Environmental and Dietary Threats to Women’s Health: Environmental and Dietary Threats to Women’s Health Kathleen Thomsen MD, MPH Assistant Clinical Professor, UMDNJ Robert Wood Johnson Medical School New Brunswick, NJ Private Practice, Women’s Health and Wellness Pennington, NJ


A Typical Days Exposure: A Typical Days Exposure Morning Sundries Shampoo and Shower Brush Teeth Apply Make-up


A Typical Days Exposure: A Typical Days Exposure Shampoos and soaps DEA: Diethanolamine Ingredient in over 600 cosmetic and personal care products DEA shows “clear evidence of carcinogenic activity” when applied to skin of rats. US DHHS National Toxicology Program, 1997


A Typical Days Exposure: A Typical Days Exposure Brush Teeth Fluoride in toothpaste dramatically decreased prevalence of cavities 1997 FDA strengthened warning on tubes Fluoride in drinking water No significant decrease in cavities if using fluoridated toothpaste and regular dental care A community saves $38 in dental treatment costs for every $1 invested in flouridation 20% of children get 80% of cavities


A Typical Days Exposure: A Typical Days Exposure Fluoride in drinking water Optimal level in water: 0.7 – 1.2ppm per CDC 1985 EPA raised acceptable level to 4ppm WHO’s fluoride safety standard: 1.5ppm Potential risks of fluoride Enamel fluorosis –white or brown mottling 2001 Harvard thesis: 7 fold increase risk of osteosarcoma in preadolescent boys 17 out of 21 countries in Europe have refused or discontinued water fluoridation


A Typical Days Exposure: A Typical Days Exposure Apply Make-up Phthalates – plastic softeners Found in hair spray, deodorant, nail polish, make-up, perfumes… Absorbed through the skin, inhaled, ingested Animal studies: damage to liver, kidneys, lungs and reproductive system – especially developing testes Human studies: direct correlation between levels in pregnant women and subtle genital birth defects in their year old sons Environmental Health Perspectives 2005


A Typical Days Exposure: A Typical Days Exposure Breakfast Teflon pan PFOA: Perfluorooctanoic acid A potential carcinogen – FDA Ubiquitous (arctic polar bears, Japanese comorants, Inuits in Alaska…) Persistent (half life in humans estimated 4 years) Resilient and indestructible (sewer sludge test) Linked to 10 point rise in cholesterol in most exposed humans


A Typical Days Exposure: A Typical Days Exposure Aspirin Commonly buffered with aluminum hydroxide or glycinate Aluminum prevented from reaching brain by blood brain barrier Orange juice citric acid transforms aluminum products to aluminum citrate – 5 times more likely to penetrate blood brain barrier


A Typical Days Exposure: A Typical Days Exposure Surprise!! Fresh cut flowers from florist 800,000 pounds farm chemicals used per year in California for growing flowers 12 pesticide residues found in significant amounts on roses and other flowers sold to customers from florists Off gas many herbicides No restrictions placed on floral products


A Typical Days Exposure: A Typical Days Exposure Picnic Lunch with Kids Ozone/Air pollution Ozone – produced by sunlight reacting with pollution from cars and industrial sources Highest between noon and 3 pm 3 independent studies showed link between increased death rates and ozone level Epidemiology, July 2005 (10ppb increased ozone score increased total mortality rate at least 4/5%) Childhood exposure in California:(The Children’s Health Study, NEJM 20040 associated with reduced lung volume, respiratory conditions, increased asthma attacks, increased incidence asthma


A Typical Days Exposure: A Typical Days Exposure Picnic Table/Playground set Chromated Copper Arsenate – treated lumber sealant (CCA = 22% pure arsenic) 12 foot section contains ~ 1 oz arsenic (enough to kill 250 people) Sources of arsenic exposure in 4 – 6 yo kids Food = 5 mcg/day; drinking water standard 23 mcg/day; playing on CCA treated wood – as high as 480mcg/day Arsenic leaches out of wood for 20 years


A Typical Days Exposure: A Typical Days Exposure Lunch with Kids Microwave lunch in plastic containers and bring soft plastic water bottles out for the picnic Bisphenol-A – found in plastic food containers, soft plastic water bottles , metal food can liners Animal studies: alters mammary gland development in mice Estrogen mimic – endocrine disruptor


