95. NYAS is a charity organization, and by being a member one supports fellow-scientists and organizers of scientific meetings in the USA. This is a good thing. But it does not bring one the "highest distinction in science", as Mr. Sosonkin has implied, aiming obviously at Russian-speaking émigrés quite receptive to such a "title."

This is clear. Now, about other "titles" of Mr. Sosonkin. In the USA, Professor is a job, not a title. For some, it is a title and job. In the US, Sosonkin does not have a professorial position. Then, PhD - in the American educational system this is a degree. Sosonkin did not earn this degree in this country. It would be like a major of the Soviet Army, moving to the USA, calling himself a major in the US Army. Formally, some authorized institutions in the USA can consider this issue and decide whether or not the Soviet scientific degree may be regarded as equivalent to the respective USA degree. This procedure is called Evaluation. It appears that Sosonkin has not gone through this procedure.

There could have been one more way to earn a medical degree in the US, or to confirm the existing one, awarded in another country: pass the necessary examinations, as many former Soviet MDs do in this country. This is a hard way, but a honorable one. It appears, that Mr. Sosonkin has "solved" the problem much faster, without any exams. No comments.

The whole story boils down this: the technical side of this issue, regarding stainless steel, ZEPTER's cookware and the health-related aspects of its use can be considered closed; the legal side of this issue, unfortunately, is just opening. But this chapter is for professionals of another kind of expertise. Watch the news.

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