The (Not So) Hidden Health Effects of Fast Fashion

Unveiling the Environmental and Health Costs of Trendy, Affordable Clothing

By Nozomi Gonzalez, ND

Introduction

We live in one of the trendiest times in history. Trends in fashion have existed almost as long as humans have worn clothes, but for most of the past, only a select number of people had the means to participate. Until the early 19^th century, clothing was handmade at home or made-to-order for those who could afford it. Clothing was created with natural fibers at a sustainable rate by individual people. Because it was expensive and time-consuming to produce, you only replaced your clothes when worn out. However, the standardization of sizes, the Industrial Revolution, and the creation of the sewing machine in 1829 led to the advent of mass production of clothing.¹ Ready-to-wear clothing began being sold at department stores, making clothes cheaper, faster, and more attainable than ever before. By the 1920s, fashion trends were accessible to the public, rather than just the elite, for the first time in history. In just 50 years, this industry increased from today’s equivalent of $333 million to $20 billion.¹ By 1951, 90% of garments purchased in the United States were ready-made.²

What is Fast Fashion?

Today, half the fashion industry is considered ‘fast fashion.’³  Fast fashion, coined in the 1990s, refers to an accelerated production model of trendy and low-quality clothing focused on convenience, accessibility, and affordability. ⁴ It perpetuates and takes advantage of a culture of overconsumption, short attention spans, and hyper-accelerated fashion trends, so-called ‘microtrends,’ to sell clothes at rates never seen before. Long gone are the days of fastidiously handmade pieces that lasted a lifetime. Today, it takes 10 days to turn a design into a garment, and 100 billion new garments are manufactured yearly. ^5,6 Though the world is an avid consumer of clothes – 80 billion pieces are sold annually – half of the clothes in closets never get worn, the pieces that are worn are considered ‘old’ after just 1 to 2 wears, and are thrown out after wearing 7 to 10 times.^7,8 

Mass-produced clothing has made fashion trends accessible to anyone with a few dollars – at a dire environmental and health cost. Fast fashion is excessively affordable to consumers because it cuts costs in production wherever possible. This has translated to poor labor practices, questionable and increasingly resource-heavy textile creation, and significant pollution. 

Health Effects

Fashion is now considered one of the largest polluters in the world, responsible for 4% of the world’s total greenhouse gas emissions and 10% of the world’s total annual carbon footprint.^9,10 Part of the problem lies in transportation. Though the United States is the largest consumer of clothing and textiles globally, almost all the clothing purchased here is produced in a different country.¹¹  Shein, a global e-commerce fast fashion platform based out of Singapore with production in China, encompasses 50% of the fast fashion market share in the U.S. – more than the next top 5 competitors combined.^12,13 To keep up with the demand of quickly changing styles, Shein relies on air shipping to send hundreds of thousands of individually addressed packages daily. In fact, 38% of Shein’s climate footprint relies on this transportation method.⁵ Unfortunately, reliance on aviation is hardly a long-term solution. There is mounting evidence of the health effects related to aviation fuel and air pollutants,  including respiratory conditions, cardiovascular disease, dementia, and even lead toxicity and cancer.¹⁴ Some studies have concluded that aviation emissions are responsible for over 50,000 premature deaths yearly.¹⁵ 

Textile production is an even more significant contributor to fast fashion’s climate footprint. Fast fashion companies largely use and produce cheap synthetic fibers – specifically polyester – to create their low-cost pieces. Production of polyester alone was responsible for the emission of over 700 million tons of carbon dioxide in 2015 and is expected to double by 2030.¹⁶  Aside from the apparent health repercussions of climate change due to greenhouse emissions, the air pollutants themselves pose a serious health risk.  These effects are due in part to ozone exposure and in part to particulate matter exposure.¹⁵ Particulate matter emitted from burning fossil fuels has been linked to neurodevelopmental disorders, reductions in brain white matter surface, and increased hospitalizations due to respiratory issues.¹⁷ Furthermore, air pollution is considered the largest environmental cause of premature death in the world, estimated to be responsible for 16% of deaths worldwide.¹⁸ Most of these occur in the low- and middle-income countries where fast fashion is produced.¹⁸ 

The textiles that are the product of this significant pollution are primarily synthetic fibers such as elastane, nylon, and polyester; the latter make up over half of all fibers used to produce these clothes.¹³ Shein’s clothing is comprised of 76% polyester.⁵ These low-cost materials can lead to poorer health outcomes, particularly for our patients who struggle with dermatitis. Polyester and other tightly woven fabrics have been shown to promote overall trans epidermal water loss on the skin. They are often produced through chemical processes involving petroleum, which may be irritating.¹⁹ The dyes used to color synthetic fibers are also more likely to be associated with contact dermatitis than those used to color natural fibers.²⁰ 

