AllergiesPersonal Care Products
Michelle Perro, MD, DHom, Anne Marie Fine, ND and Bonnie Nedrow, ND
Last month, Dr. Perro focused on quaternary ammonium compounds (QACs or quats) used in many hand sanitizers and the concerning health impacts of this class of chemicals. In summary, quats are some of the most commonly used disinfectants in the food industry. Quats are associated in humans with atopic disease such as asthma and dermatitis, with documented cases of eye/mucous membrane injuries and ingestion injuries. The atopic disease is driven by inflammatory interleukins, which are increased with quat exposure. Animal studies show an increase in fetal death, low birth weight, small for gestational age, preterm labor, infertility and neural tube defects.
This extensive list of reproductive effects that were epigenetic in nature, should cause pause for us all as we consider multigeneration effects of exposure to these compounds. In a small human study, immune function was altered by quat as measured with blood levels. This study of 43 people found decreases in mitochondrial function and altered cholesterol synthesis.
What seems to be missing here is the Precautionary Principle. In some areas of the US, young children in the developmental window are being sprayed with these compounds upon entering school. World-wide, children, lactating mothers, pregnant women and men and women in the preconception window are all being exposed minimally through application to their hands with subsequent absorption into the bloodstream.
Beyond exposure to quats is the exposure to an array of other concerning chemicals. The combined and potentially synergistic interactions between these chemicals have often unknown consequences. This article will focus on those compounds and outline safer alternatives for disinfection and sanitization that we, in the environmental medicine community, should champion.
PFAS Ingredients found in Hand Sanitizers
The finding of PFAS in hand sanitizers is worrisome[1] as per- or poly-fluorinated substances (PFASs) are persistent in the environment to the extent that they have been nicknamed the Forever Chemicals. Besides hand sanitizers, products that contain PFAS include nonstick cookware, food wrappers, water-repellent clothing, stain-resistant fabrics, carpets, firefighting foams and more. Exposure to PFASs are linked to testicular cancer, liver disease, thyroid disease, infertility and hypertension. If you have not had a chance to see the film, The Devil We Know, please watch it here.
Of particular concern of serious health effects in 2021, toxicologists have considered that exposure to PFAS may increase a person’s likelihood of developing severe COVID-19. A number of studies in the scientific literature have now linked elevated PFAS levels with immune system suppression, as well as decreased response to vaccines. Philippe Grandjean, an adjunct environmental health professor at Harvard University, and colleagues have found that higher levels of the PFAS perfluorobutanoic acid (PFBA) in the blood are associated with increased severity of COVID-19 infections. PFBA, a breakdown product of other PFAS chemicals, is known to accumulate in the lungs more than any other compound in its class[2].
BPA and Hand Sanitizers
According to the work of BPA scientist, Dr. Frederick vom Saal, alcohol is one of the penetration enhancers added to hand sanitizers[2]. In his work he demonstrated that when someone uses hand sanitizers before touching a thermal receipt, the absorption of BPA is up to 100 x higher.
BPA is the poster child for endocrine disruption. It changes thyroid hormone levels, is the #1 obesogen, contributes to diabetes, obesity, breast and prostate cancer, infertility, recurrent miscarriages and all-cause mortality. A 2015 study of 268 women in China demonstrated a significant risk of increased recurrent miscarriages for higher urinary BPA levels[3].
Phthalates
Phthalates are a group of chemicals called plasticizers that are also endocrine disruptors. One of the places they are found are in fragrances, as a fragrance fixative (Phthalates are the chemical used in fragrances to make them last.) They are not listed on labels of hand sanitizers and other personal care products. Health effects of phthalates are extensive and include endocrine disruption, thyroid disruption, decreased testosterone, diabetogenic and obesogenic effects and reproductive toxicant. Phthalates are associated with the following diseases: Breast cancer, testicular dysgenesis, autistic traits in males, asthma, allergies and eczema[4].
