Over the years there has been a steady rise in women's health conditions such as breast cancer, fibroids, endometriosis, miscarriage, and infertility. There also has been a rise in conditions such as fibromyalgia, chronic fatigue syndrome and hypothyroidism, which mostly affect women. Studies show that human exposure to chemicals in our environment such as pesticides, herbicides, insecticides, and manufacturing by-products, can cause these endocrine disrupting conditions.
An endocrine disruptor is any substance that alters normal hormone levels or activity in the body. Synthetic chemicals can disturb the normal activity of estrogens, androgens, thyroid and other hormones.¹ They do so by binding directly to hormone receptors, activating it and causing the chain of events as if the hormone itself were binding to the receptor.^1-3 The toxic chemical may also bind and occupy the receptor, blocking normal hormonal activity, or it may interfere with proteins that regulate the activity of hormones.^1-5 These effects may be associated with the development of illness and disease.

We are exposed to endocrine-disrupting compounds in our everyday life, often without knowing we are being exposed. Pesticide residues can be found on fruits and vegetables sitting in the store to be sold.⁹ Animal products are tainted with dioxins and dioxin-like compounds and often have hormones and antibiotics added to them.⁹ Certain fish have high levels of mercury and pesticides.^9,14 Chemicals used as plasticizers in flexible polyvinyl chloride products can harm the female reproductive system. Polyvinyl chloride products include tablecloths, shower curtains, soft-squeeze children's toys, plastic medical equipment and plastic food wrappings.The plastic containers that food and condiments are stored in can leach out harmful chemicals.^10,26 Hormone disrupting compounds can be found in both well water and city water providing yet another means of exposure.⁹ Toxic compounds are also inhaled or absorbed through the skin by contact with most household cleaning products, cosmetics, perfumes, dry cleaning, carpet, vinyl floors, copy machines, furniture glues, air fresheners, mattresses, shampoos, and the list goes on.^11,12

Some of the most common endocrine disrupting compounds include dioxins, polychlorinated biphenyls, bisphenol-A, phthalates, pesticides, formaldehyde and heavy metals. All have been shown to cause adverse health effects in women.^2,3,15 There are many other chemicals, compounds and by-products in the environment that are considered toxins as well.

Dioxins are a byproduct produced by industrial incineration and combustion. They are produced by manufacturing of chlorine-containing products such as pesticides, wood preservatives and the bleaching of paper. Dioxins persist in the environment for years and accumulate in the food chain. Dioxins decrease thyroid hormones, testosterone and have both estrogenic and anti-estrogenic effects.²⁶ Dioxins are linked to endometriosis and thyroid dysfunction in women, as well as increased rates of stillbirths.^16-21,35,37

Polychlorinated biphenyls (PCBs) are used as coolants, lubricants, and insulation for electrical equipment, in paints, plastics, dyes, wood and rubber. PCBs accumulate in human adipose, the food chain, and are found in rivers and lakes. PCBs weaken the immune system, affect neurological development, behave like estrogen and affect thyroid function in rats and humans.^22,23,35,36

Bisphenol-A is a compound found in plastics. It is used in the manufacturing of compact disks, plastic bottles, the lining of metal food cans, and dental sealants. It leaches out of plastics into food and the environment. Bisphenol-A has estrogen-like effects on estrogen receptor positive breast cancer cells.²⁴

Phthalates are additives to plastics to make them strong, soft, and flexible. Most supplements are packaged in plastics made with phthalates. It is used in carpet backing, paints, glues, insect repellants, hair spray, and nail polish. Phthalates are used in personal care products such as lotions, hair color, shampoo and deodorants. Phthalates are also used in the manufacture of enteric coated medications, like Asacol, for example.³⁹ Phthalates have hormone disrupting effects and can suppress ovulation, estradiol production and contribute to polycytic ovarian syndrome.^10,26,27 In rats phthalates cause spontaneous abortion and birth defects.³⁷