Even for those in whom dermatitis is not an issue, cheaply made fabrics present a significant toxic risk. Several reports have independently tested clothing from fast fashion brands and found hazardous chemicals and heavy metals at levels of concern. These toxicants – phthalates, perfluoroalkoxy alkanes (PFAs), bisphenol A (BPA), nickel, and lead – have been found in everything from children’s clothing to items as intimate as underwear.^21–24 Consumers are at risk of exposure to these toxicants through constant and direct contact with the textiles on the skin and through inhalation or ingestion of dust released from them.  Concerningly, studies already show the potential for toxicants to permeate deeper layers of the skin and suggest eventual systemic absorption through clothing exposure.²⁵ 

Polyester and synthetic fibers continue to wreak havoc even if they are not being worn. Polyester fibers comprise a long chain of polymers, the most common of which is polyethylene terephthalate (PET).²⁶ Polymers, synthesized in part for their durability, are estimated to take years or centuries to break down entirely.²⁷ In the meantime, they degrade into smaller and smaller particles that infiltrate our oceans, soil, air, and body.  These particles, known as microplastics, are tiny pieces of plastic measuring as small as 100 nanometers and have big health concerns. Synthetic fiber use in clothing has contributed to a rise in microplastic fiber release, particularly from laundering. Over 550,000 tons of plastic microfibers – equivalent to more than 50 billion plastic water bottles – are estimated to pollute the ocean yearly from washing.¹⁰  There is mounting evidence regarding the health effects of microplastics and suggestions that humans consume significantly more than previously thought. Microplastics have been found to elicit health effects through a broad range of mechanisms and organ systems, such as causing loss of integrity of mitochondria, lipid metabolism disturbance, and gut microbiota dysbiosis.²⁸  Studies have even suggested that these tiny plastics can cross the blood-brain barrier and accumulate in microglial cells, eventually triggering cell death.²⁹ 

Interventions

Fortunately, many naturopathic detoxification strategies can mitigate multiple of the health effects secondary to fast fashion’s rise. Vegetables from the brassica family, for example, can protect against air particulate matter and support liver glucuronidation necessary for removing xenobiotics.³⁰ Probiotics have emerging research as a potential therapy to bind heavy metals, eliminate BPA, and counteract the effects of microplastics through actions such as strengthening the blood-brain barrier and improving the integrity of tight junction proteins.^31–33 N-acetylcysteine is well known for its respiratory and liver-supportive actions. It is an established antioxidant and mucolytic, especially for chronic obstructive respiratory disease patients, and is the primary antidote for acetaminophen overdose.^34,35 What may be less known is its rising prospect for use in heavy metal chelation. Studies have shown its ability to increase the excretion of mercury and lead, and, importantly, without depletion of other essential metals such as iron and magnesium, with significantly fewer side effects than traditional chelators.³⁶ Furthermore, it can counteract neurodegenerative changes and increase mitochondrial functioning that may be impacted by microplastic accumulation.^37,38 Sauna therapy can increase skin hydration and stability of the epidermal barrier, reduce the risk of respiratory disease, and facilitate the excretion of metals and toxicants through perspiration.^39–41

The best protection against fast fashion’s impact is an overhaul of the culture that stimulates the desire to shop excessively. Our second-best protection is educating ourselves on its risks and avoiding its products. Many endeavors are already underway to make this effort easier for the consumer. For example, in response to the overwhelming evidence of the negative health impacts of fast fashion, some brands have based their mission on selling only clothing made with recycled or recyclable materials. Standardized certifications now endorse clothing that has been produced with reduced environmental impact, such as Bluesign and B Corp.  Numerous organizations generate research and resources intending to eliminate fashion waste and pollution. For example, the Ellen MacArthur Foundation champions the ‘circular economy’ as a method of fully recycling materials.⁴² The United Nations established the UN Alliance for Sustainable Fashion in 2019, intending to collaborate with existing environmental initiatives around the world, one of which includes the signing of 100 brands committed to reducing greenhouse gases by 30% by 2030.⁴³ France, home to the fashion capital of the world, recently had a bill seeking penalties on fast fashion products passed by the lower house of parliament.⁴⁴ 

In conclusion

Fast fashion has gained popularity as a means of making trendy clothing affordable to a larger population than ever before. Unfortunately, low-cost clothing made from problematic production practices comes at a high cost to our health. We eventually pay, whether directly through exposure to toxicants or indirectly through air pollutants from increased air travel and plastic microfiber accumulation. As healthcare providers, we must become aware of these risks and arm ourselves and our patients with this knowledge to combat its deleterious effects best.

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