How plastics are harming our health

Plastic Free July is a global movement started in Western Australia in 2011 by the Plastic Free Foundation. The initiative empowers millions worldwide to be part of the solution to plastic pollution by providing resources and education about how to reduce single-use plastic waste (see link below). Single-use plastics make up a large proportion of plastic pollution globally, with detrimental effects on marine and terrestrial ecosystems, as well as human health.

Here at One5 Health, we are passionate about environmentally responsible business and aim to reduce our environmental impact across all operations. We are proud to support Plastic Free July and are working hard to reduce single-use plastics in our clinics. In addition, as preventative medicine specialists we want to raise awareness of the human health implications of plastic products and plastic pollution, as both have significant effects on our long-term health.

How plastics effect health

The devastating consequences of plastic pollution for wildlife and ecology are well known, but the equally concerning implications for human health are less often discussed. The effects of plastics on health are now well-studied and whilst further research is needed, the plastics we use in our everyday lives are likely having a lasting impact on our health.

As preventative and lifestyle medicine practitioners, we believe it is important to highlight these facts to our readers as proactive changes in our lifestyle today, can improve our health for years to come.

The impacts of plastics on health can be broadly divided into two categories: the effects related to Endocrine Disrupting Chemicals (EDCs), which are chemicals often contained within or emitted by plastics, and effects related to small particles of plastics (microplastics) which make their way into our bodies from the environment. Let’s look at each in turn.

What are EDCs?

EDCs are exogenous substances that alter the normal function of the human endocrine (hormonal) system [1]. People are exposed to EDCs primarily via their diet, although air, dust and water are other potential sources. EDCs are found in many everyday products including plastics, cosmetics and certain foods and beverages, as well as pesticides and industrial chemicals [2][3]. EDCs are released into the environment (air, soil and water) when products are used and ultimately thrown away [4].

In fact, EDCs are now so common in the environment that exposure to them is almost universal; studies repeatedly show that most people have EDCs present in their bodies [5][6]. Exposure to EDCs and associated hormonal dysregulation can cause many diseases including diabetes, thyroid disorders, reproductive disorders, neurodevelopmental disorders and cancers including breast, prostate, ovarian, testicular and endometrial cancers [4][6][7][8].

The health effects of EDCs are dependent on the chemical in question, the hormone pathway affected, the degree of exposure and whether exposure occurs at a sensitive time of development, such as pregnancy or puberty [6][7][9]. From a health economics perspective, the estimated cost of EDC exposure in the USA and Europe combined, exceeds $550 billion (US) [10].

However, due to the prevalence of EDCs in everyday products, their regulation is complex and non-standardised, with some countries taking a risk-based approach to specific EDCs and others banning individual chemicals completely [11]. This is further complicated by a lack of standardisation in the testing methods used for EDCs or agreement on precise levels of exposure that are harmful to health.

Establishing clear causative links between EDCs and specific diseases is difficult due to long latency periods between exposure and detectable effects, as well as the limited number of hormonal pathways that can be investigated using current methods. Additionally, the presence of confounding factors such as previous exposure to similar chemicals and lifestyle factors that influence disease development, such as diet and exercise, complicates research into EDCs further [11][12].

EDCs in plastics

Plastics may contain many different EDCs dependent on the type of plastic. EDCs in plastics may be structural building blocks of the material itself (bisphenols) or additives that enhance desirable properties, such as plasticisers which improve flexibility (phthalates), flame retardants (brominated flame retardants) or colourants (often containing heavy metals). Recycling of plastics can further concentrate specific toxins (phthalates) and even produce new super toxic chemicals (dioxins) [2][6][13].

The case of BPA

One well known EDC commonly found in plastics is BPA (bisphenol A). BPA is a structural building block of many polycarbonate plastics used to make food containers and water bottles, as well as epoxy resins used to coat the inside of metal food cans, bottle tops and water pipes. Whilst exposure is most commonly via ingestion, BPA is also found in thermal paper used for printing receipts and even some medical and sports equipment.

BPA can also leach from landfill sites into ground water, which may subsequently contaminate household drinking water [13][14][15]. Studies suggest that even very low levels of BPA exposure may have significant health effects, such as increased risk of certain cancers including breast, prostate, ovarian and endometrial [16][17][18][19].

