Environmental wellness: Should you care?

When we think about wellness, we typically think about preventative measures we can take to avoid disorders, disease or unhealthy tendencies. The focus is often upon what intentional behaviors we can curtail, because they are unhealthy: like smoking or consuming an unhealthy diet. Or, we contemplate intentional behaviors we can adopt  to improve the health of our lifestyles, whether it be a new exercise regimen or learning to practice meditation.

However, there are health hazards that we may be encountering unintentionally — such as unhealthy substances or objects in our broader environment that we breathe, ingest, or in some other way come into contact with, perhaps without even knowing it. Certain of these environmental risks seem so far out of our individual control that many of us just throw up our hands and say, “Oh, well” — and do nothing about it.

Yet, many of these environmental health dangers merit evaluating because some of them are indeed within our individual influence (if not complete control). Other environmental hazards will need our collective influence and control to better understand and then work as a community and nation to mitigate — but those efforts are not only worthwhile, they may prove imperative to save future generations from living less healthy lives than our current generation. (Have you heard? Recently, the life expectancy for the U.S.population declined — after years of lengthening. We’re not living longer any more, and won’t if various environmental hazards aren’t addressed, and soon.)

This HealthySteps to Wellness article is in no way an exhaustive study of every environmental wellness issue we confront; the topic is enormous. Thus, we have chosen to focus our attention on several significant environmental hazards we encounter frequently in our homes and surroundings, with particular focus on several hazards readers may be less familiar with: arsenic in food; radon and wood smoke in the air; toxic chemicals in nonstick cookware; blue light; and climate change’s multi-faceted threat.

In addition to reviewing the latest scientific and medical research, we have drawn from the expertise of Jennifer Hartle, DrPH (former Stanford postdoctoral scholar and now assistant professor at San Jose State); Eric Zee, MD (clinical assistant professor, pediatrics – pulmonary medicine, Stanford University); and Paul Auerbach, MD (professor emeritus of emergency medicine, Stanford University).

Items in your pantry

Scientists have long been warning of toxic levels of certain chemicals, both natural and man-made, in our everyday foods and food containers. In August of 2016, in a Stanford Prevention Research Center seminar, Jennifer Hartle, DrPH (former Stanford postdoctoral scholar and now assistant professor at San Jose State) gave a talk entitled “Pantry Pollutants” about such “endocrine-disrupting chemicals” as Bisphenol-A (BPA) and other toxic chemicals such as arsenic.

Unfortunately, our government agencies have been slow to react to science, even in the face of compelling evidence. The last comprehensive report by CDC on toxic chemicals is dated 2009: the Fourth National Report on Human Exposure to Environmental Chemicals. While CDC has published updated tables to that report in recent years, the agency has not published detailed analyses of all the data sets. Government agencies have failed to act even after scientists have demanded action and various agencies have seemingly concurred that action is required — as we will portray, especially in today’s headline news about arsenic in fruit juice (see below).

Here is CDC’s 2017 Substance Priority List — with arsenic, lead and mercury leading the list.

1. Arsenic and other heavy metals in food

Scientists, including Hartle, have long been concerned about elevated levels of “heavy metals” in our food supply. Consumer Reports stated in its 2018 report on heavy metals in baby and toddler food:

“As the FDA is aware, exposure to even small amounts of these elements may, over time, increase the risk of several serious health problems, including those involving carcinogenic, cognitive, and reproductive effects. Babies and young children are the most at risk, particularly given the potential harms of heavy metal exposure on developing brains in the form of lower IQ and behavior problems.”

Heavy metals may be less risky to adults, but exposure can still lead to health problems. Over many years, even modest amounts of heavy metals may raise the risk of bladder, lung, and skin cancer; cognitive and reproductive problems; and type 2 diabetes, among other conditions. And arsenic, cadmium, and lead each pose their own set of potential harms. Lead, for example, is associated with high blood pressure, heart disease, and fertility problems. Arsenic is linked to cardiovascular disease. And long-term cadmium exposure increases the risk of bone damage and kidney disease, among other issues.

The case of infant rice cereals

In her talk, Hartle warned of high arsenic levels in many infant rice cereals. Two years later, in August 2018, Consumer Reports published their own test results, showing “worrisome levels” of arsenic, as well as other heavy metals, in many brands of infant rice cereals. CR sent FDA a letter urging the agency to “ensure” that “companies implement strong, recognized best practices” to prevent and reduce heavy metal contamination in foods.

More recently, Consumers Union has chided the FDA for its “incomplete response”:

“… the agency has not done enough to limit the risks to consumers of arsenic in food. Infants and children are especially vulnerable to exposure to arsenic, a known carcinogen that has been linked to damage to the brain, cardiovascular system, and nervous system.”