Harmful pesticides such as DDT and its metabolite DDE have been banned in this country but their effects still linger in our environment. DDT was an insecticide used in agriculture and for mosquitoes. It has estrogen effects and anti-androgen effects as well as effects on cognition. Pesticides have been linked to infertility, spontaneous abortion and breast cancer.^37,38 DDT still persists in the environment, accumulated in adipose tissue and in the food chain.^9,28-31

Formaldehyde is a compound originally used in homes in the 1970s as a form of insulation. The fumes caused depression, fatigue, poor memory, headaches, asthma, cough, skin rashes, and much more.¹² Formaldehyde is no longer used in insulation but is found in shampoo, conditioners, cosmetics, construction materials, cleaning supplies, carpet, paper products, plastics, and the list goes on.^12,32 It has been linked to reduced fertility, spontaneous abortion, and endometriosis.^21,33,34

Various heavy metals can be considered endocrine disruptors and are linked to many women's health conditions. Exposure to low levels of cadmium is associated with an increased risk of osteoporosis and fractures.^40,41 Low-to-moderate lead exposures may increase the risk for spontaneous abortion.^42,43 There is also a link between mercury, manganese and lead exposure and reduced fertility.^44,45

A recent study by Darbe PD, in the Journal of Applied Toxicology 2004;24(1), found a high concentration of parabens in human breast tumors. This is significant due to the amount of parabens and methylparabens women are exposed to each day. Parabens are used as preservatives in thousands of cosmetics, food and pharmaceutical products including hormonal creams. Parabens are known endocrine disruptors.

Evaluation
Evaluating whether or not a patient's health condition is due to environmental exposure begins in the office with an in-depth exposure history. Start by making a time-line of the patient's symptoms, where they were living and working during these symptoms and when they last felt well. An in-depth history of residence, occupation, hobbies and lifestyle can help narrow down what they may have been exposed to over time. Testing can provide valuable information on recent exposure as well as retention of compounds in the body. Testing for heavy metals, pesticides, solvents, phthalates and other compounds is available from various labs.

Avoidance
It is important to be familiar with the link between women's health conditions and environmental toxins, in order to educate patients in ways to minimize exposure to these compounds. Avoiding endocrine disrupting compounds begins simply with choices made at home and at the store.
1. Buy organic fruits and vegetables grown without pesticides, herbicides, synthetic fertilizer or hormones.
2. Buy fresh/frozen fruits and vegetables when possible, avoiding canned foods.
3. Buy organic hormone-free meats, eggs, and dairy products and avoid eating the fat of the animal.
4. Buy grass fed and lower fat animal products.
5. Eat fish low in mercury and fat since toxins accumulate in the fat of fish.
6. Avoid: tilefish, tuna, swordfish, shark, king mackerel, red snapper, orange roughy, moonfish, bass, marlin, and trout.
7. Drink filtered water out of glass jars or cups instead of plastic bottles.
8. Buy natural chemical and fragrance free soaps, detergents, and cleaning supplies.
9. Use natural pest control instead of pesticides and instead of herbicides for your lawn. Change your mind on what looks beautiful.
10. When remodeling look into earth friendly or 'green' building supplies.
11. Remove shoes when entering the house to prevent tracking residues into the house.
12. Use a high quality air purifier in the home.
13. Use natural/organic cosmetics and grooming products free of phthalates and parabens.
14. Use a non-toxic 'green' dry cleaners.
15. Avoid plastics as much as possible.

a. Store food in glass or ceramic containers.
b. Do not heat food in plastic containers or with plastic wrap over the top.
c. Buy condiments in glass containers instead of plastic.
d. Use an organic fiber shower curtain instead of plastic.
e. Carry cloth bags in your car for groceries instead of plastic bags.
f. Replace vinyl miniblinds with linen curtains
g. Use metal hangers instead of plastic.

