Alexsia Priolo, ND

Docere

Personal care products are defined as products used to maintain personal hygiene and beautification. In 2015, US retail sales of beauty products reached an estimated $46.2 billion, and are forecast to continue to grow.¹ The average woman uses 12 personal care products each day, which comprise about 168 ingredients.²

Many of these 168 unique ingredients are known as endocrine-disrupting chemicals (EDCs) due to their interference with hormonal balance. New research has also shown that not only do these chemicals primarily affect fertility, they may also play a part in other conditions such as obesity and coronary heart disease.

This review will specifically focus on the effects of phthalates, bisphenol A, triclosan, and parabens on female health, as these EDCs are most often found in women’s personal care products.

Phthalates

Phthalates are diesters used in plastics to improve elasticity and pliability. Because they are not bound to plastic via covalent bonds, they can be absorbed by the body. They have been found in fluids including blood, breast milk, saliva, and urine. Phthalates can be classified as high-molecular weight (HMW) or low-molecular weight (LMW), based on the types of phthalates and how easily they accumulate within the body.³ HMW phthalates bio-accumulate less than LWM phthalates, although they’re not as prominent in personal care products. LMW phthalates include di-butyl phthalate (DBP), dimethyl phthalate (DMP) and diethyl phthalate (DEP) – all of which have been found in personal care products. Phthalates are considered both estrogenic and anti-androgenic endocrine disruptors that have been shown in animal studies to affect reproductive organs and prenatal development.

A 2009 study⁴ assessed the association between prenatal exposure of phthalates and their effects on children’s heath – specifically anogenital distance, as it is an indicator of in-utero androgenic exposure. The study was conducted using pregnant women planning to undergo amniocentesis. Urine and amniotic fluid were both collected from the pregnant women. Upon the birth of 65 newborns, their birth weight, height, gestational age, and anogenital distance were recorded. It was determined that phthalate exposure of methyl-butyl phthalate (a metabolite of DBP) was linked with a shorter anogenital index (adjusted for weight) in female newborns. According to the study, this may have a wide variety of implications, including delayed onset of puberty and impairments in pituitary function in women.⁴ Conversely, a study by Chou et al,⁵ which studied 89 girls (56 with early puberty), demonstrated a higher urinary level of monomethyl phthalate (MMP, a metabolite of dimethyl phthalate, or DMP) in the premature thelarche when compared to the control group. Therefore, while phthalate exposure does appear to affect female health, more research is needed to determine its exact effects.

In 2012, Olsen et al⁶ examined the relationship between circulating levels of common phthalate metabolites and cardiovascular risk factors in 1016 elderly subjects in Sweden. It was determined that the metabolite MMP (from DMP) was associated with LDL-cholesterol and an increased risk of coronary heart disease.

Bisphenol A

Bisphenol A (BPA) is used in the manufacturing of polycarbonate products and epoxy resins. Humans are most often exposed through oral ingestion of food which has been stored in containers using a BPA-lining.⁷ Exposure may also occur via drinking water as well as contact with thermal paper or household particles. BPA is commonly excreted in the urine, and present in bodily fluids and tissues. It is structurally similar to 17β-estradiol and can therefore bind to estrogen-related receptors. The binding of BPA to these receptors has been shown to promote insulin resistance, adipogenesis, pancreatic beta-cell dysfunction, inflammation, and oxidative stress.

In 2011, Carwile and Michaels⁸ used data from 2747 adults, aged 18-74, from the 2003-2006 National Health and Nutrition Examination Surveys (NHANES) to determine the effects of BPA and the incidence of general and central obesity. Overweight and obesity were defined as a BMI of 25-29 and >30, respectively. They determined that urinary BPA concentrations were associated with general and central obesity. Participants in the upper BPA quartiles had a higher BMI, on average, than those in the lowest BPA quartile.⁸ In addition, they noted that participants in the upper 3 BPA quartiles had a 3.64-3.98-greater waist circumference, as well as increased odds of being classified as abdominally obese, compared to those in the lowest BPA quartile. Although this was seen in both men and women, when stratified by sex, associations were stronger in men.

