Phthalates Linked to 100,000 Yearly Deaths
Air Date: Week of October 15, 2021
Often, produce is wrapped in plastic which contains harmful chemicals. Phthalates used in many products to make plastics more flexible then are carried along by the food and we can easily ingest them. (Photo by Simmremmai, Wikimedia Commons, CC BY-SA 3.0)
Phthalates are a group of chemicals commonly found in plastics, to the extent that they’re often referred to as “everywhere chemicals” with a wide variety of health effects. Detailed statistical analysis conducted for a new study in the US finds that people aged 55-64 with documented phthalate exposure a decade earlier died at a rate of over 100,000 people a year, most commonly from cardiovascular disease. Persons in other age groups aren’t exempt from risk; indeed phthalates are considered by some to pose the greatest risk to children in the womb and during early years of development, though so far other studies have been more limited in scope. Living on Earth’s Bobby Bascomb talks to Dr. Leonardo Trasande of NYU, the lead researcher on the newly published study, about how to avoid unnecessary exposure to these chemicals that can sometimes seem unavoidable.
CURWOOD: I’s Living on Earth I’m Steve Curwood.
A new study published in the journal Environmental Pollution found phthalate chemicals are associated with more than 100,000 premature deaths each year in the US. Researchers looked at National Health data which included phthalate levels in urine and cause of death. They correlated high phthalate levels with elevated cardiac death rates in people aged 55 to 64. A number of sources indicate phthalates can be found in countless consumer products including food packaging, shampoo, children’s toys, flooring, perfume, detergents, the list goes on and on. The health problems associated with phthalates include obesity, cancer, asthma, and heart problems just to name a few. Phthalates are dangerous because they can act like hormones in the body, and fetuses and children are especially sensitive to hormone disruption during development. Phthalates interfere with testosterone, which is present in both men and women, and exposure during pregnancy has been linked genital development problems and autism traits in boys. But the health effects of these chemicals aren’t easy to quantify so this new study has remarkable statistical clarity about they may contribute to early death for people in middle age. Leonardo Trasanade is lead author of the study, professor of pediatrics, and directs the NYU Center for the investigation of environmental hazards. He spoke with Living on Earth’s Bobby Bascomb.
BASCOMB: So, it would be unethical to expose some people to chemicals that we know are potentially toxic. So, how did you go about this research?
TRASANDE: We put together data from the National Health and Nutrition Examination Survey, a nationally representative sample of people who were enrolled between 2001 and 2010, and we linked their data to the National Death Index. Which not only identifies, unfortunately, when people pass away, but it identifies causes of death that are listed on the death certificate. And so we looked at levels of phthalates in urine of these adults and related them to the time of death, or whether they died at all.
BASCOMB: And what were your basic findings?
TRASANDE: We found that levels of phthalates were consistently associated with increases in mortality. And particularly, it was a specific subgroup of phthalates, the phthalates that are typically found in food packaging. They're these soft wraps that you see in healthy food as well as unhealthy food. By the way, we controlled for diet and physical activity, and tobacco smoke exposure, which is important. We understand those are categories of exposures that are not good for you, in some cases, and are important to control for when you do these kinds of studies.
BASCOMB: And just to be clear, the people in this study, they weren't working in chemical manufacturing or anything like that, their exposure came from ordinary household products.
TRASANDE: Yes, unfortunately, these are everywhere chemicals. These are chemicals that have come into such widespread use because of their utility, that they're in personal care products, cosmetics, food packaging. These are chemicals you touch and get into your skin and absorb into your body that way. You inhale them because they can get into dust that accumulates in homes. And because you eat on the go, especially, you can eat food that comes into contact with these chemicals, and the chemicals come along for the ride.
BASCOMB: And one of your key findings, as I understand it, is that phthalates may contribute to roughly 100,000 premature deaths each year in the US. What did the people in your study actually die of? We're not talking about, you know, acute toxicity or something here.