A Typical Days Exposure: A Typical Days Exposure Dinner Grilled Fish Charcoal grilling of meat– releases polycyclic aromatic hydrocarbons (PAHs) which can interfere with bodies detoxification of estrogens Fish great source of omega-3 fatty acids (important for brain development, anti-inflammatory properties, anti-clotting…) Also great source of mercury (135 Massachusetts mothers and babies: additional fish serving per week increased babies cognitive score 7%; for each increase in 1ppm of mercury, babies score dropped 12.5%; Environmental Health Perspectives, May 2005


A Typical Days Exposure: A Typical Days Exposure Fish Mercury: coal and oil fired power plants, manufacturing plants, incinerators… release mercury into the air and rain (43M pounds in 2000) Methyl mercury formed in the soil by algae and bacteria Ingested by fish and accumulate in fish fat The bigger the fish, the more mercury (shark, mackerel, sashimi tuna, swordfish, tilefish) Mercury toxicity can cause brain dysfunction… Canned tuna limited to < 1 can per week in pregnant women and small children (mercury toxic to fetal brain)


A Typical Days Exposure: A Typical Days Exposure Fish Farmed salmon Omega 3 fatty acids come from eating plankton Farmed salmon are fed fishmeal (made from the fatty parts of dead fish); Farmed salmon don’t make omega 3 fatty acids PCBs are insulator chemicals used in industry which have leaked into the oceans PCBs found in fish fat bio-accumulate 60% of US salmon is coming from Chile Chile can only regulate 12% of their salmon farms


Synthetic Chemicals: Synthetic Chemicals Since WWII 75,000 to 80,000 new chemicals released into environment Less than 50% of these have been tested for potential toxicity in humans Over 4 billion pounds used per year in US (8 # per each man woman and child; EPA 1999) 350 different pesticides can be used by law on the food we eat Average American home contains 3 – 10 gallons of hazardous materials


Synthetic Chemicals: Synthetic Chemicals 400 synthetic chemicals have been found in the human body BodyBurden Study 2003 9 volunteers had blood and urine tested for 211 possible contaminants. Findings: 167 pollutants, including an average of 56 carcinogens in each person BodyBurden2, the Pollution in Newborns, 2005 10 newborns umbilical cord blood tested. Findings: Newborns averaged 200 contaminants


Types of Environmental Threats: Types of Environmental Threats 1. Pesticides Insecticides Herbicides 2. Industrial Compounds and Chemical Byproducts Volatile organics solvents, detergents, (benzene, toluene) Toxic metals (mercury, lead, arsenic) Plastisizers (phthlates: DHEP, DEHA) Insulators (asbestos, PCBs) 3. Combustion/Incineration Pollutants (dioxins, mercury) 4. Synthetic Medications (groundwater study) 5. Food Additives and Preparation Byproducts (preservatives, colorings, polycyclic aromatic hydrocarbons) 6. Cosmetic Additives (nail polish, hair sprays, perfumes)


Environmental Threats: Environmental Threats Concepts Most not anticipated when products created or during regulatory processes Toxic Substances Control Act 1979 58,000 chemicals in use were grandfathered in 32,550 applications since 1979: 1,662 withdrawn after EPA requested changes, handful rejected Full toxicity data exist on about 25% chemicals found in everyday consumer products Unlike drugs, process assumes chemicals are safe until proven unsafe Europe’s new chemical policy effective 2006: REACH – Registration, Evaluation, and Authorization of Chemicals


Environmental Threats: Environmental Threats Concepts Toxicity determined by acute exposure Chronic low level exposure not studied Difficult to determine exposure, causality Genetically different people have different risks Multiple sources of exposures may have synergistic effects Persistent Organic Pollutants (POPs) Bioaccumulation Rachel Carson, Silent Spring 1962


Endocrine Disruptors: Endocrine Disruptors Chemicals that act like hormones Estrogen signals cells to grow and proliferate Estrogen-like chemical may tell cells to grow and proliferate perhaps without regulation Adverse reproductive effects seen in birds and reptiles Examples DES, a pharmaceutical Endocrine Disruptor 1940 – 1970s used to decrease miscarriage Increased risk of vaginal cancer in female offspring


Endocrine Disruptors: Endocrine Disruptors Examples (con’t) Premature thelarch in Puerto Rico (1969-2001 data) 7,600 cases of premature sexual development in girls 6 -24 months old 8 cases/1,000 births (highest rate ever recorded) Suspected: phthlate esters (plastisizers) found in packaging for storing and preserving foods; chlorinated pesticides Feminization of male trout in Great Lakes associated with high levels of PCBs in water samples Malformations in the sexual organs of alligators in Lake A Florida where high concentrations of DDT and its degradation products have been detected