BPA is also known to affect brain development and behaviour, with exposure associated with neurodevelopmental disorders in foetuses, as well as higher levels of anxiety, depression and inattention [17][19] [20]. Moreover, through effects exerted at the genetic and epigenetic level, BPA has also been linked to adverse reproductive outcomes, including dysfunctional cell division in egg cells, reduced sperm count & quality, Polycystic Ovarian Syndrome and disruption of normal foetal development [17][20][21].

Concerningly, rates of exposure to BPA amongst Western populations are extremely high. The 2003-4 National Health and Nutrition Examination Survey (NAHNES III) conducted by the US Centres of Disease Control (CDC) found detectable levels of BPA in over 90% of 2517 urine samples tested from participants aged 6 and over* [22].

These figures are considered representative of the general population of the United States, with similar levels reasonably expected in European populations [14]. Furthermore, BPA has been shown to bioaccumulate, building up in the body’s tissues and exerting ongoing negative effects, even after prolonged periods of non-exposure [22][23].

Many modern plastics are marketed as ‘BPA-free’ and were previously thought to be less harmful to health. However recent animal studies suggest that this may not be true, as alternative plastics contain alternative bisphenols (also EDCs) with similar harmful effects to BPA [24][25]. Additionally, many bioplastics (bio-degradable plastics) contain similar levels of toxic chemicals. Whilst these plastics may biodegrade faster, they still leach EDCs into the environment, posing significant challenges for even cutting edge pollution clean-up technologies, such as bioremediation [5][26].

*Please note that One5 Health do not offer urine, blood or other testing for BPA levels at this time.

Microplastics

Microplastics are tiny particles of plastic defined as less than 5mm diameter but often much smaller, that are found in the environment. Microplastics may be designed for specific commercial uses such as in personal care products or cosmetics, but most often result from the breakdown of larger plastic items in the environment.

Microplastics may also be shed as microscopic fibres from synthetic textiles and clothing, making their way into water systems when clothes are washed, and released into the air when clothes are worn and machine dried. The sheer amount of microplastics now present in the environment mean that they contaminate our food and drinking water, accumulating in our bodies and exerting negative effects on health. Like EDCs, microplastics have been linked to metabolic and reproductive disorders, as well as certain cancers.

Unfortunately, the average person consumes considerable amounts of microplastics every day. A 2019 report from the World Wildlife Foundation details research undertaken by the University of Newcastle Australia which found that an average person globally may be ingesting up to 5g of plastic per week, through food, beverages and inhaled air [27]. That’s a credit card’s worth of plastic each week. The report states that the majority of plastic consumed is through diet, with drinking water accounting for the greatest proportion on average (bottled more than tap), a fact corroborated by other studies into microplastic ingestion [28][29].

Common food sources mentioned in the study include seafood (shellfish especially), beer and salt. Other studies into human microplastic consumption suggest highly processed foods and canned food and drink as other important sources [30]. Less obvious sources include water boiled in plastic kettles, plastic-containing teabags or coffee capsules and heating food in plastic containers [31][32]. The everyday prevalence of microplastics mean that they have been found in samples of human faeces and urine, and more recently blood, lung and even placental tissue [33][34][35].

So, what are the health implications of ingesting microplastics? At present, the long-term impacts are not well understood, but a substantial body of evidence points towards significant harm. In addition to leaching EDCs once inside the body, microplastics may carry other environmental pollutants from soil, water or air.

For example, airborne microplastics in urban areas have been found to carry Polycyclic Aromatic Hydrocarbons (PAHs), toxins created from burning fossil fuels, tar and organic substances, some of which are known to cause cancer and other diseases [36][37]. Furthermore, some studies suggest that when other environmental toxins are combined with microplastics their toxicity is compounded, creating super-toxic particles [38].

In addition, microplastics have been shown to act as reservoirs for harmful bacteria and viruses in the environment, which may ‘hitch-hike’ their way into our bodies when microplastics are ingested, although the health risks associated with this phenomenon remain unclear [39][40].

Top tips for reducing EDC & microplastic exposure

So, what can you do to reduce your exposure to EDCs and microplastics? Despite the prevalence of plastics in our everyday lives, there are many practical steps you take to reduce personal exposure. Here’s our top ten:

1. Avoid drinking bottled water - opt for tap water instead (where drinkable). Add activated charcoal pieces to re-usable bottles and jugs to help reduce the taste of chlorine.