TRASANDE: That's right, we're talking in particular, the signal was strongest in relationship to heart disease, and ultimately death from heart disease. Now, we can't say definitively or in more detail whether it was heart attacks or stroke, and it was only one of the metabolites for which the signal was significant enough to meet our threshold for calling it important. The overall trend, though, is that across the US population, this equates to 100,000 55 to 64 year olds dying early. And that's in peak earning years. And when adults die early in those peak earning years that has an impact on our economy. The lost economic productivity we added up totaled $40 billion. That's an annual cost and so far as these exposures continue at current levels.
BASCOMB: And you found that these people were dying prematurely of heart related problems, but as I understand it, phthalates are known to cause a whole host of health concerns. Can you tell us a bit about that, please?
TRASANDE: Yes, of course, this is a single study. And when you observe a single study, you can't interpret that definitively to say for certain that it's linked to mortality. But the reality is that phthalates have quite the rap sheet across multiple populations, and multiple disease endpoints. Phthalates are known in the laboratory to disrupt metabolism and the hormones in our bodies, our basic signaling molecules, and they literally make us sicker and fatter. They, by disrupting those hormones in our bodies, they can contribute to obesity, and they can contribute to diabetes.
BASCOMB: Now, from what I understand previous studies have phthalates have found that this suite of chemicals are especially problematic for the endocrine system, which you just mentioned, and testosterone levels actually in men. Can you talk a bit about that also, please?
TRASANDE: So we know that the lower molecular weight phthalates, the phthalates used in personal care products, cosmetics, and such, antagonize the male sex hormone testosterone. And low T is either a predictor for or a marker of adult cardiovascular disease. And we've actually identified 10s of 1000s of men before this study who indirectly died because phthalates reduced their testosterone levels. We were expecting in this study, that only the men were going to have increases in death for that reason, because we thought, well, we know phthalates antagonize the male sex hormone. Lo and behold, we saw two things that were striking. It wasn't the phthalates used in cosmetics and personal care products that were associated with death, it was the food packaging, these higher molecular weight phthalates that were associated with death. And then when we looked further, it was not the men that were dying, it was the men and the women who were dying early in this pattern that appeared to be related to heart disease. Now, that's not necessarily so surprising because phthalates also cause inflammation in the blood vessels. And inflammation in the coronary arteries is not a good thing, it narrows the coronary arteries, you don't get as much oxygen to the heart. And that's what sets you up for heart attacks and even stroke.
BASCOMB: Your study looked at exposure and health outcomes in people ages 55 to 64. Why look at that age group specifically?
TRASANDE: Well, in this study, we were only able to look at a single time point of measurement of the chemical exposure related to heart disease, and well, to death from heart disease and deaths due to cancer across 10 years of time. So there was a limit to how much we could interpret the data. And we wanted to be really careful. It seemed that the effects of these chemicals were concentrated in older populations. So there wasn't a difference in the degree of association. And so when we focus these estimates, unfortunately, we focused on the population in whom, you see earlier, heart disease.
BASCOMB: Now, how widely were phthalates used in household products, when people in the age range were coming of age? I'm wondering if they were exposed as children?
TRASANDE: Well, they were because these chemicals came on the scene, in the 1920s. The great news is these are not chemicals that are forever chemicals. What's important here about these plasticizer exposures, these phthalates chemical exposures, is that they tend to wash out of the body. They have a short half life. So about half of it gets out in two to three days. That's why studies have demonstrated easily in low income, as well as high income populations, that you can reduce your level in the urine quickly by taking safe and simple steps to reduce these exposures.
BASCOMB: Well, what can consumers do to minimize their phthalate exposure in light of this and you know many other studies that suggest there are potential health hazards here?
