Health Effects of Lead

Lead contamination poses a serious threat to the safety of our nation’s drinking water. This colorless, tasteless, and odorless heavy metal can go virtually undetected in drinking water. Excessive amounts of lead place adults at higher risk for cancer, stroke, and hypertension. It has even been hypothesized that Imperial Rome’s dependence on lead water pipes contributed to its decline…the suggestion being that the Roman aristocracy faltered and died off from nothing more complicated than simple chronic lead poisoning.

Lead, however, is even more harmful for the very young.

Fetuses, infants, and children up to the age of six have rapidly growing little bodies which, unfortunately, are quick and efficient absorbers of lead. Lead can cause brain damage, premature birth, reduced birth weight, seizures, behavioral disorders, and a lower IQ level in children. In most cases this damage is irreversible. Consequently, the U.S. Environmental Protection Agency (EPA) considers lead the most serious environmental health hazard for children in the United States. Many lead toxicologists agree and have even suggested that EPA’s lead standard for children’s drinking water ought to be more stringent than that for adults.

Sources of Lead in Drinking Water

Rarely, lead gets into water from the erosion of natural underground deposits or industrial activity. It is much more likely to enter drinking water through corrosion as it passes through lead and galvanized pipes, soldered connections, brass fittings and fixtures within the household plumbing, and brass fittings on submersible well pumps. Lead solder was banned in 1986. Even so, lead can be found in the drinking water of older houses containing lead solder. Prior to 2014, plumbing could contain up to 8% by weight of lead. As other environmental controls have been placed on leaded gasoline, lead solder, leaded paint, and use of lead in housewares, drinking water as a potential source of lead exposure over the past several decades has steadily increased in importance.

The EPA has estimated that about 40 million Americans are exposed to drinking water lead concentrations that exceed 15 ug/L for municipal water.

A survey of private water supplies (homes using wells and springs) across Pennsylvania, for example, found 20 percent contained unsafe lead levels — a corrosion problem that persisted in all regions of the state. Water corrodes plumbing containing lead at increased rates as its acidity increases and its concentration of calcium carbonate decreases. A drinking water below a pH of 7 with a low calcium carbonate (CaCo3, limestone, chalk) content will generally corrode lead from a building’s plumbing system.

Water standing in contact with a building’s plumbing will be the first water out of the tap in the morning; therefore, lead concentrations in drinking water usually are the highest in the first water out of the system. Researchers in Flint, Michigan found the highest concentrations in the second draw which was collected after 45 seconds of flushing. The EPA Lead and Copper rule needs to be strengthened to address variables such as pre-flushing and low flow rate. Soluble lead concentrations will decrease as the water is run but particulate levels of lead may not. If lead pipes, leaded solder, or brass fixtures are present, even relatively noncorrosive water can dissolve dangerous amounts of lead if the water sits in contact with these materials for an hour or more. Similarly, heat will accelerate the lead corrosion process, so hot water will typically yield higher lead concentrations than cold water samples taken from the same tap. As noted below, parents are cautioned against using first flush tap water for preparing infant formula, and never to use hot water for that purpose.

A more recent contributor to the problem of lead corrosion in public water systems is the switch in disinfection agents from chlorine to chloramines. Chlorine reacts with dissolved organic matter in water to create by-products that are suspected of causing human health problems, including some forms of cancer. So, many public water treatment plants now are beginning to use chloramines, combinations of chlorine and ammonia. Unfortunately, in some previously lead-stable public water supplies this switch has coincided with an increase in lead in the drinking water, perhaps because chloramines changed the redox potential of the water. The change in redox potential destabilized existing scale in the pipeline and a more soluble form of lead was formed.

It should be noted that some trade agreements with foreign nations still allow them to export plumbing components for sale in America that are not lead free and that, in fact, can contain significant amounts of lead.

Lead Abatement and Alternatives

As a general precaution, the Centers for Disease Control and Prevention (CDC) recommend using only cold tap water (that has been flushed long enough after a period of inactivity for the water to run noticeably colder) for drinking, cooking, and mixing infant formula. In homes with children or pregnant women with water lead levels exceeding EPA’s action level of 15 parts per billion of water (ppb), the CDC recommends using only bottled water for drinking, cooking, and infant formula.

If the drinking water still has elevated levels of lead after flushing, specific water filtration units or bottled water may be an effective long term solution. A National Sanitation Foundation (NSF) seal certifying lead reduction capability (NSF-53) on a filtration system is one method of ensuring that the unit has been tested for adequate removal efficiency. All such filters must be maintained and replaced periodically in accordance with the manufacturer’s guidelines to be effective. All bottled waters produced by licensed bottlers in the United States are subject to a Federal Food and Drug Administration (FDA) maximum contaminant level for lead called a Standard of Quality (SOQ). This bottled water SOQ (5 ppb) is one third of the (15 ppb) amount allowed in tap water, and so bottled water can be assumed to safe from lead in water concentrations deemed to be a health risk by the EPA for tap water.