Endocrine Disruptors: Endocrine Disruptors Examples Male frogs exposed to Atrazine became hermaphrodites Atrazine widely used as herbicide in US Applied to corn and sorghum fields in Spring to prevent emergent weeds Runoff into streams is high in Spring when tadpoles are developing Hermaphrodites created at exposure 30 times lower than the maximum contamination limit set by the EPA for drinking water Field studies reproduced in lab with same results


Endocrine Disruptors: Endocrine Disruptors Examples PBDE – polybromated diphenylethers Flame retardants; created to protect highly flammable polyurethane products Not bound well to products, it migrates onto household dust Very fat soluble Found in soil, chicken, pork, sausage, dairy products, sewage sludge, crop fertilizer, fresh and saltwater fish, wild birds, on computer and desk surfaces, in clothes dryer lint, insides of residential windows, human fetal liver tissue, and breast milk (American women have the highest levels in the world; levels double every 5 years) Causes brain and thyroid damage in rats Banned in Europe: Heavy exposure at Ground Zero 9/11


Environmental Toxins: Environmental Toxins Symptoms of Chronic Exposure Recurrent headache Muscle aches and weakness Numbness, tingling of extremities Brain fog Recurrent infections Infertility


Environmental Toxins: Environmental Toxins Disorders linked to chronic exposures Chronic fatigue syndrome Fibromyalgia Multiple chemical sensitivity Allergies, asthma Atherosclerosis Cancer Autoimmune disease Inflammatory bowel disease Endocrine disruption (hypothyroid, breast cancer) Reproductive disporders Chronic dermatitis Neurogenerative disorders (Parkinson’s, MS) Autism and ASDs


Environmental Threats: Environmental Threats Why don’t we hear about this? Conflicts of interest Government protection of industry No financial incentive to do the research needed Research is difficult Mixed messages Health effects of passive smoking Mid 1990’s, authorities concluded; increased lung cancer in adults and respiratory problems in kids; also increased risk CVD and SIDS Still some published review articles reported no ill health effects 1998 review of 106 review articles 31 written by tobacco-affiliated authors 94% reported no ill health effects 75 written by scientists unaffiliated with tobacco industry 87% reported passive smoking is harmful


What to Do: What to Do Vote with your wallet Form community advocacy groups Write your congressman Learn about the “green” / sustainability movements in your profession Speak up anytime you can


What to Do: What to Do Test for toxins Test your detoxification genes Decrease exposure Safe handling of chemicals Integrated pest management Avoid cigarette smoke Eat organic foods Drink purified water Lower intake of large fatty fish Safe grilling Nontoxic building materials and carpets Natural cosmetics, nail polishes, fragrances Clean indoor air with plants and ionizers Avoid bare skin contact with CCA wood Don’t microwave food in plastic or with plastic wrap


What to Do: What to Do Increase protection Exercise daily Increase antioxidant reserve Increase phase II detoxification Encourage beneficial GI flora Increase elimination Yoga, massage Increase hydration Optimize bowel transit time with fiber, exercise Infrared sauna Create and attract joyful, happy and loving energy


Dietary Threats: Dietary Threats High Fructose Corn Syrup


First Line Therapy: First Line Therapy Body Composition Analysis – BIA Provides accurate, individualized data Used to start and monitor lifestyle modification program Physician supervised nutritional and exercise program: low glycemic index foods, easy to follow, convenient Regular (weekly) follow-up visits with nurse; BIA monitoring and coaching for success Goal is to improve well-being, decrease sarcopenic obesity, eliminate metabolic syndrome, lower cholesterol and blood sugar, improve overall health


Resources: Resources Environmental Working Group www.ewg.org Cornell University Program on Breast Cancer and Environmental Risk Factors www.cfe.cornell.edu/bcerf/ Breast Cancer Fund www.breastcancerfund.org Our Stolen Future www.ourstolenfuture.org Pesticide Action Network of North America www.panna.org US EPA Office of Pesticide Programs www.epa.gov/pesticides Physicians for Social Responsibility www.envirohealthaction.org American Institute for Cancer Research www.aicr.org National Institute of Environmental Health Sciences www.niehs.nih.gov Union of Concerned Scientists www.ucsusa.org