Medscape Medical News...

What's the Disease Burden From Plastic Exposure?

Liam Davenport | January 11, 2024

Exposure to endocrine-disrupting chemicals (EDCs) via daily use of plastics is a major contributor to the overall disease burden in the United States and the associated costs to society amount to more than 1% of the gross domestic product, revealed a large-scale analysis.

The research, published in the Journal of the Endocrine Society on January 11, 2024 indicated that taken together, the disease burden attributable to EDCs used in the manufacture of plastics added up to almost $250 billion in 2018 alone.

"The diseases due to plastics run the entire life course from preterm birth to obesity, heart disease, and cancers," commented lead author Leonardo Trasande, MD, MPP, Jim G. Hendrick, MD Professor of Pediatrics, Department of Pediatrics, NYU Langone Medical Center, New York, in a release.

"Our study drives home the need to address chemicals used in plastic materials" through global treaties and other policy initiatives, he said, so as to "reduce these costs" in line with reductions in exposure to the chemicals.

Co-author Michael Belliveau, Executive Director at Defend Our Health in Portland, ME, agreed, saying: "We can reduce these health costs and the prevalence of chronic endocrine diseases such as diabetes and obesity if governments and companies enact policies that minimize exposure to EDCs to protect public health and the environment."

Plastics may contain any one of a number of EDCs, such as polybrominated diphenylethers in flame retardant additives, phthalates in food packaging, bisphenols in can linings, and perfluoroalkyl and polyfluoroalkyl substances (PFAS) in nonstick cooking utensils.

These chemicals have been shown to leach and disturb the body's hormone systems, increasing the risk for cancer, diabetes, reproductive disorders, neurological impairments in developing fetuses and children, and even death.

In March 2022, the United Nations Environment Assembly committed to a global plastics treaty to "end plastic pollution and forge an international legally binding agreement by 2024" that "addresses the full lifecycle of plastic, including its production, design and disposal."

Minimizing EDC Exposure

But what can doctors tell their patients today to help them reduce their exposure to EDCs?

"There are safe and simple steps that people can take to limit their exposure to the chemicals of greatest concern," Trasande told Medscape Medical News.

This can be partly achieved by reducing plastic use down to its essentials. "To use an example, when you are flying, fill up a stainless steel container after clearing security. At home, use glass or stainless steel" rather than plastic bottles or containers.

In particular, "avoiding microwaving plastic is important," Trasande said, "even if a container says it's microwave-safe."

He warned that "many chemicals used in plastic are not covalently bound, and heat facilitates leaching into food. Microscopic contaminants can also get into food when you microwave plastic."

Trasande also suggests limiting canned food consumption and avoiding cleaning plastic food containers in machine dishwashers.

Calculating the Disease Burden

To accurately assess the "the tradeoffs involved in the ongoing reliance on plastic production as a source of economic productivity," the current researchers calculated the attributable disease burden and cost related to EDCs used in plastic materials in the United States in 2018.

Building on previously published analyses, they used industry reports, publications by national and international governing bodies, and peer-reviewed publications to determine the usage of each type of EDC and its attributable disease and disability burden.

This plastic-related fraction (PRF) of disease burden was then used to calculate an updated cost estimate for each EDC, based on the assumption that the disease burden is directly proportional to its exposure.

They found that for bisphenol A, 97.5% of its use, and therefore its estimated PRF of disease burden, was related to the manufacture of plastics, while this figure was 98%-100% for phthalates. For PDBE, 98% of its use was in plastics vs 93% for PFAS.

The researchers then estimated that the total plastic-attributable disease burden in the United States in 2018 cost the nation $249 billion, or 1.22% of the gross domestic product. Of this, $159 billion was linked to PDBE exposure, which is associated with diseases such as cancer.

Moreover, $1.02 billion plastic-attributable disease burden was associated with bisphenol A exposure, which can have potentially harmful health effects on the immune system; followed by $66.7 billion due to phthalates, which are linked to preterm birth, reduced sperm count, and childhood obesity; and $22.4 billion due to PFAS, which are associated with kidney failure and gestational diabetes.

The study was supported by the National Institutes of Health and the Passport Foundation.

Trasande declared relationships with Audible, Houghton Mifflin, Paidos, and Kobunsha, none of which relate to the present manuscript.

No other financial relationships were declared.

Are your prenatal vitamins measuring up?

 Another interesting research article I came across in Medscape on Prenatal supplements…

"Although drugstore shelves might suggest otherwise, affordable dietary supplements that provide critical nutrients in appropriate doses for pregnant women are virtually nonexistent, researchers have found.

