insights

Personal care items are just one example of consumer products that may add to the chronic levels of toxicants in a home. And as cumulative levels of indoor pollutants potentially increase, the possible risks for adverse health impacts are important to consider.

Biomonitoring, VOCs, and Indoor Air Pollutants

The US Centers for Disease Control and Prevention (CDC) began measuring human exposure to chemicals in 1976. These “biomonitoring” studies are ongoing and continue to find a range of toxicants in subjects’ blood and urine, including substances such as:

• Persistent organic pollutants (POPs) such as dichlorodiphenyltrichloroethane (DDT), which has already been banned from the US for more than three decades.
• Glyphosate from pesticides.
• Bisphenol-A (BPA) from food containers, plastics, and cash register receipts.¹
• Phthalates in toys and shampoos.²
• Volatile organic compounds (VOCs) such as benzene in common household cleaning supplies and detergents.³

Scientists continue to research indoor air pollutants and the complex nature of VOCs. The EPA has regulated only a few VOCs despite their associated health effects, which may include headache, damage to the liver, kidneys, and nervous system, visual disorders, memory impairment, and cancer.⁴ A 2020 analysis of national survey data indicated that all annual levels of VOCs from ambient air, typically known as outdoor air, actually decreased between 2005 and 2013; however, urinary metabolites of several VOCs from individuals increased during that same time period.⁵ The analysis suggested that ambient VOCs are not necessarily the primary source of exposure.⁵ One consideration is that VOCs also pollute indoor air.⁶ Compounding such potential exposure, semi-volatile organic compounds (SVOCs), a subgroup of VOCs, are also found indoors, binding to surfaces as well as in dust particles, and are emitted from building materials, from consumer products, and during resident activities.^7-9

In the following video, IFM educator Robert Rountree, MD, explains how he advises parents on toxicant exposures in children:

Indoor Pollutants, Consumer Products, & Risks to Children

According to the EPA, Americans, on average, spend up to 90% of their time indoors, where some pollutants may potentially have concentrations two to five times higher than outside.¹⁰ Small children may even be at greater risk than adults to the adverse health effects linked to indoor contaminants because of their small body mass, limited ability to detoxify and excrete xenobiotic toxic chemicals, rapid growth, activities close to the floor, tendency for inadvertent ingestion of non-food items, and hand-to-mouth behavior.¹¹

Carpets, Home Furnishings, and Toys

A wide variety of toxic chemicals have been known to gather into indoor dust and accumulate on carpets.^11,12 In addition to this potential exposure, some children and their families may be exposed to chemical flame retardants, including PBDEs, in synthetic materials like furniture and/or rugs or carpet padding, which have been linked to cancer, hormone disruption, and other health effects.¹³ A 2017 systematic review and meta-analysis found that there was sufficient evidence to support an association between developmental PBDE exposure and reduced IQ.¹⁴ Further, children spend much of their time sleeping, and studies suggest that they may be exposed to elevated concentrations of chemicals released from some crib mattresses.¹⁵

VOCs can be emitted indoors through the odorous off-gassing from a variety of household items, or they may have no detectable smell and still be present.^16,17 A recent study noted a lack of standard testing methods to assess consumer inhalation exposure to these consumer products, including toys.¹⁷ The investigation focused on 14 common VOCs and used four specific toy samples.¹⁷

• Results noted a rapid decrease in emissions from the samples after a few hours from an acute concentration. A lower chronic concentration continued to be present during the 28-day monitoring period depending on the tested material.¹⁷
• Conclusions suggested that consumer products represent an additional source of VOCs inside the home, and that further emission content of household products, to include SVOCs, is necessary to understand health risks for consumers.¹⁷