A 2014 study by Sun et al⁹ examined the association of urinary concentrations of BPA and phthalate metabolites and risk of type 2 diabetes in the Nurses Health Study (NHS) and NHSII cohorts. Urinary samples were collected from both cohorts to determine BPA exposure, and diabetes was diagnosed via questionnaires; a total of 971 confirmed type 2 diabetes cases were included in the study. Moreover, positive correlations were found between both BPA and butyl phthalate concentrations and type 2 diabetes incidence in women enrolled in the NHSII cohort.⁹

Although BPA is mainly present in food products and enters the body through oral ingestion, a recent study from Hormann et al¹⁰ has demonstrated a unique route of entry. After coming into contact with BPA-lined thermal paper (ie, receipts) after using hand sanitizer, BPA absorption into the skin increased. They indicated that some hand sanitizers and other skincare products contain mixtures of chemicals that are also used as dermal penetration enhancers to increase the transdermal delivery of drugs. This study mimicked aspects of behavior of individuals at a fast-food restaurant. Holding a receipt for 45 seconds after using hand sanitizer resulted in maximum BPA absorption (581 µg BPA). At 2 and 15 seconds, 40% and 58% of BPA, respectively, was recovered from the hand, when compared to baseline numbers. Serum unconjugated BPA was increased after using hand sanitizer, handling thermal paper and eating French fries with the contaminated hand. This result was markedly increased in females versus males. When thermal paper was handled without using hand sanitizer, less BPA was transferred, as compared to baseline.

Although the majority of BPA is not found in personal care products, this research demonstrates that certain products contain chemicals that increase dermal absorption of BPA, thereby contributing to the growing risk of obesity and diabetes.

Triclosan

Triclosan, an ester, is commonly used as an antimicrobial agent in personal care and healthcare products including: toothpaste, antibacterial soap, shampoo, and deodorant. It’s absorbed mainly by the dermal and digestive route and was detectable in 75% of the urine samples in the NHANES survey.¹¹ Triclosan has a similar structure to BPA and thyroid hormones, suggesting it may influence endocrine function.¹²

Velez et al¹³ utilized data from the Maternal-Infant Research on Environmental Chemicals (MIREC) study from women across Canada between 2008 to 2011. This was a pregnancy-based retrospective time-to-pregnancy (TTP) study, assessing 1699 women in the triclosan analysis. It was determined that triclosan was associated with longer TTP and that women in the highest quartile of triclosan burden also showed evidence of a 16% decrease in fecundity.

Parabens

Parabens are commonly used as antimicrobial preservatives in cosmetics, food products, and pharmaceuticals. They primarily enter the body through dermal absorption and are largely excreted in the urine, although can remain in the body’s adipose tissue. Parabens are classified as an EDC, as they have weak estrogenic activity.¹⁴ Animal studies have demonstrated adverse effects with respect to female reproductive and endocrine function.

There are 4 types of parabens: butyl-, ethyl-, methyl- and propylparabens. The methyl and propyl forms are most commonly used as preservatives in cosmetics. A 2013 study¹⁵ examining 192 patients seeking infertility treatment showed a negative relationship between propylparaben concentration and antral follicle count. Higher urinary propylparaben was associated with a higher Day-3 follicle stimulating hormone.¹⁵ It thus appears that propylparaben may negatively influence ovarian reserve and contribute to ovarian aging.

Prevention

A study conducted in 2016¹⁶ with female adolescents, demonstrated that replacing commonly used personal-care products containing EDCs with their “free-from” counterparts reduced exposure to these disruptors. This study was unique because it taught the young women about these chemicals and their health effects. At the conclusion of the study, 71% of the participants indicated that they would purchase personal care products that were free from EDCs, and 23% of the participants assessed their regular products for these chemicals.