In a new study published this month (April 2023), in the American Journal of Clinical Nutrition, investigators observed what many physicians have long suspected: most prenatal vitamins and other supplements do not adequately make up the difference of what food-based intake of nutrients leave lacking. Despite patients believing they are getting everything they need with their product purchase, they fall short of guideline-recommended requirements. (see attached research study below)

The researchers analyzed 24-hour dietary intake data from 2450 study participants across five states from 2007 to 2019. Sauder and colleagues focused on six of the more than 20 key nutrients recommended for pregnant people, and determined the target dose for vitamin A, vitamin D, folate, calcium, iron, and omega-3 fatty acids.

The researchers tested more than 20,500 dietary supplements, of which 421 were prenatal products. Only 69 products — three prenatal — included all six nutrients. Just seven products — two prenatal — contained target doses for five nutrients. Only one product, which was not marketed as prenatal, contained target doses for all six nutrients but required seven tablets a serving and cost patients approximately $200 a month.  

More than half of pregnant people in the United States are at risk of inadequate intake of vitamin D, folate, and iron from their diet alone, and one third are at risk for insufficient intake of vitamin A and calcium.

Although more than 70% of pregnant women take dietary supplements, the products do not eliminate the risks for deficiencies. The effects of inadequate nutrition during pregnancy may include neural tube defects, alterations in cardiovascular structure, and impaired neurocognitive development.

I thought it would be interesting to see how our Everyday Essentials Pregnancy (R275P), and Prenatal (R714), formulas compared to what the researchers determined as the target dose for vitamin A, vitamin D, folate, calcium, iron, and omega-3 fatty acids:

The target daily dose for Vitamin A was ≥198 mcg retinol activity equivalents (RAE) of total vitamin A (with ≤2063 mcg preformed retinol):

• Everyday Essentials Pregnancy (per daily packet): 1,500 mcg RAE (80% as mixed carotenoids and 20% as retinyl palmitate)
• Prenatal (six capsules daily): 1,500 mcg RAE (80% as mixed carotenoids and 20% as retinyl palmitate)

The target daily dose for Vitamin D3 was 7–91 mcg:

•  Everyday Essentials Pregnancy (per daily packet):  50 mcg.
• Prenatal (six capsules daily): 50 mcg.

The target daily dose for Folic Acid was 169–720 mcg dietary folate equivalents (DFE) of folic acid:

•  Everyday Essentials Pregnancy (per daily packet): 1,700 mcg DFE (as calcium L-5-methyltetrahydrofolate)
• Prenatal (six capsules daily): 1,700 mcg DFE (as calcium L-5-methyltetrahydrofolate)

The target daily dose for Calcium was  383–943 mg. 

•  Everyday Essentials Pregnancy (per daily packet): 400 mg. (as calcium citrate)
• Prenatal (six capsules daily): 400 mg. (as calcium citrate)

The target daily dose for Iron was 13–22 mg.

•  Everyday Essentials Pregnancy (per daily packet): 30 mg. (as ferrous bisglycinate chelate) (Ferrochel™) 
• Prenatal (six capsules daily): 30 mg. (as ferrous bisglycinate chelate) (Ferrochel™) 

The target daily dose for Omega-3 Fatty Acids was ≥59 mg ω-3 FAs:

•  Everyday Essentials Pregnancy (per daily packet): Total Omega-3 Fatty Acids - 1.6 grams (1600 mg.) - (860 mg. of EPA, 580 mg. of DHA and 160 mg. of Additional Omega-3 Fatty Acids)  
• Prenatal (six capsules daily): None

NOTE: Other than the Prenatal (R714), NOT containing Omega-3 Fatty Acids, BOTH NutriDyn prenatal formulas met or exceeded the research determined target dose for vitamin A, vitamin D, folate, calcium, iron, and in the case of Everyday Essentials Pregnancy, the omega-3 fatty acids.

Also, our retail price for a month supply is $67.25 for Everyday Essentials Pregnancy (R275P), and $42.25 for the Prenatal (R714)… NOT $200.00 a month!

Original article:Dietary supplements and requirements in pregnancy 

Most pregnant women in the United States (US) are at risk of inadequate intake of key nutrients during pregnancy from foods alone. Current dietary supplement practices reduce risk of inadequacy for only some nutrients and induce excessive intake of other nutrients.

Objectives

Our study aimed to estimate the doses of supplementation needed to help most pregnant women achieve the recommended intake without exceeding upper limits for key prenatal nutrients and to identify US dietary supplements providing these doses.