16. Visit www.ewg.org for a list of foods lowest in pesticides and fish lowest in mercury.

Take Action
It is important to educate ourselves and others about the links between environmental toxins and women's health. It is equally important to get politically involved in local and national organizations to help put an end to the manufacture and use of toxic compounds. Physicians for Social Responsibility, www.psr.org, is one group committed to informing practitioners and the public about endocrine disrupting compounds. Many states have environmental organizations such as The Oregon Environmental Council; that has lectures for health care providers and the public.

When educating patients on how to avoid endocrine disrupting compounds, it becomes obvious that the natural products industry needs to explore alternatives to delivering foods and medicinal agents in plastic packaging. Despite cost increases and shorter shelf life, hopefully we will see more glass bottles for supplements, less products with parabens, and less plastics in packaging of juices, foods and dairy products.

Dr. Marianne Marchese is a naturopathic physician practicing in Portland, Oregon at A Woman's Time. Correspondence can be addressed to Dr. Marchese at awomanstime@aol.com

Recommended Reading
1. Our Stolen Future by Theo Colburn
2. Having Faith and Living Downstream by Sandra Steingraber
3. Multiple Chemical Sensitivity by Pamela Gibson

Recommended Websites
www.cheforhealth.org
www.nottoopretty.org
www.noharm.org
www.healthytomorrow.org
www.thegreenguide.org

