By putting a dollar value on the health impacts of phthalates, researchers hope to make people aware of the cost of continuing to use the synthetic chemical. “Safer alternatives, even if they cost more, could still provide economic benefits by preventing early deaths,” says Leonardo Trasande, MD, a professor of pediatrics, environmental medicine, and population health at NYU Langone Health in New York City and the lead author of the study, which was published on October 12, 2021, in the journal Environmental Pollution.
‘Everywhere Chemicals’ May Interfere With Hormone Function
Chemicals called phthalates are found in so many products common in daily life that the class is actually nicknamed the “everywhere chemicals.” They’re used in toys, vinyl flooring, food packaging and storage, shampoo, and many cosmetics and cleaners that contain fragrances. Phthalates are one of many chemicals referred to as endocrine disruptors, as they may mimic or interfere with the body’s hormones, which are part of the endocrine system, according to the National Institute of Environmental Health Sciences. The endocrine system regulates all biological processes in the body from the time a person is born until they die, including the development of the brain and nervous system, metabolism and blood sugar levels, and the growth and function of the reproductive system, according to the United States Environmental Protection Agency (EPA). Endocrine disruptors “are linked with developmental, reproductive, brain, immune, and other problems,” states the NIH. Because these chemicals are slow to break down, they are potentially hazardous over time.
High Concentrations of Phthalates Linked to Early Death and Death Due to Heart Disease
To evaluate the association of phthalate exposure with mortality and to estimate the cost of early death and lost economic productivity, investigators used data from 5,303 adults who participated in the U.S. National Health and Nutrition Examination Survey (NHANES) from 2001 to 2010. The researchers limited their analysis to those whose cause of death had been tracked through 2015. The authors did a subgroup analysis of participants who were between ages 55 and 64, because previous studies had based estimates of phthalate-driven death on this age group. By limiting their focus, the researchers could accurately compare their study results with the prior estimates. All participants provided urine samples for phthalate metabolite measurements, which is a way to measure exposure to the chemical. Researchers controlled for many factors, including preexisting heart disease, diabetes, poor diet, physical activity, body mass index, and levels of other hormone disruptors. Models from earlier studies, along with data from the U.S. Centers for Disease Control and Prevention Wonder database and the U.S. Census Bureau were used to estimate the economic cost of early death for this group. Investigators found that participants between ages 55 and 64 with the highest concentrations of phthalates in their urine were more likely to die of heart disease than those with lesser exposure. Individuals in the high-exposure group were also more likely to die of any cause than those in low-exposure groups. High levels of the toxins did not appear to increase risk of death due to cancer.
A ‘Dangerous and Unnatural Experiment’
Although the study does link increased phthalate exposure to early death, the new study doesn’t prove a direct cause-and-effect relationship, says Dr. Trasande. In order to prove a direct cause-and-effect relationship between phthalates and heart disease or early death, the gold standard would be a double-blind randomized clinical trial, he says. “From an ethical perspective, you can’t get this sort of study approved — we can’t intentionally dose people with an adverse exposure. … The reality is that we’re all exposed to phthalate all the time — you might say we’re all undergoing what might be described as a dangerous and unnatural experiment in which people are being exposed through their daily living,” he says. We have to rely on observational studies to understand how phthalates affect the body, says Trasande. “If they are carefully designed, these types of studies can provide very useful insights,” he says. A further limitation of the study is that it captures only a moment in time — phthalate levels were measured only once, acknowledges Dr. Trasande. On the other hand, people’s diet and lifestyle behaviors typically remain relatively constant, and so it’s likely those levels are a good representation, he says.
Phthalates ‘Hack Our Hormonal Signaling’
“We have decades of literature showing that these chemicals wreck hormones — they hack our hormonal signaling and contribute to obesity and diabetes, and then they cause inflammation in blood vessels, which is the essential condition of the process underlying cardiovascular disease,” says Trasande. Although certainly diet and exercise play a big role in cardiovascular health, this study provides further evidence that synthetic chemicals can have similar effects on metabolism, he says.
Expert Tips on How to Reduce Your Exposure to Phthalates
Although it isn’t easy to avoid phthalates, there are ways you can limit your exposure, says Trasande.
Avoid or limit ultra-processed foods. According to a study published in October 2019 in Environment International, these include items such as sodas and fruit drinks, frozen pizza, and ready-to-eat packaged sandwiches, hamburgers, and french fries.Reduce your plastic footprint by avoiding or limiting your use of plastics.If you use plastic containers to store food, don’t microwave or machine wash them — the heat can break down the linings so they may be absorbed more readily.