And now the fruit juice scare

In breaking news, just days before publication of this HealthySteps to Wellness article, Consumer Reports issued findings and a letter (dated January 30, 2019) urging “the Food and Drug Administration (FDA) to immediately finalize the action level of 10 ppb for inorganic arsenic in apple juice that the agency proposed in 2013.”

Consumer Reports tested 45 fruit juices, including apple, grape and juice blends, and found that 21 — roughly half of them —- had “concerning levels” of cadmium, arsenic and/or lead, according to the new report. (Highest on the list for arsenic levels: Trader Joe’s Fresh Pressed Apple Juice.) “In some cases, drinking just 4 ounces a day — or half a cup — is enough to raise concern,” says James Dickerson, Ph.D., CR’s chief scientific officer.

Solutions:  The main advice is quite simple — the best way to reduce your child’s exposure to heavy metals in fruit juice is to limit how much fruit juice they drink. The American Academy of Pediatrics (AAP) has long recommended limiting how much juice children consume, mainly because it contains lots of sugar, contributing to tooth decay, and calories, leading to obesity. Says Steven A. Abrams, MD, director of the Dell Pediatric Institute and co-author of the AAP’s juice guidance: “Many perceive fruit juice as healthy, but it is not a good substitute for fresh fruit,” he says. “Though juice does have some nutrients, such as vitamin C, it lacks fiber.” Because of those nutritional concerns, the AAP says parents should avoid giving children younger than 1 year old any fruit juice. After that, the daily maximum amounts are: 1- to 3-year-olds, 4 ounces; 4- to 6-year-olds, 6 ounces; 7 years and older, 8 ounces.

Now, with the arsenic concern, many parents may well choose to cut these amounts in half or avoid fruit juice altogether. Learn more in this CR guide for parents and consumers.

2. BPA

Bisphenol-A (BPA), a chemical that has been used to harden plastics for over 40 years, is found in thermal (ATM) paper, dental sealants, the lining of canned foods, plastic wrap and containers. The U.S. Food and Drug Administration used to say that BPA was safe, pointing to standardized toxicity tests showing it to be safe at the current low levels of human exposure. But, in 2010, the agency altered its position (based on alarming animal studies), expressing concern about the potential effects of BPA on the brain, behavior, and prostate glands in fetuses, infants, and young children. In 2012, FDA banned BPA in the manufacture of baby bottles and “sippy cups,” but BPA is still used rather widely in other plastics. Peer-reviewed, large-scale human research studies have yet to be published on BPA, although some scientists remain concerned that BPA alters hormonal activity and is possibly linked to cancer, neurological development and other disorders.

In short, BPA is still a concern, particularly if you have older “sippy-cups” and other plastic containers and food cans at the back of your pantry; they could contain toxic BPA levels.

Solutions:  Avoid plastic containers altogether, in favor of glass. If you insist on using plastic containers or baby bottles and cups, make sure they were not purchased prior to 2012. Do not ever microwave polycarbonate plastic food containers.

The air you breath

1. CO

Most all of us know of the dangers of carbon monoxide poisoning — and, fortunately, an increasing number of Californians have a CO alarm installed in their homes. However, information about CO dangers is still worth repeating: Carbon monoxide is an odorless, colorless and toxic gas. Because it is impossible to see, taste or smell the toxic fumes, CO can kill you before you are aware it is in your home. The effects of CO exposure can vary greatly from person to person depending on age, overall health and the concentration and length of exposure. The good news is that the solutions are straightforward:

  • Have fuel-burning appliances, furnace flues, and chimneys checked once a year.
  • Never use gas ovens or burners for heat; never use barbecues or grills indoors or in the garage.
  • Never sleep in rooms with unvented gas or kerosene space heaters.
  • Don’t run cars or lawnmowers in the garage.
  • Install in sleeping areas a CO alarm that meets UL, IAS, or Canadian standards.

2. Radon

However, while CO dangers are publicized frequently, the danger of radon in the home is no longer getting the press or attention that is merited. Radon danger is not new news. And yet, this invisible, radioactive substance remains the second largest cause of lung cancer and results in 21,000 deaths each year in the U.S. We don’t get as much press about radon here in the Bay Area, where levels tend to be relatively low — but radon comes from rock and soil, so it can be anywhere. (Radon enters the home or building through cracks in walls, basement floors, foundations and other openings, and can exist at dangerous levels indoors.)  It may not be at your neighbor’s home, but your home could have elevated levels — and 1 in 15 homes in the U.S. has a dangerous level or radon.

Solutions:  Various forms of do-it-yourself test kits are simple to use, inexpensive and can be purchased online or at home improvement and hardware stores. To learn more about radon and how to test homes, visit Lung.org/radon or call the tollfree Lung HelpLine at 1-800-LUNGUSA.

