Environmental and Dietary Threats to Women’s Health Kathleen Thomsen MD, MPH Assistant Clinical Professor, UMDNJ Robert Wood Johnson Medical School New

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 WellnessPennington, NJ

A Typical Days Exposure

• Morning Sundries

– Shampoo and Shower

– Brush Teeth

– Apply Make-up


• 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


• 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


• 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


• 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


• 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


• 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


• 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


• 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


• 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


• 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


• 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

–


• 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)


• 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

• 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

• 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 Threats1. Pesticides

InsecticidesHerbicides

2. Industrial Compounds and Chemical ByproductsVolatile 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

• 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


• 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

• 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


• 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


• 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


• 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

• Symptoms of Chronic Exposure– Recurrent headache– Muscle aches and weakness– Numbness, tingling of extremities– Brain fog– Recurrent infections– Infertility

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


• 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 effects1998 review of 106 review articles

31 written by tobacco-affiliated authors94% reported no ill health effects

75 written by scientists unaffiliated with tobacco industry87% reported passive smoking is

harmful

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• 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

• 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

High Fructose Corn Syrup

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• 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

http://www.ewg.org/

http://www.cfe.cornell.edu/bcerf/

http://www.breastcancerfund.org/

http://www.ourstolenfuture.org/

http://www.panna.org/

http://www.epa.gov/pesticides

http://www.envirohealthaction.org/

http://www.aicr.org/

http://www.niehs.nih.gov/

http://www.ucsusa.org/

Documents

Environmental and Dietary Threats to Women’s Health Kathleen Thomsen MD, MPH Assistant Clinical Professor, UMDNJ Robert Wood Johnson Medical School New