TRASANDE: So, there are safe and simple steps we can all take. They don't have to break the bank, they don't require a PhD in chemistry. Avoiding the use of plastic containers when possible, is important. Using glass or stainless steel is a great alternative. If you need to use plastic, particularly, please don't microwave or machine dish wash the plastic. That will facilitate the resorption of the chemical that's used in the lining that reabsorbs into food and gets into our bodies. And there's a recycling number on the bottom of the plastic bottle for a reason. The ones to avoid are three, six, and seven. Three are for the phthalates we're talking about here. Six is for styrene, a known carcinogen. And seven are for bisphenols. You all have covered BPA and its its relatives, and have shown how many health effects, not unlike what we're seeing here. In fact, we've published a study before this, showing early death in relationship to BPA. The phthalates we found here had their effects even when we added in BPA into our model so these are separate effects. And that doesn't mean that there isn't hope going forward for our health if we do the right thing now.
BASCOMB: Leonardo Trasande is lead author of the report and Professor of Pediatrics. He directs the NYU Center for the Investigation of Environmental Hazards, and is author of Sicker, Fatter, Poorer. Leonardo Trasande, thank you so much for taking the time with me today.
TRASANDE: It was a joy. Thanks again.
CURWOOD: So, Bobby, this new study is really pretty troubling, considering how so common these products are.
BASCOMB: Yes, I mean they are called everywhere chemicals for a reason.
And after working on this story I started digging a little to figure out what people can do to avoid phthalates.
CURWOOD: Oh, and what did you find?
BASCOMB: Well starting with personal care products like cosmetics and shampoo.
You won’t see phthalates on a list of ingredients but we do know that they are used to make fragrances last longer, so if you want to avoid these chemicals you need to look for products that don’t include the word “fragrance” in the list of ingredients.
CURWOOD: Uh oh Does that mean I have to skip aftershave?
BASCOMB: Well maybe. It does mean you should dig a little deeper into the products you use to see what’s included in their fragrances.
CURWOOD: Hmmm….well, what about phthalates in plastics?
BASCOMB: Well, as Dr. Trasande mentioned, phthalates are in number 3 plastics, which is polyvinyl chloride or PVC. You can find that commonly in pipes and window fittings as well as some car parts, thermal insulation, and medical tubbing. It’s also in bubble wrap, shower curtains and some food trays.
CURWOOD: And what about food packaging?
BASCOMB: Yeah. If you look very closely at the bottom of most plastic containers you see the three little arrows that form a circle and inside that is typically a number. You can sometimes find the number three on soft, flexible plastic like clear food wrap, the kind that your meat might come wrapped in. It’s also sometimes in cooking bottles and cleaner bottles.
CURWOOD: Ok. Dr. Trasande also mentioned a couple of other types of plastic that are associated with health concerns. What did you find there?
BASCOMB: Yeah, number 6 plastic contains styrene, or Styrofoam, which is a possible human carcinogen. That’s used in insulation and Styrofoam takeout food containers, and hot drink cups. Number 7 is a kind of a catch all for any plastics that didn’t fit in categories one through 6. So, that can include biodegradable plastics, which can also contain toxic chemicals according to a study published in 2020. Number 7 also includes a group of plastics which can contain Bisphenol A, or BPA, which is a known endocrine disruptor. BPA was commonly in things like hard plastic water bottles, baby bottles, and sippy cups though public pressure has forced some companies to phase out BPA in their products. So, those are the chemicals of concern in plastic and generally how to avoid them. But that’s saying nothing about micro plastics that we unwittingly ingest.
And of course, less than 10 percent of plastic is recycled in this country.
So that means the vast majority is being incinerated, going in a landfill, or washing into rivers and ultimately the ocean. So, really it’s best to avoid disposable plastics as much as possible for many reasons.
CURWOOD: Indeed! And now in addition to generalized concerns we have fairly hard statistical evidence that demonstrates how death is associated with phthalates at least one age cohort.
BASCOMB: Hopefully more research will quantify the risks for everyone with enough rigor to get these toxins regulated and out of our environment.
CURWOOD: Alright, well thanks, Bobby, for looking into this.
BASCOMB: Sure thing, Steve.
CURWOOD: Living on Earth’s Bobby Bascomb
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