Overall, many women find the sheer number of product options overwhelming and often turn to consumers for information on how to choose beauty products.¹ This lends itself to an interesting opportunity for naturopathic doctors as teachers because we can help educate women on which products to avoid that are harmful to our health – especially fertility. At all initial visits, naturopathic doctors should be asking their clients which products they are using on a day-to-day basis. We can then use this information as a teaching tool, helping women to choose safer products for themselves and their family.

Refs:

1. 7 in 10 Female Beauty Consumers Say It’s Important to Look Their Best When Leaving the House. October 6, 2016. Mintel.com Web site. http://tinyurl.com/ya253vcg. Accessed July 10,2017.
2. Exposures add up – Survey results. 2007-2017. EWG’s Skin Deep® Cosmetics Database. EWG Web site. http://tinyurl.com/yd9o7cb3. Accessed July 10, 2017
3. Mariana M, Feiteiro J, Verde I, Cairrao E. The effects of phthalates in the cardiovascular and reproductive systems: A review. Environ Int. 2016;94:758-776.
4. Huang PC, Kuo PL, Chou YY, et al. Association between prenatal exposure to phthalates and the health of newborns. Environ Int. 2009;35(1):14-20.
5. Chou YY, Huang PC, Lee CC, et al. Phthalate exposure in girls during early puberty. J Pediatr Endocrinol Metab. 2009;22(1):69-77.
6. Olsén L, Lind L, Lind PM. Associations between circulating levels of bisphenol A and phthalate metabolites and coronary risk in the elderly. Ecotoxicol Environ Saf. 2012;80:179-183.
7. Rancière F, Lyons JG, Loh VH, et al. Bisphenol A and the risk of cardiometabolic disorders: a systematic review with meta-analysis of the epidemiological evidence. Environ Health. 2015;14:46.
8. Carwile JL, Michels KB. Urinary bisphenol A and obesity: NHANES 2003–2006. Environ Res. 2011;111(6):825-830.
9. Sun Q, Cornelis MC, Townsend MK, et al. Association of urinary concentrations of bisphenol A and phthalate metabolites with risk of type 2 diabetes: a prospective investigation in the Nurses’ Health Study (NHS) and NHSII Cohorts. Environ Health Perspect. 2014;122(6):616-623.
10. Hormann AM, Vom Saal FS, Nagel SC, et al. 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;9(10):e110509.
11. Calafat AM, Ye X, Wong LY, et al. Urinary concentrations of triclosan in the U.S. population: 2003–2004. Environ Health Perspect. 2008;116(3):303-307.
12. Dann AB, Hontela A. Triclosan: environmental exposure, toxicity and mechanisms of action. J Appl Toxicol. 2011;31(4):285-311.
13. Vélez MP, Arbuckle TE, Fraser WD. Female exposure to phenols and phthalates and time to pregnancy: the Maternal-Infant Research on Environmental Chemicals (MIREC) Study. Fertil Steril. 2015;103(4):1011-1020.e2.
14. Ma WL, Zhao X, Lin ZY, et al. A survey of parabens in commercial pharmaceuticals from China and its implications for human exposure. Environ Int. 2016;95:30-35.
15. Smith KW, Souter I, Dimitriadis I, et al. Urinary paraben concentrations and ovarian aging among women from a fertility center. Environ Health Perspect. 2013;121(11-12):1299-1305.
16. Harley KG, Kogut K, Madrigal DS, et al. Reducing Phthalate, Paraben, and Phenol Exposure from Personal Care Products in Adolescent Girls: Findings from the HERMOSA Intervention Study. Environ Health Perspect. 2016;124(10):1600-1607.

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Alexsia Priolo, ND, is a naturopathic doctor, licensed and registered with the College of Naturopaths of Ontario. Dr Priolo graduated from York University with a (honors) Bachelor Degree of Science, and from the Canadian College of Naturopathic Medicine. She currently practices in Toronto, and while she has a general family practice, her passion resides in women’s and children’s health. Dr Priolo aims to educate and empower her patients so they can lead happy and healthy lives.