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Every day, doctors are faced with patients with symptoms that prove difficult to diagnose. When healthy and active Larry Luitjens shows up in his doctor’s office with some peculiar and frightening symptoms, his doctor is put to the test to find the cause and get him the treatment he desperately needs.

(Source: WHO) Arsenic is a natural component of the earth’s crust and is widely distributed throughout the environment in the air, water and land. It is highly toxic in its inorganic form. People are exposed to elevated levels of inorganic arsenic through drinking contaminated water, using contaminated water in food preparation and irrigation of food crops, industrial processes, eating contaminated food and smoking tobacco. Long-term exposure to inorganic arsenic, mainly through drinking of contaminated water, eating of food prepared with this water and eating food irrigated with arsenic-rich water, can lead to chronic arsenic poisoning. Skin lesions and skin cancer are the most characteristic effects.

Sources of Arsenic Exposure

Drinking-water and food

The greatest threat to public health from arsenic originates from contaminated groundwater. Inorganic arsenic is naturally present at high levels in the groundwater of a number of countries, including Argentina, Bangladesh, Chile, China, India, Mexico, and the United States of America. Drinking-water, crops irrigated with contaminated water and food prepared with contaminated water are the sources of exposure.

Fish, shellfish, meat, poultry, dairy products and cereals can also be dietary sources of arsenic, although exposure from these foods is generally much lower compared to exposure through contaminated groundwater. In seafood, arsenic is mainly found in its less toxic organic form.

Industrial processes

Arsenic is used industrially as an alloying agent, as well as in the processing of glass, pigments, textiles, paper, metal adhesives, wood preservatives and ammunition. Arsenic is also used in the hide tanning process and, to a limited extent, in pesticides, feed additives and pharmaceuticals.


People who smoke tobacco can also be exposed to the natural inorganic arsenic content of tobacco because tobacco plants essentially take up arsenic naturally present in the soil. Also, in the past, the potential for elevated arsenic exposure was much greater when tobacco plants used to be treated with lead arsenate insecticide.

Health effects of arsenic exposure

Arsenic occurs in inorganic and organic forms. Inorganic arsenic compounds (such as those found in water) are highly toxic while organic arsenic compounds (such as those found in seafood) are less harmful to health.

Acute effects

The immediate symptoms of acute arsenic poisoning include vomiting, abdominal pain and diarrhoea. These are followed by numbness and tingling of the extremities, muscle cramping and death, in extreme cases.

Long-term effects

The first symptoms of long-term exposure to high levels of inorganic arsenic (e.g. through drinking-water and food) are usually observed in the skin, and include pigmentation changes, skin lesions and hard patches on the palms and soles of the feet (hyperkeratosis). These occur after a minimum exposure of approximately five years and may be a precursor to skin cancer.

In addition to skin cancer, long-term exposure to arsenic may also cause cancers of the bladder and lungs. The International Agency for Research on Cancer (IARC) has classified arsenic and arsenic compounds as carcinogenic to humans, and has also stated that arsenic in drinking-water is carcinogenic to humans.

Other adverse health effects that may be associated with long-term ingestion of inorganic arsenic include developmental effects, neurotoxicity, diabetes and cardiovascular disease. In China (Province of Taiwan), arsenic exposure has been linked to “blackfoot disease”, which is a severe disease of blood vessels leading to gangrene. However, this disease has not been observed in other parts of the world, and it is possible that malnutrition contributes to its development.

Magnitude of the problem

Arsenic contamination of groundwater is widespread and there are a number of regions where arsenic contamination of drinking-water is significant.

Arsenic in Bangladesh has attracted much attention since recognition in the 1990s of its wide occurrence in well-water in that country. Since this time, significant progress has since been made and the number of people exposed to arsenic exceeding the Bangladesh drinking-water quality standard has decreased by approximately 40%. Despite these efforts, it is estimated that about 20 million and 45 million people in Bangladesh are at risk of being exposed to arsenic concentrations that are greater than the national standard of 50 μg/litre and the WHO guideline value of 10 μg/litre respectively1.

The symptoms and signs caused by long-term elevated exposure to inorganic arsenic differ between individuals, population groups and geographical areas. Thus, there is no universal definition of the disease caused by arsenic. This complicates the assessment of the burden on health of arsenic.

Similarly, there is no method to distinguish cases of cancer caused by arsenic from cancers induced by other factors. As a result, there is no reliable estimate of the magnitude of the problem worldwide.

In 2010, the Joint FAO/WHO Expert Committee on Food Additives (JECFA) re-evaluated the effects of arsenic on human health, taking new data into account. JECFA concluded that for certain regions of the world where concentrations of inorganic arsenic in drinking-water exceed 50–100 μg/litre, there is some evidence of adverse effects. In other areas, where arsenic concentrations in water are elevated (10–50 μg/litre), JECFA concluded that while there is a possibility of adverse effects, these would be at a low incidence that would be difficult to detect in epidemiological studies.

Prevention and control of arsenic exposure

The most important action in affected communities is the prevention of further exposure to arsenic by the provision of a safe water supply for drinking, food preparation and irrigation of food crops. There are a number of options to reduce levels of arsenic in drinking-water.

  • Substitute high-arsenic sources such as groundwater, with low-arsenic, microbiologically safe sources such as rain water and treated surface water. Low-arsenic water can be used for drinking, cooking and irrigation purposes, whereas arsenic-rich water can be used for other purposes such as bathing and washing clothes.
  • Discriminate between high-arsenic and low-arsenic sources. For example, test water for arsenic levels and paint tube wells or hand pumps different colours. This can be an effective and low-cost means to rapidly reduce exposure to arsenic when accompanied by effective education.
  • Blend low-arsenic water with higher-arsenic water to achieve an acceptable arsenic concentration level.
  • Install arsenic removal systems – either centralized or domestic – and ensure the appropriate disposal of the removed arsenic. Technologies for arsenic removal include oxidation, coagulation–precipitation, absorption, ion exchange and membrane techniques. There is an increasing number of effective and low-cost options for removing arsenic from small or household supplies.

Long-term actions are also required to reduce occupational exposure from industrial processes.

Education and community engagement are key factors for ensuring successful interventions. There is a need for community members to understand the risks of high arsenic exposure and the sources of arsenic exposure, including the intake of arsenic by crops (e.g. rice) from irrigation water and the intake of arsenic into food from cooking water.

High-risk populations should also be monitored for early signs of arsenic poisoning – usually skin problems.

WHO response

Arsenic is one of WHO’s 10 chemicals of major public health concern. WHO’s work to reduce arsenic exposure includes setting guideline values, reviewing evidence and providing risk management recommendations. WHO publishes a guideline value for arsenic in its Guidelines for drinking-water quality. The Guidelines are intended for use as the basis for regulation and standard setting worldwide. The current recommended limit of arsenic in drinking-water is 10 μg/litre, although this guideline value is designated as provisional because of measurement difficulties and the practical difficulties in removing arsenic from drinking-water. Where it is difficult to achieve the guideline value, Member States may set higher values as standards taking into account local circumstances, resources and risks from low arsenic sources that are contaminated microbiologically.

Source: The World Health Organization 

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