References
1. Environmental endocrine disrupters Physicians for Social responsibility position statement. 2001
2. Colburn T, Dumanoski D, Myers JP. Our stolen future. Penguin Group Publ. 1997. 70-86
3. Steingraber S. Living downstream. Addison-Wesley Publ. 1997
4. Soto AM, et al. The pesticides endosulfan, toxaaphene, and dieldrin have estrogenic effects on human estrogen-sensitive cells. Env Health Persp 1994;102(4):380-383.
5. Frigo DE, et al. DDT and its metabolites alter gene expression in human uterine cell lines through estrogen receptor-independent mechanisms. Env Health Persp. 2002;110(12)1239-1243.
6. Bell IR, Baldwin CM, Schwartz GE. Illness from low levels of environmental chemicals: relevance to chronic fatigue syndrome and fibromyalgia. Am J Med 1998;105(3a):74s-82s.
7. Davis DL, Bradlow HL. Can environmental estrogens cause breast cancer? Scientific American 1995:166-172.
8. DeBruin LS, Josephy PD. Perspectives on the chemical etiology of breast cancer. Env Health Persp 2002;110(1):119-127.
9. Crinnion WJ. Environmental Medicine, Part 4: Pesticides-biologically persistent and ubiquitous toxins. Alt Med Rev 2000:5(5);432-447.
10. Colon I, et al. Identification Of phalate esters in the serum of young Puerto Rican girls with premature breast development. Env Health Persp 2000;108(9):895-900.
11. Crinnion WJ. Environmental Medicine, Part 1: The human burden of environmental toxins and their common health effects. Alt Med Rev 2000;5(1):52-63.
12. Crinnion WJ. Environmental Medicine, Part 2-Health effects of and protection from ubiquitous airborne solvent exposure. Alt Med Rev 2000;5(2):133-143.
13. Liska DJ, Roundtree R. The role of detoxification in the presence of chronic degenerative diseases. Applied Nutritional Science Reports 2002:1-8.
14. Clarkson TW, Mangosl, Myers GJ. The toxicology of mercury. NEJM 2003;3489180;1731-1737.
15. Steingraber S. Having Faith. Perseus Publ. 2001. 136-145.
16. Birnbaum LS, Cummings AM. Dioxins and Endometriosis; a plausible hypothesis. Env Health Persp. 2002;110(1):15-21.
17. Eskenazi B, et al. Serum dioxin concentrations and endometriosis: a cohort study in seveso, italy. Env Health Persp 2002;110(7):629-634.
18. Foster WG, Agarwal SK. Environmental contaminants and dietary factors in endometriosis. Ann NY Acad Sci 1998:213-229.
19. Rier SE. The potential role of exposure to environmental toxicants in the pathophysiology of endometriosis. Ann NY Acad Sci. 1998:201-211.
20. Rier S, Foster WG. Environmental dioxins and endometriosis. Toxicol Sci 2002;70:161-170.
21. Taskinen H.K, et al. Reduced fertility amoung female wood workers exposed to formaldehyde. Am J Ind Med 1999;36:206-212.
22. Steingraber S. Having Faith. Perseus Publ. 2001. 143-145
23. Colburn T. Our stolen future. Penguin Group Publ. 1997. 181-193
24. Olsen CM, et al. Effects of the environmental oestrogens bisphenol A, (and others), on oestrogen receptor binding, cell proliferation and regulation of oestrogen sensitive proteins in the human breast cancer cell line MCF-7. Pharm & Toxicol 2003;92:180-188.
25. Warner M, et al. Serum dioxin concentrations and breast cancer risk in the seveso women's health study. Env Health persp 2002;110(7):625-628.
26. Lovekamp-Swan T, Davis BJ. Mechanisms of phalate ester toxicity in the female reproductive system. Env Health Persp 2003;111(2):139-145.
27. Davis BJ, et al. Di-(2-ethylhexyl) phthalate suppresses estradiol and ovulation in cycling rats. Toxicol & Appl pharm 1994;128:126-223.
28. Wolfe MF, Seiber JN. Environmental activation of pesticides. Occup Med 1993;8(3);561-573.
29. Liu B, G HM, H JS. Parkinson's disease and exposure to infectious agents and pesticides and the occurance of brain injuries. Env health Persp 2003;111(8):1065-1073.
30. Cabello G, et al. A rat mammary tumor model induced by the organophosphorous pesticides parathion and malathion, possibly through acetycholinesterase inhibition. Env Health Persp 2001;109( 5):471-478.
31. Falck F, et al. Pesticides and polychlorinated biphenyl residues in human breast lipids and their relation to breast cancer. Arch of Env Health 1992;47(2):143-146.
32. Horowitz s. Indoor environmental health threats. Altern & Comple Therapies. 2002;12:363-369.
33. Rogers S. Tired or Toxic. Prestige Publ. 1990
34. Rogers S. The E.I. Syndrome. Prestige Publ. 1998
35. Koopman-Esseboom C, et al. Effects of dioxins and PCB's on thyroid hormone status of pregnant women and their infants. Pediatric Res. 1994;36(4):468-473.
36. Gauger KJ, et al. Polychlorinated biphenlos exert thyroid hormone-like effects in the fetal rat brain but do not bind to thyroid hormone receptors. Env Health Persp. 204;112(5):516-523.
37. Sharara FI, Seifer DB, Flaws JA. Environmental toxicants and female reproduction. Fertility and Sterility. 1998;70(4):613-622.
38. Snedeker SM. Environmental chemicals and breast cancer. BCERF 2002;fact sheet #45:1-8.
39. Hauser R, et al. Medications as a source of human exposure to phthalates: a case report. Env Health Persp. 2004;29:1-16.
40. Alfven T, et al. Low-level cadmium exposure and osteoporosis. J Bone Mineral Density. 2000;15(8):1579-1586.
41. Staessen JA, et al. Environmental exposure to cadmium, forearm bone density, and risk of fracture: prospective population study. Lancet.1999;353:1140-1144.
42. Borja-Aburto VH, et al. Blood lead levels measured prospectively and risk of spontaneous abortion. Am J Epid. 1999;150(6):590-597.
43. Hertz-Picciotto I. The evidence that lead increases risk for spontaneous abortion. Am J Ind Med. 2000;38:300-309.
44. Hruska KS, et al. Environmental factors in fertility. Clin Obst Gyn. 2000;43(4):821-829.
45. Choy CM, et al. Infertility, blood mercury concentrations and dietary seafood consumption: a case-control study. BJOG. 2002;109:1121-11125.

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