3. Residential wood burning

Burning wood produces emissions that are widely recognized as harmful to human health. Many of these harmful emissions can occur both indoors and outdoors. The emissions can cause coughing, wheezing, asthma attacks, heart attacks, lung cancer, and premature death. People with lung disease face special risks, but so do children, older adults, people with cardiovascular disease and diabetics.

The Bay Area has climate tendencies that can cause wood smoke, especially in winter, to be of great concern. In a comprehensive review of wood smoke’s health effects, data from San Jose indicate that 42% of the particulate matter (PM) during winter months could be attributed to wood burning, and in Santa Clara County, wood smoke is the single largest contributor to winter PM levels. The Spare the Air organization notes that even after years of its program to curb particulate matter emissions, “wood smoke from the 1.4 million woodstoves and fireplaces in the Bay Area contributes about one-third of the overall PM pollution” in the wintertime. “Cars and other motor vehicles also contribute significant amounts.”

And, particulate matter isn’t the only concern. As detailed by the American Lung Association, wood smoke adds to the outdoor levels of carbon monoxide, as well as increasing indoor concentrations. Wood smoke also produces nitrogen oxides, harming health indoors and outdoors and helping to exacerbate particle pollution. Wood smoke also contains volatile organic compounds that contribute to creating ozone pollution (and some of these gases are carcinogens, including benzene and formaldehyde). Lastly, wood smoke adds carbon dioxide and methane to the air, two pollutants that contribute significantly to climate change (see our final section, below).

While to date most clinical research on the health effects of wood smoke has focused on the obvious pulmonary and respiratory effects, some scientists and medical professionals are raising concerns about the effects on the brain. A Science Magazine report from 2017 states that “a growing body of evidence suggests that exposure can also harm the brain, accelerating cognitive aging, and may even increase risk of Alzheimer’s disease and other forms of dementia.” However, the link between air pollution and dementia remains controversial, as more research needs to be done, but “a growing number of epidemiological studies from around the world, new findings from animal models and human brain imaging studies, and increasingly sophisticated techniques for modeling PM2.5 exposures have raised alarms.”

A Stanford pediatric pulmonologist, Eric Zee, MD, echoes the sentiments voiced by an increasing number of medical professionals who are concerned that particulate matter in wood smoke may impact mental health and neurological development, particular in children and teens. “We’re finding in young adults that there may be an increased risk of psychiatric problems like depression… and it may also affect grades and test scores.” However, Zee cautions that large-scale research studies need to be performed to better evaluate these concerns.

Solutions:  One problematic issue about wood smoke is the fact that even woodstoves and fireplaces operating well and that vent most smoke outside may produce substantial exposures through penetration back into the house, a characteristic of “neighborhood pollution.” In other words, even if you don’t burn wood in your house, you may still be vulnerable to the adverse effects of wood smoke. So, we need community solutions, and while our Spare the Air organization has helped to greatly reduce emissions both of particulate matter from wood smoke in winter and ozone-forming pollutants in summer, our levels remain worrisome. Thus, lobbying for tougher laws and regulations may be imperative going forward.

Individually, what you can do if you really want to burn includes: (1) burn only dry, seasoned wood, and start fires with clean newspaper and dry kindling, maintaining a hot (vs. a more dangerous smouldering) fire; (2) have a certified technician inspect and service your appliance annually; (3) keep your home healthy by upgrading to an efficient, EPA-approved wood-burning appliance; (4) switch to a gas or electric fireplace, or at least install a certified wood-burning fireplace insert which meets federal emission standards and provides high fuel efficiency. See: Learn Before Your Burn – What You Can Do and the CA Wood Burning Handbook.

If you don’t burn, but you know it’s a “Spare the Air Day” and that the air may be unhealthy, see these 10 Tips to Protect Yourself From Unhealthy Air, which include: staying indoors, not counting on a dust mask,closing your house and car windows and keeping air conditioning on the “recirculate” setting, and refraining from outdoor exercise.

1 Ordinary dust masks, designed to filter out large particles, are of little help. They still allow the more dangerous smaller particles to pass through. Special, more expensive dust masks with true HEPA filters will filter out the damaging fine particles but are difficult for people with lung disease or children to use. Consult with your doctor before using a mask, especially if you have a lung disease. See also: Stanford Children’s Health: Wildfire Smoke and Local Air Quality.

Nonstick cookware

The CDC’s Fourth National Report on Human Exposure to Environmental Chemicals noted that there has been widespread exposure in the U.S. to chemicals known as PFAS (per- and polyfluoroalkyl substances), which include PFOA, PFOS, and GenX chemicals. These man-made chemicals can accumulate in the body for long periods of time, leading to cancer (PFOA), thyroid hormone disruption (PFOS), low infant birthweight and a host of adverse immune system effects.