The way to know if a product contains phthalates is to look on the label for the word fragrance or parfum. Fragrances are considered trade secrets and so the list of ingredients that make up the formulation are proprietary and not necessarily listed on the label.
Parabens
Parabens are another common personal care product ingredient found in many hand sanitizers, although many personal care products are presently being formulated without them. Unlike phthalates, parabens will be listed on the label. The many negative health effects of parabens include estrogen agonist, androgen antagonist, inhibitor of sulfotransferase enzymes (crucial detox pathway), genotoxic activity, potentiate UVB damage through reactive oxygen species and nitric oxide. Diseases associated with paraben exposure include infertility with reduced antral follicle numbers, shortened menstrual cycles, preterm births, decreased weight at birth and cancer[5].
Safer Alternatives
The list of safer choices includes soap and water, hydrogen peroxide, thymol, lactic acid, citric acid, caprylic acid and some of the essential oils (i.e. pine oil). The commonly used alcohol preparations are in themselves a non-toxic solution. However, they can cause increased absorption of other toxic substances such as BPAs, known endocrine disrupting compounds.
How Does Soap Work?
When hands are washed with soap and water, any microorganisms on the skin are surrounded by soap molecules. Soap molecules are hydrophobic and have a hybrid design, meaning their heads bond to water while their tails are repelled by it. This allows their antimicrobial properties to work in tandem with water molecules, binding their bacteria-fighting lather to the oils and fats in whatever harmful substances our hands have come into contact with.
The fragments of debris and destroyed viral elements are then trapped by soap within tiny bubbles called micelles, which wash away in water. Soap and water work together to deliver maximum germ-killing power. Once soap molecules have breached the lipid layers of most viruses and microbes and broken them apart, water comes in to remove them from the skin entirely. According to the FDA, hand washing is best, but hand sanitizers are indicated when hand washing is not possible.
Advice for our patients
Habits
- Whenever possible, wash your hands with soap and water instead of using a hand sanitizer.
- Do not handle receipts, particularly if you just sanitized your hands with an alcohol based hand sanitizer.
- Carry your own hand sanitizer to avoid using unknown products at stores and events.
Read the label and don’t buy products with:
- Fragrances
- Parabens
- PFASs
Community
- Local movements by parents to create a less toxic approach to hygiene in our schools.
- Request your local store to carry less toxic hand sanitizer options.
Resources
- Made Safe, www.madesafe.org
- Woman Voices for the Earth, https://www.womensvoices.org/
- Beyond Pesticides, https://www.beyondpesticieds.org
References:
[1] https://www.documentcloud.org/documents/7333622-Foaming-Alcohol-Hand-Sanitizer.html
[2] Hormann AM, Vom Saal FS, Nagel SC, Stahlhut RW, Moyer CL, Ellersieck MR, Welshons WV, Toutain PL, Taylor JA. Holding thermal receipt paper and eating food after using hand sanitizer results in high serum bioactive and urine total levels of bisphenol A (BPA). PLoS One. 2014 Oct 22;9(10):e110509. doi: 10.1371/journal.pone.0110509. PMID: 25337790; PMCID: PMC4206219.
(3) https://www.chemistryworld.com/news/pfas-exposure-found-to-increase-risk-of-severe-covid-19/4012992.article?ct=t(RSS_EMAIL_CAMPAIGN)
[4] Shen Y, Zheng Y, Jiang J, Liu Y, Luo X, Shen Z, Chen X, Wang Y, Dai Y, Zhao J, Liang H, Chen A, Yuan W. Higher urinary bisphenol A concentration is associated with unexplained recurrent miscarriage risk: evidence from a case-control study in eastern China. PLoS One. 2015 May 26;10(5):e0127886. doi: 10.1371/journal.pone.0127886. PMID: 26011304; PMCID: PMC4444137.
[5] PMIDs 28800472, 29206197, 28388912, 30588877, 32073305, 31996892
[5] PMID 18484575, 25047802, 28356401