Personal Care and Natural Products

Certain phthalates, ubiquitous xenobiotics found in many plastic products, cosmetics, and personal care products, have shown endocrine-disrupting and anti-androgenic properties in human studies.¹⁸ Vulnerable populations, such as women of reproductive age, infants, and young children, as well as racial and ethnic minorities, may be more exposed to phthalates than persons of other demographic strata.¹⁹ A 2017 observational study of a diverse population of urban mother-child pairs suggested that maternal exposure to phthalates in late pregnancy was negatively associated with the female child’s mental and psychomotor development.¹⁸ In addition, a 2018 Environmental Research study suggested that hair products commonly used by Black women and children in the United States may contain multiple chemicals associated with endocrine disruption and asthma, and that those chemicals may not even be listed on the product label.²⁰

It’s important to note that not all products labeled “natural” are harmless to the human body. A 2018 Australian study analyzed the VOC emissions from 42 fragranced baby products, and half of the products were promoted as all-natural or organic.²¹ The analysis only tested for VOCs, and results indicated that 228 different VOCs were emitted from the products, with 43 classified as potentially hazardous.²¹ Emissions from the all-natural and organic products were reportedly not significantly different than the regular products.²¹

Natural compounds such as terpenes and terpenoids, quinones, and peroxides may be found in personal care products such as soaps, shampoos, creams, and lotions and potentially pose a risk to human health.²² In fact, a 2015 study in Environmental Sciences Europe identified over 1,000 natural substances—mainly of herbal origin—that appear in the International Nomenclature of Cosmetics Ingredients (INCI) and found that:²³

• 38% are classified as hazardous to human health.
• 53 are classified as carcinogens, mutagens, and substances toxic to reproduction.

Clinical Applications

Humans are exposed to literally hundreds of chemicals, many of which have the potential to negatively affect health. As with many pollutants, the toxicant concentration and length of exposure time may indicate the extent of impact and inform any treatment considerations. Understanding toxicity and taking practical steps to improve biotransformation are essential pieces to improving a patient’s health and well-being.

Functional Medicine practitioners approach each patient with toxicity concerns through an individual assessment. Patterns and potential toxic exposures are identified and evaluated to ensure a comprehensive strategy to ultimately reduce those exposures and promote detoxification through appropriate biological pathways. Personalized treatments may include lifestyle modifications as well as nutritional support through specific nutrients that enhance toxicant elimination and through therapeutic diets, such as IFM’s Detox Food Plan.

Learn more about toxicants, toxic exposures, and elimination through the following IFM articles and podcasts.