2. Avoid heating, microwaving or purchasing hot foods in plastic containers - including take-aways! Opt for glass, ceramic or steel containers/utensils, especially when used for hot foods and liquids

3. Switch to plastic-free kitchen appliances - particularly those used to heat food and drink (kettles, coffee machines, air-fryers, toastie makers, slow-cookers etc) and appliances that may shear off small plastic particles (food mixers and blenders)

4. Avoid single-use plastic food wrapping - instead opt for re-usable silicone covers or traditional waxed cotton food wraps (silicone is not a plastic and likely less harmful to health – read more here https://www.healthline.com/health/body-modification/is-silicone-toxic)

5. Use a plastic-free reusable water bottle & coffee cup

6. Use plastic-free baby bottles - opt for tempered glass, steel or silicone

7. Wear clothing made of non-synthetic fibres & air-dry your clothes - Opt for natural fibres like cotton, linen, bamboo or hemp (note that production of some natural fabrics also have significant negative environmental impacts)

8. Reduce consumption of highly processed foods - including ready meals, processed meat and dairy, ice cream, canned foods and bottled/canned drinks. Avoid teabags and coffee capsules made of plastic.

9. Reduce consumption of seafood - especially shellfish, which are known to accumulate microplastics from polluted oceans

10. Avoid (or better, eliminate) single-use plastic packaging

In addition, we can all take steps to reduce the amount of plastic that ends up in the environment by limiting single-use plastic use wherever possible. Further national and international regulation is also vital to reduce the overall burden on plastic waste on the environment, ecosystems and human health. As we say in medicine, prevention is always better than cure.

The One5 perspective

At One5 Health we know that a proactive approach to our health is important. We strive to provide evidence-based, reliable information that empowers people to make healthier, more informed decisions about their lifestyle. In our modern lives it is near impossible to avoid plastics altogether, but minimising exposure where possible will mitigate against the known - and as yet unknown - health implications. Whilst further research into the long-term health effects of plastics is needed, current evidence suggests that reducing our exposure now is likely beneficial to long-term health.

Whilst awareness and proactive avoidance is important, as practitioners we are limited by current technology. Specific tests that determine the levels of individual pollutants, EDCs and microplastics in our bodies are not yet widely available, and there is no consensus currently on the interpretation of such tests; we are keenly watching this space and may offer such tests in future.

However, at One5 Health we can provide a comprehensive assessment of overall health with our unique WellMan & WellWoman checks. As well as a consultation with one of our expert GPs, we screen for common micronutrient, metabolic and hormone imbalances, and offer additional tests to detect blood markers for the commonest forms of cancer. For further details on how to book a comprehensive health check please see our website, or head over to the ‘book now’ tab.

Doing our bit

At One5 Health we are proud to operate an entirely paperless and cashless service and aim to reduce single use plastics wherever possible in our clinics, whilst always maintaining patient safety. However, due to infection control requirements of routine clinical practice, it is still necessary to use some single use plastics in our clinics, such as blood-taking equipment, swabs and sample bottles. However, we are keenly on the lookout for new innovations in this space and endeavour to be early adopters once suitable alternatives are available. For further information on our range of comprehensive health checks and GP services, please see our website.

The bottom line

• Plastics are everywhere in our modern lives and avoiding them altogether is difficult. However, the practical steps outlined above can help reduce unnecessary exposure to EDCs and microplastics.
• The effects of exposure to EDCs and microplastics on health are complex and not yet fully understood, but current evidence links both to a variety of metabolic, endocrine, reproductive and neurological disorders, as well as increased risk of certain cancers. Taking steps to reduce exposure now is likely to improve long-term health.
• Whilst individuals can take steps to reduce personal exposure to plastics, further regulatory consensus and policy implementation is vital to curb industrial sources of plastic pollution, and subsequently reduce the impact on human, animal and environmental health.
• It is unclear whether BPA-free plastics or bioplastic are substantially safer for human health, so we advise to switch to non-plastic alternatives wherever possible.
• We can all do our bit to reduce personal plastic waste, by using re-usable, non-plastic products and avoiding single-use plastics altogether. Please visit the official Plastic Free July website for more information.
• For further information on the health and environmental impacts of plastics, please see the other useful links below. To book a check-up or appointment with one of our expert GPs, please head over to the ‘book now’ tab.

