Written by Israelbelle Ferolino
The Problem
The Kato Repro Biotech Center estimates that one in every 10 Filipinos suffers from infertility. Taking into account that there are about 110 million Filipinos in 2022, that’s about 11 million people who struggle with having a child.
The Philippines is not alone in this reproductive health crisis. Dr. Shanna Swan, a professor of environmental medicine and public health, combed through 185 studies involving almost 45,000 healthy men with her team. They were able to conclude that sperm counts among men in many countries had dropped by 59 percent between 1973 and 2011.
These fertility issues have repercussions. Low sperm concentration in men is linked to poor overall health. In a 2016 study of 13,000 men diagnosed with male infertility, researchers discovered that men with low sperm counts had a 30% higher risk of acquiring diabetes and a 48% higher risk of developing ischemic heart disease than men who had not been diagnosed with infertility. Male infertility is also linked to an increased risk of cancer, especially testicular cancer and high-grade prostate cancer.
On the other hand, there are strong links between fertility and a woman's future well-being. Researchers from Stanford University discovered that infertile women had an 18 percent increased chance of getting uterine, ovarian, thyroid, liver, and pancreatic cancers, as well as leukemia, in a 2019 study encompassing over 64,000 women diagnosed with infertility issues.
The Culprits
While lifestyle habits contribute to these trends in infertility, experts in environmental and reproductive epidemiology warn that our over-dependence on plastics is a big factor in causing this damage to our reproductive health and sexual development. In particular, they have zeroed in on phthalates and bisphenol A (BPA), chemicals used in the production of plastics, as the culprits.
Phthalates are a broad category of compounds used to make plastics more durable. Plastic and vinyl, floor and wall coverings, medical gadgets, toys, and personal-care goods such as nail polish, fragrances, hair sprays, soaps, shampoos, and others contain phthalates.
Phthalates can reduce the production of male hormones such as testosterone, which are required for a man to properly masculinize, causing him to become infertile or have a decreased sperm count. A 2018 review of the literature found strong evidence of a link between phthalate exposure and male reproductive outcomes such as shorter anogenital distance (the distance between the anus and the base of the penis), reduced semen quality, and lower testosterone levels, as well as lower semen quality and a longer time to conceive. Men who have been exposed to phthalates extensively over their adult lives have lower sperm counts and more improperly shaped sperm.
It has also been demonstrated that prenatal phthalate exposure can affect a male child's reproductive development, particularly the size of his genitals. Furthermore, findings reveal that by early adulthood, males whose mothers had greater levels of various phthalates during pregnancy had smaller testicles, which is linked to poorer testicular function.
Phthalates are bad news for women too. Anovulation, or the failure of the ovaries to produce an egg throughout the menstrual cycle, has been linked to high levels of phthalate exposure. It's also linked to polycystic ovary syndrome (PCOS), a hormonal condition characterized by impaired ovarian function and high androgen levels. To add, greater blood levels of some phthalates have been related to early ovarian failure in other studies. In addition to possibly accelerating menopause, evidence shows that heavy exposure to phthalates from personal-care items, in particular, is linked to a higher frequency of hot flashes in women between the ages of 45 and 54.
In Administrative Order No. 2009-005, the Department of Health of the Philippines released a guideline on the regulation of phthalates. However, the guideline only applies to toys and child care articles. Other primary modes of phthalate exposure such as food packaging and food contact application are not prohibited. More so, the guideline only prohibits Phthalate in large doses and Dr. Swan says that this is erroneous.
"Contrary to the widely held assumption that the dose makes the poison, which was based on the notion that only a high enough concentration of a toxic substance could cause harm, endocrine-disrupting chemicals often don’t behave this way. Rather, they can have harmful impacts even at very low doses. These low doses occur not from occupational exposures or industrial accidents, but with ordinary, everyday contact such as simply putting on makeup or body lotion or even carrying this book around in a plastic bag," Dr. Swan notes.
Another culprit for this infertility trend is Bisphenol A (BPA). BPA is a chemical that is manufactured in huge amounts for usage in polycarbonate plastics. Shatterproof windows, eyewear, water bottles, and epoxy resins that coat some metal food cans, bottle caps, and water supply pipes are among the products that contain them.
BPA exposure, particularly industrial exposure, has been linked to a reduction in sperm quality in men. Researchers from Kaiser Permanente found that men with detectable levels of BPA in their urine were more than four times as likely to have lower sperm counts, more than three times as likely to have poorer sperm vitality, and more than twice as likely to have lower sperm motility than men with undetectable BPA in their urine in a study with factory workers in China.
Sons of men who have been exposed to a lot of BPA have a shorter anogenital distance. When researchers looked at sexual satisfaction in males who worked in the BPA and epoxy resin industries, they discovered that these men had greater rates of sexual dysfunction, including erectile dysfunction and ejaculatory problems, as well as lower sexual desire.
Because BPA mimics the female hormone estrogen, it can create estrogen-like changes in the body. Thus, the potential impacts on women's reproductive health are significantly larger. There's strong evidence that women with high BPA levels in their blood have a higher risk of fertility issues, including infertility; it's unclear whether this is due to the chemical's negative impact on the function of various reproductive organs or on the proper cycling of estrogen levels, which is critical for ovulation.
