As a medical student in the late 1990s, I learned about the effects of childhood lead exposure on the developing brain, and of air pollution in children with asthma. Environmental health questions have not yet found their way into the medical board exams, yet a large body of literature tells us that the endocrine system is exquisitely vulnerable to the effects of synthetic chemicals commonly used in furniture, agriculture, cookware, food packaging materials, cosmetics, and personal care products.
Scientific statements from the Endocrine Society, American Academy of Pediatrics, International Federation of Gynecology and Obstetrics, and World Health Organization and United Nations Environment Programme describe the role that these preventable exposures have in a variety of chronic conditions, such as cognitive deficits and developmental disabilities, obesity, diabetes, endometriosis, fibroids, infertility, birth defects, prematurity, and even cardiovascular disease.
I remember being taught the adage that "only the dose makes the poison," which is akin to the notion that we should consume everything in moderation. This Paracelsian paradigm stood for 500 years even though hundreds of studies suggest that timing, other coexisting exposures, genetics, and many other factors can produce serious health consequences at the lowest levels of exposure.
As clinicians, we might react with a sense of powerlessness because we have no medication or treatment to counteract past exposures as we do with lead poisoning (ie, chelation). There is much opportunity for prevention, however, especially because many of these exposures have been proven to dissipate within 1-3 days if certain measures are taken.
There are safe and simple steps to help avoid exposure to endocrine-disrupting chemicals. In the context of the busy and ever shortening clinical visit, the following tips shouldn't take more than a couple of minutes to discuss.
1. Mind your cookware.
Nonstick pans contain perfluoroalkyl substances (best known as PFAS). Patients may have heard of the movie Dark Waters, which documents the consequences of industrial water contamination with PFAS. These chemicals have been shown to slow metabolic rate and promote the return of weight after a successful dietary intervention. Cast iron and stainless steel cookware are good alternatives.
2. Open your windows and use a wet mop.
Flame retardants and other persistent organic pollutants used in electronics and other products accumulate in household dust and can impair thyroid function. Using a wet mop will help to better rid the house of these pollutants. Patients should also be on the lookout when buying new furniture. A California law now requires disclosure when flame retardants are added to upholstery.
3. Eat organic.
Organophosphate pesticides are well-known thyroid disruptors, and multiple studies have shown their effects on cognitive potential. Some studies have suggested associations with an increased risk for cancer.
Eating organic has become much less expensive because of growing market share, such that the big-box stores are displaying organic and conventional products side by side with competitive pricing. I focus on prioritizing organic leafy greens and vegetables, where pesticides are more likely to be ingested, and place foods like avocados, which have a protective outer rind, further down the list.
4. Avoid canned foods.
Bisphenols are estrogenic, antagonize adiponectin, and make fat cells larger. Studies suggest that stopping canned-food consumption can decrease bisphenol levels in urine as much as 90% or more. BPA-free cans are misleading in many cases because there are 40 or so replacement bisphenols. What little we know about one BPS suggests similar estrogenicity and toxicity to embryos, as well as persistence in the environment. A doubling of type 2 diabetes risk was also observed among adults with higher levels of BPS in their urine.
5. Don't microwave or machine-wash plastics.
Phthalates commonly found in food packaging can negatively influence lipid and carbohydrate metabolism, with exposure linked to increased weight gain over multiple years. The "microwave safe" label was intended for gross misshaping or warping. The reality is that the polymers break down at the microscopic level and get into food, and the noncovalently bound additives are mostly not tested.
I've learned the hard way that giving too many suggestions can overwhelm patients, even those with the best intentions. My advice is to prioritize the first two tips; write them down (prescription pad optional) and follow up at each visit to see how families are doing. And perhaps you and your loved ones will see the benefits at home too!
Leonardo Trasande, MD, MPP, is the Jim G. Hendrick, MD, Professor of pediatrics and directs the NYU Center for the Investigation of Environmental Hazards. His recent book, Sicker, Fatter, Poorer: The Urgent Threat of Hormone-Disrupting Chemicals on Our Health and Future...and What We Can Do About It , describes the effects of synthetic chemicals that disrupt hormones on our health.
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Cite this: Avoiding Endocrine-Disrupting Chemicals: 5 Tips - Medscape - Feb 07, 2020.
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