Useful links

https://www.plasticfreejuly.org/

https://www.plastichealthcoalition.org/

https://www.endocrine.org/topics/edc/plastics-edcs-and-health

References

1. Endocrine Society, "Endocrine Disrupting Chemicals," 23 January 2022. [Online]. Available: https://www.endocrine.org/patient-engagement/endocrine-library/edcs.
2. Endocrine Society, "Common EDCs and where they are found," [Online]. Available: https://www.endocrine.org/topics/edc/what-edcs-are/common-edcs.
3. J. P. Buckley, "Ultra-processed food consumption and exposure to phthalates and bisphenols in the US National Health and Nutrition Examination Survey, 2013–2014," Environment International, vol. 131, no. 105057, 2019.
4. L. G. Khan, "Endocrine-disrupting chemicals: implications for human health," The Lancet Diabetes & Endocrinology, vol. 8, no. 8, pp. 703-718, 2020.
5. Endocrine Society, "Press release: Plastics pose threat to human health," 15 December 2020. [Online]. Available: https://www.endocrine.org/news-and-advocacy/news-room/2020/plastics-pose-threat-to-human-health.
6. Endocrine Society; IPEN, "Plastics, EDCs & Health: A guide for public interest organisations and policy-makers on endocrine disrupting chemicals & plastics," December 2020. [Online]. Available: https://www.endocrine.org/-/media/endocrine/files/topics/edc_guide_2020_v1_6chqennew-version.pdf.
7. C.-G. Bornehag, "The SELMA Study: A Birth Cohort Study in Sweden Following More Than 2000 Mother–Child Pairs," Paediatric and Perinatal Epidemiology, vol. 26, no. 5, pp. 456-467, 2012.
8. The Lancet Oncology, "Endocrine disruptors - the lessons (not) learned," The Lancet Oncology (Editorial), vol. 22, no. 11, p. 1483, November 2021.
9. Healthline News, "You’re Likely Ingesting Plastic from Your Water, Food, Toys, and Cosmetics," Healthline, 30 March 2018. [Online]. Available: https://www.healthline.com/health-news/ingesting-plastic-from-water-food-toys-cosmetics.
10. L. M. Jaacks, "The ecological cost of continued use of endocrine-disrupting chemicals," The Lancet Diabetes & Endocrinology (Correspondence), vol. 5, no. 1, pp. 14-15, 2016.
11. C. D. Kassotis, "Endocrine-disrupting chemicals: economic, regulatory, and policy implications," The Lancet Diabetes & Endocrinology, vol. 8, no. 8, pp. 719-730, 2020.
12. E. Grignard, "Regulatory Testing for Endocrine Disruptors; Need for Validated Methods and Integrated Approaches," Frontiers in Toxicology (Opinion), vol. 3, no. 821736, 2022.
13. N. Rustagi, "Public Health Impacts of Plastics: An Overview," Indian Journal of Occupational & Environmental Medicine, vol. 15, no. 3, pp. 100-103, 2011.
14. National Institute of Environmental Health Sciences, "Environmental Agencts: Bisphenol A (BPA)," [Online]. Available: https://www.niehs.nih.gov/health/topics/agents/sya-bpa/index.cfm.
15. T. Greens, "A review of dietary and non-dietary exposure to bisphenol-A," Food and Chemical Toxicology, vol. 50, no. 10, pp. 3725-3740, 2012.
16. W. V. Welshons, "Large Effects from Small Exposures. III. Endocrine Mechanisms Mediating Effects of Bisphenol A at Levels of Human Exposure," Endocrinology, vol. 147, no. 6, pp. s56-s69, 2006.
17. P. Fenichel, "Bisphenol A: An endocrine and metabolic disruptor," Annales d'Endocrinologie (Paris), vol. 74, no. 3, pp. 211-220, 2013.
18. N. G. Khan, "A comprehensive review on the carcinogenic potential of bisphenol A: clues and evidence," Environmental Science and Pollution Research International, vol. 28, pp. 19643-19663, 2021.
19. J. R. Rochester, "Bisphenol A and human health: A review of the literature," Reproductive Toxicology, vol. 42, pp. 132-155, 2013.
20. M. Kundakovic, "Sex-specific epigenetic disruption and behavioral changes following low-dose in utero bisphenol A exposure," Proceedings of the National Academy of Sciences USA, vol. 110, no. 24, pp. 9956-9961, 2013.