Women with the highest levels of BPA in their blood have an 83 percent higher risk of miscarriage in the first trimester. During the first trimester of pregnancy, women with greater BPA levels in their urine are more likely to have daughters with a much shorter anogenital distance. According to human research, BPA also plays a role in polycystic ovarian syndrome (PCOS), as blood levels of BPA are higher in women with PCOS than in reproductively healthy women. Furthermore, BPA exposure during childhood and adulthood has been linked to low egg quality and has been implicated as a possible cause of premature ovarian insufficiency, which leads to menopause at a younger age.
The Solution
The solution to mitigating exposure to endocrine-disrupting plastics can be divided into personal and societal levels. Personal solutions should concentrate on the kitchen, which is one of the most common sources of phthalates, BPA, and other hormone-disrupting chemicals. These insidious chemicals can find their way into foods and beverages at any step along the supply chain, from farm to fork to manufacturing factory to cup or bottle. The bathroom may also carry a great risk of exposure to phthalates, BPA, and other potentially dangerous compounds in your home. Take the following actions to avoid multiple endocrine-disrupting chemicals in the kitchen and bathroom:
Fresh, unprocessed foods should be prioritized in your diet. Sticking to fresh meals, especially fruits, vegetables, and seafood, will help you avoid chemical exposure. Phthalates in the plastic or lining of cans can come into touch with packed meals during processing, and because these chemicals aren't bonded to the packaging material, they can leach into the food. Even if a product is labeled as BPA- or phthalate-free, alternatives may be just as dangerous as the chemicals they replace. In general, it's recommended to utilize fewer canned and packaged goods.
Rethink the containers you use to store food. Many foods and beverage containers include phthalates and bisphenol A (BPA); you're exposed to these hormone-disrupting chemicals when they seep into your food or drinks, or when these containers are heated in the microwave. The recycling sign for plastic containers containing phthalates is 3 and V or PVC. Many water bottles and plastic containers still contain BPA, as do the epoxy resins that protect canned foods from contamination. Glass, metal, or ceramic containers with caps or aluminum foil are the finest options for food storage.
Microwaves should not be used with plastic. If you want to reheat food in the microwave, avoid using a plastic container. Cover it with parchment paper, wax paper, a white paper towel, or a domed (glass or ceramic) container that fits over the plate or bowl if it needs to be covered. Even if the box says it's safe to microwave, don't microwave plastic food storage bags or grocery store plastic bags.
Upgrade your cooking utensils. If you've been using nonstick pots and pans, it's time to upgrade: nonstick cookware contains PFOA (perfluorooctanoic acid) or Teflon compounds (a brand name for the chemical polytetrafluoroethylene). While cooking on a heated nonstick surface makes cleanup easier, endocrine-disrupting chemicals have plenty of opportunities to sneak into your meal. If you do decide to keep using your nonstick cookware, only do so for brief periods at medium-low heat, and discard it if the surface becomes scratched or starts to flake. We have moved to cast-iron pots and pans in my house, and we adore them. Another acceptable option is stainless steel.
As much as possible, prepare meals at home. Food-packaging materials or food-handling gloves, believe it or not, are linked to greater levels of phthalates in the body when people eat out or order takeout often.
Get rid of your vinyl shower curtain. Chemical off-gassing, or the release of volatile organic compounds and phthalates into the air, causes the new shower curtain scent that comes with a new vinyl curtain or liner. It is harmful to your health. Instead, choose an environmentally friendly choice consisting of cotton, linen, or hemp.
Pay attention to personal-care product labeling. Avoid products that contain triclosan (often found in liquid soap and toothpaste), dibutyl phthalate (commonly found in hair spray and nail products), and parabens like methyl-, ethyl-, propyl-, isopropyl-, butyl-, and isobutyl-paraben (preservatives found in shampoos, conditioners, facial and skin cleansers, moisturizers, deodorants, sunscreens, toothpas\e, and makeup).
Remove all air fresheners. Stop using plug-in air fresheners, wick air fresheners, or spray air fresheners. Phthalates and other possibly hazardous compounds are present in all of them. Use an exhaust fan, open a window, or keep an open box of baking soda in the bathroom to absorb unwanted odors and improve air quality.
On a societal level, scientists, environmental activists, and health specialists are increasingly asking for the "precautionary principle" to be implemented in public health and environmental decision-making. The precautionary principle moves regulatory action from damage control after a problem has been recognized to proactive action before damage occurs, which is exactly what we need to preserve human and environmental health. The precautionary principle has the effect of shifting the burden of proof of safety from the public to the makers. It also removes the need to wait for scientific confirmation before taking protective or preventative action. Strong suspicion may be enough in some circumstances to keep potentially dangerous substances out of ordinary products. Humans would suffer significantly fewer harmful exposures daily if we applied the precautionary approach to endocrine-disrupting chemicals and other hazardous substances that are likely culprits in sperm count reduction and impairment of male and female reproductive development.
Since phthalates are also abundant in single-use plastics, the passage of House Bill (HB) 9147 or the Single-use Plastic Products Regulation Act would also help tackle this problem. Not only would HB 9147 operationalize a national standard definition of single-use plastics in the Philippines, but it will also enable our local government units to act in a streamlined manner in reducing our plastic dependence.
Our global plastic addiction is not only polluting our environment, it is also polluting our bodies. It is time to remove, replace, and regulate these everyday plastic items. Let us break free from these toxic plastics. The fate of humanity is at stake!
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