Addressing the Body Burden

Toxins and Toxicants as Drivers of Disease

Food and Toxins: Safe Grilling and Frying Methods

References

1. Lee C, Kim CH, Kim S, Cho SH. Simultaneous determination of bisphenol A and estrogens in hair samples by liquid chromatography-electrospray tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci. 2017;1058:8-13. doi:10.1016/j.jchromb.2017.05.007
2. US Food & Drug Administration. Phthalates. Updated December 5, 2013. Accessed July 8, 2020. https://www.fda.gov/cosmetics/productsingredients/ingredients/ucm128250.htm
3. Centers for Disease Control and Prevention. Fourth national report on human exposure to environmental chemicals: updated tables, January 2019, volume One. Published January 2019. Accessed July 8, 2020. https://www.cdc.gov/exposurereport/pdf/FourthReport_UpdatedTables_Volume1_Jan2019-508.pdf
4. US Environmental Protection Agency. Volatile organic compounds’ impact on indoor air quality. Updated November 6, 2017. Accessed July 8, 2020. https://www.epa.gov/indoor-air-quality-iaq/volatile-organic-compounds-impact-indoor-air-quality
5. Konkle SL, Zierold KM, Taylor KC, Riggs DW, Bhatnagar A. National secular trends in ambient air volatile organic compound levels and biomarkers of exposure in the United States. 2020;182:108991. doi:10.1016/j.envres.2019.108991
6. Manisalidis I, Stavropoulou E, Stavropoulos A, Bezirtzoglou E. Environmental and health impacts of air pollution: a review. Front Public Health. 2020;8:14. doi:10.3389/fpubh.2020.00014
7. US Environmental Protection Agency. Indoor semi-volatile organic compounds (i-SVOC) version 1.0. Updated June 5, 2017. Accessed July 8, 2020. https://www.epa.gov/chemical-research/indoor-semi-volatile-organic-compounds-i-svoc-version-10
8. Li HL, Liu LY, Zhang ZF, et al. Semi-volatile organic compounds in infant homes: levels, influence factors, partitioning, and implications for human exposure. Environ Pollut. 2019;251:609-618. doi:10.1016/j.envpol.2019.05.048
9. Kristensen K, Lunderberg DM, Liu Y, et al. Sources and dynamics of semivolatile organic compounds in a single-family residence in northern California. Indoor Air. 2019;29(4):645-655. doi:10.1111/ina.12561
10. US Environmental Protection Agency. Report on the environment: indoor air quality. Updated July 16, 2018. Accessed July 8, 2020. https://www.epa.gov/report-environment/indoor-air-quality
11. Roberts JW, Ott WR. Exposure to pollutants from house dust. In: Ott WR, Steinemann AC, Wallace LA, eds. Exposure Analysis. CRC Press; 2006:319-346. doi:10.1201/9781420012637.pt5
12. Paustenbach DJ, Finley BL, Long TF. The critical role of house dust in understanding the hazards posed by contaminated soils. Int J Toxicol. 1997;16(4-5):339-362. doi:10.1080/109158197227008
13. Leonetti CP, Butt CM, Stapleton HM. Disruption of thyroid hormone sulfotransferase activity by brominated flame retardant chemicals in the human choricocarcinoma placenta cell line, BeWo. Chemosphere. 2018;197:81-88. doi:10.1016/j.chemosphere.2017.12.172
14. Lam J, Lanphear BP, Bellinger D, et al. Developmental PBDE exposure and IQ/ADHD in childhood: a systematic review and meta-analysis. Environ Health Perspect. 2017;125(8):086001. doi:10.1289/EHP1632
15. Boor BE, Järnström H, Novoselac A, Xu Y. Infant exposure to emissions of volatile organic compounds from crib mattresses. Environ Sci Technol. 2014;48(6):3541-3549. doi:10.1021/es405625q
16. Dodson RE, Udesky JO, Colton MD, et al. Chemical exposures in recently renovated low-income housing: influence of building materials and occupant activities. Environ Int. 2017;109:114-127. doi:10.1016/j.envint.2017.07.007
17. Even M, Girard M, Rich A, Hutzler C, Luch A. Emissions of VOCs from polymer-based consumer products: from emission data of real samples to the assessment of inhalation exposure. Front Public Health. 2019;7:202. doi:10.3389/fpubh.2019.00202
18. Doherty BT, Engel SM, Buckley JP, Silva MJ, Calafat AM, Wolff MS. Prenatal phthalate biomarker concentrations and performance on the Bayley Scales of Infant Development-II in a population of young urban children. Environ Res. 2017;152:51-58. doi:10.1016/j.envres.2016.09.021
19. Buck Louis GM, Zhai S, Smarr MM, et al. Endocrine disruptors and neonatal anthropometry, NICHD Fetal Growth Studies – Singletons. Environ Int. 2018;119:515-526. doi:10.1016/j.envint.2018.07.024
20. Helm JS, Nishioka M, Green Brody J, Rudel RA, Dodson RE. Measurement of endocrine disrupting and asthma-associated chemicals in hair products used by Black women. Environ Res. 2018;165:448-458. doi:10.1016/j.envres.2018.03.030.
21. Nematollahi N, Doronila A, Mornane PJ, Duan A, Kolev SD, Steinemann A. Volatile chemical emissions from fragranced baby products. Air Qual Atmos Health. 2018;11(7):785-790. doi:10.1007/s11869-018-0593-1
22. Bucheli TD, Strobel BW, Hansen HCB. Personal care products are only one of many exposure routes of natural toxic substances to humans and the environment. Cosmetics. 2018;5(1):10. doi:10.3390/cosmetics5010010
23. Klaschka U. Naturally toxic: natural substances used in personal care products. Environ Sci Eur. 2015;27:1. doi:10.1186/s12302-014-0033-2