The most effective and most expensive lead removal method is to replace the leaded plumbing components with nonleaded components. This procedure often involves replacing copper pipes and lead solder with plastic PVC pipes (NSF-pw labeled). Replacing home plumbing components will be effective only if the source of the lead is within the home plumbing system. If the lead contamination originates from outside the home within a public water system’s lead service lines, this method may be of limited use.

Lead Regulations

Tap Water: Public Water Supplies with an adverse lead-testing experience (i.e., more than 10 percent of its household lead sampling results showing an exceedance of the EPA Action Level of 15 ppb) will be in violation of the National Primary Drinking Water Regulation for lead. The water utility must then notify the public and the local government of the violation and undertake corrective treatment measures. These measures may include replacement of lead service lines and/or the addition of corrosion-preventive chemicals to the drinking water. These chemical corrosion inhibitors added to the tap water may be sufficient to abate any dangerous lead concentrations in buildings with leaded plumbing components. In 2011, Congress passed the Reduction of Lead in Drinking Water Act (RLDWA), revising the definition of lead free by lowering the maximum lead content of the wetted surfaces of plumbing products (such as pipes, pipe fittings, plumbing fittings and fixtures) from 8% to a weighted average of 0.25%, establishing a statutory method for the calculation of lead content, and eliminating the requirement that lead free products be in compliance with voluntary standards established in accordance with SDWA 1417(e) for leaching of lead from new plumbing fittings and fixtures.

There are no Federal lead in drinking water regulations for individual private water supplies (e.g., private wells, springs).

Bottled Water: Bottled water is regulated federally by the United States Food and Drug Administration as a food product. Instead of accepting EPA’s 15 ppb Action Level for lead in bottled water, the FDA issued a lower, 5 ppb, SOQ for allowable levels of lead in bottled water. Furthermore, FDA Good Manufacturing Practices for Bottled Water (GMPs) prohibit water bottlers from using any food contact material (tanks, pipes, fittings, pumps, bottling equipment, containers, closures, etc.) that might adulterate or render the bottled water product unsafe — including, of course, contamination by lead. All bottled waters that use public water supplies as their source, at a minimum, remove chlorine and chloramines as the early part of their water treatment and product purification train.

Any finished bottled water product found to be in violation of the FDA’s 5 ppb lead SOQ for any reason and without exception is subject to removal from the market and must be destroyed.

Parity: In 1996, the Federal Food, Drug, and Cosmetic Act was amended to require that FDA regulations for bottled water be at least as protective of the public health as the US EPA National Primary Drinking Water Regulations (NPDWRs). FDA reviews the US EPA NPDWRs, including Maximum Contaminant Levels (MCLs), and makes a determination of their applicability to bottled water. FDA must establish Standards of Quality (SOQ) and monitoring requirements for bottled water that are as protective of the public health as those issued by EPA for public drinking water.


Lead in drinking water is a serious public health matter — especially for children. Because of the end-of-the-pipeline origin of most lead in tap water, the nation’s laws and regulations dealing with lead contamination in tap water are very different from and less protective of children’s health than the laws and regulations which govern lead in bottled water. Parents who have children under the age of six should be aware of this profound difference and choose their family’s primary source of drinking water accordingly.

Click here for a more comprehensive Comparison of Drinking Water Regulations

Author’s note June 2016: Special thanks for updates to this article from members of the Virginia Tech Flint Water Research Team.


Flint Water Study Update

Prevention of Childhood Lead Toxicity, a policy statement from the American Academy of Pediatrics COUNCIL ON ENVIRONMENTAL HEALTH, published in Pediatrics,2016;138(1):e20161493

EPA Information on Lead and Drinking Water at Schools and Child Care Facilities

University of Pennsylvania, Environmental Resources Institute, Swistock, B.R. and Sharpe, W.E., “Lead in Drinking Water” issued as Extension Circular 416, Cooperative Extension Service of the College of Agricultural Sciences.

U. S. Food and Drug Administration, Center for Food Safety and Nutrition, FDA Consumer,January-February 1998, “Dangers of Lead Still Linger”.

Minnesota Dept of Health, “Lead In Well Water Systems”

New York State Department of Health, Information for a Healthy New York, “Get Ahead of Lead! Get the Lead Out of Drinking Water”

EPA Lead Information

CDC Lead Information

FDA Report Lead in Food Consumed by Children

Low-level lead exposure and mortality in US adults: a population-based cohort study


Jack C. West is Chairman of Drinking Water Research Foundation’s Board of Trustees.