While people can be exposed to these chemicals through a variety of means, from drinking water to exposure to contaminated soil to food packaging, one significant use of PFOA was as a “synthesis aid” in the manufacture of a commonly used polymer, polytetrafluoroethylene, used to create heat-resistant nonstick coatings — such as Teflon™ — in cookware.

Certain PFAS chemicals are no longer manufactured in the United States as a result of phase-outs, including the EPA’s PFOA Stewardship Program. Although PFOA and PFOS are no longer manufactured in the U.S., they are still produced internationally and can be imported into the U.S. in consumer goods such as carpet, leather and apparel, textiles, paper and packaging, coatings, rubber and plastics.

Unless you have recently purchased cookware that is specifically labeled PFOA-free, then it is distinctly possible that the nonstick pans in your kitchen are a source of this potentially dangerous chemical. PFOA and other hazardous toxins have been shown to be released from nonstick cookware when heated to high temperatures.

Solutions:  Purchase only PFOA-free nonstick cookware, or ceramic cookware. Dispose of nonstick pans of an unknown origin/date, especially if they were purchased prior to 2015, have a nicked or cut surface, and you tend to heat the cookware to high levels (e.g., for searing meat).

Blue light

The American Academy of Opthalmology says that “When you stare at a screen for hours at a time, whether it is a computer, TV, phone or tablet, you are exposed to blue light from the device. But there is no scientific evidence that blue light from digital devices causes damage to your eye.” Rather, the discomfort some people have after looking at screens is most likely digital eye strain.

However, blue light does affect the body’s circadian rhythm, our natural wake and sleep cycle. During the day, blue light wakes us up and stimulates us. But too much blue light exposure late at night from your phone, tablet or computer can make it harder to get to sleep. One major study comparing the biological effects of reading an electronic book on a light-emitting device (LE-eBook) with reading a printed book in the hours before bedtime found that participants reading an LE-eBook took longer to fall asleep and had reduced evening sleepiness, reduced melatonin secretion, later timing of their circadian clock, and reduced next-morning alertness when compared with those study participants who read printed books.

A growing body of research links exposure to artificial light at night not just to sleep problems, but also to weight gain, depression, cancer, and heart disease.

Last June, the American Medical Association went so far as to state that the new ultra-bright light-emitting diode (LED) lamps many cities are now using in their streetlights could “contribute to the risk of chronic disease.”

Interestingly, although people often associate blue light with computers and phones, the largest source of blue light is sunlight. Other sources include fluorescent light, compact fluorescent light bulbs and LED light. All of them, in excess and particularly in the evening hours, have been shown to disrupt sleep patterns. Research in this arena is still immature. However, it may not just be that too much blue light is unhealthy; rather, it may prove to be that darker evenings prior to sleep, generally, have health benefits.

Solutions:  These may seem quite simple, but such behavior changes are proving very difficult for Americans to implement:

  • Beyond the 7-8 hours of sleep you should try to get each night, endeavor to get 3 more hours of relative darkness before you go to bed. That means low lighting and limiting your screen time.
  • Replace the lights in your bedroom and bathroom with dimmer, longer-wavelength lights.
  • Consider using blackout shades if streetlights shine into your window.
  • Invest in an eye mask for when it’s time to go to sleep.

Climate change and global warming

Climate change may be the biggest global health threat of the 21st century.

The ill effects resulting from the “climate change cascade” now underway have been painstakingly documented in the book Environmedics, co-authored by Jay Lemery, MD (associate professor of medicine at the University of Colorado) and Paul Auerbach, MD (professor emeritus of emergency medicine at Stanford). They explain that there are four main “environmental stressors” from which adverse health effects originate:

  • Rising temperature (global warming) – increasing numbers of strokes, heart attacks, more respiratory failure, heatstroke, asthma, dehydration
  • Extreme weather events – injuries and fatalities; malnutrition caused by drought; infectious diseases caused by flooding; mosquito-borne illnesses caused by both; respiratory problems and death caused by wildfires
  • Rising sea level – cholera, harmful algal blooms
  • Increased carbon dioxide – rising allergens, asthma, cardiovascular disease

In the above, we list only a few of the adverse health effects that can result from these climate stressors. The authors go on to connect the stressors to numerous other health risks brought on by the ensuing air, water and soil pollution and resulting food insecurity. In the book’s sobering conclusion, the authors warn that “if earth is warming because of global climate change, then human health will suffer.”

Solutions:  What can we do as individuals? The Environmedics authors lay out where we must go from here, including purchasing wisely and promoting conservative practices; voting for motivated public officials; and letting yourself be heard by using your voice, pen and ballot. Thus, our efforts must combine individual choices and directives with better organized community and legislative changes. The challenges may seem daunting, but as the authors conclude:

“…it’s time to come together as a unified human race and face this issue….we need to make prompt decisions. Human history is replete with creativity, resilience, determination, and optimism. Let’s get going.”

By Lane McKenna
February 2019