21. P. Lizunkova, "A Mixture of Endocrine Disrupting Chemicals Associated with Lower Birth Weight in Children Induces Adipogenesis and DNA Methylation Changes in Human Mesenchymal Stem Cells," International Journal of Molecular Sciences, vol. 23, no. 4, p. 2320, 2022.
22. R. W. Stahlhut, "Bisphenol A Data in NHANES Suggest Longer than Expected Half-Life, Substantial Nonfood Exposure, or Both," Environmental Health Perspectives, vol. 117, no. 5, 2009.
23. D. Biello, "Like a Guest That Won't Leave, BPA Lingers in the Human Body," Scientific American, 28 January 2009.[Online]. Available: https://www.scientificamerican.com/article/bpa-lingers-in-human-body/.
24. B. Mastroianni, "Is BPA-Free Plastic Better? Researchers Don’t Think So," Healthline News, 28 September 2018. [Online]. Available: https://www.healthline.com/health-news/even-bpa-free-plastics-may-be-harmful-to-your-health.
25. T. S. Horan, "Replacement Bisphenols Adversely Affect Mouse Gametogenesis with Consequences for Subsequent Generations," Current Biology, vol. 28, no. 18, pp. 2948-2954, 2018.
26. A. Ismanto, "Endocrine disrupting chemicals (EDCs) in environmental matrices: Occurrence, fate, health impact, physio-chemical and bioremediation technology," Environmental Pollution, vol. 302, no. 119061, 2022.
27. The University of Newcastle Australia; Dalberg, "No Plastic in Nature: Assessing plastic ingestion from nature to people," WWF Analysis International, Gland, Switzerland, 2019.
28. K. Senathirajah, "Estimation of the mass of microplastics ingested – A pivotal first step towards human health risk assessment," Journal of Hazardous Materials, vol. 404, no. Part B, p. 124004, 2021.
29. S. Usman, "Microplastics Pollution as an Invisible Potential Threat to Food Safety and Security, Policy Challenges and the Way Forward," International Journal of Environmental Research & Public Health, vol. 17, no. 24, p. 9591, 2020.
30. K. D. Cox, "Human Consumption of Microplastics," Environmental Science & Technology, vol. 53, no. 12, pp. 7068-7074, 2019.
31. McGill University, "Some plastic with your tea?," McGill University News, 25 September 2019. [Online]. Available: https://www.mcgill.ca/newsroom/channels/news/some-plastic-your-tea-300919.
32. L. M. Hernandez, "Plastic Teabags Release Billions of Microparticles and Nanoparticles into Tea," Environmental Science & Technology, vol. 53, no. 21, pp. 12300-12310, 2019.
33. K. Kannan, "A Review of Human Exposure to Microplastics and Insights Into Microplastics as Obesogens," Frontiers in Endocrinology, vol. 12, p. 724989, 2021.
34. H. A. Leslie, "Discovery and quantification of plastic particle pollution in human blood," Environment International, vol. 163, p. 107199, 2022.
35. L. C. Jenner, "Detection of microplastics in human lung tissue using μFTIR spectroscopy," Science of The Total Environment, vol. 831, p. 154907, 2022.
36. J. Gasperi, "Microplastics in air: Are we breathing it in?," Current Opinion in Environmental Science & Health, vol. 1, pp. 1-5, 2018.
37. Centres for Disease Control and Prevention, "Chemical Factsheets: Polycyclic Aromatic Hydrocarbons (PAHs) Factsheet," National Biomonitorig Program, [Online]. Available: https://www.cdc.gov/biomonitoring/PAHs_FactSheet.html.
38. A. E. Rubin, "Interactions of microplastics and organic compounds in aquatic environments: A case study of augmented joint toxicity," Chemosphere, vol. 289, p. 133212, 2022.
39. N. Wu, "Colonization characteristics of bacterial communities on microplastics compared with ambient environments (water and sediment) in Haihe Estuary," Science of the Total Environment, vol. 708, p. 134876, 2020.
40. J. Bowley, "Oceanic Hitchhikers – Assessing Pathogen Risks from Marine Microplastic," Trends in Microbiology, vol. 29, no. 2, pp. 107-116, 2021.