hormone disruptors & women’s health

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1. Sarah Janssen, M.D., Ph.D., M.P.H. Science Fellow, Natural Resources Defense Council sjanssen@nrdc.org Hormonal Effects of Chemical Pollutants Endocrine Disruptors and Reproductive Health 2. Increasing Incidence of Health Conditions Infertility Premature births Birth defects of genitalia Early onset of puberty Cancer - testicular Neurological conditions ADHD, autism Insulin resistance/Diabetes Obesity 3. Endocrine Disruptor An exogenous agent that interferes with the synthesis, secretion, transport, binding, action, or elimination of natural hormones in the body that are responsible for the maintenance of homeostasis, reproduction, development, and /or behavior. U.S. EPA, February 1997 Or in simpler terms: A substance which interferes with natural hormones. 4. Endocrine disruptors and health Abnormal development of reproductive organs or neurological system Reduced fertility male and female Poor birth outcomes LBW/IUGR, SA Development of pre-cancerous/cancerous lesions Lower IQ Behavioral abnormalities 5. Synthetic Estrogens Seven women ages 15- 22 presented at the Massachusetts General Hospital with clear cell adenocarcinoma of the vagina, 1966-69 Herbst, AL. et al N Engl J Med 1971, 284:878. The Wood siblings From: www.desexposure.com 6. Diethylstilbestrol - DES Estradiol 7. DES Health Effects - Female Vaginal cancer (clear-cell adenocarcinoma) Gross and cellular structural abnormalities of reproductive organs: fallopian tubes, uterus, cervix, and vagina Suppression of cell-mediated immunity Infertility (5x) Preterm labor Uterine fibroids Breast cancer Trans-generational effects DES granddaughters 8. DES Health Effects - Male Cryptorchidism Testicular hypoplasia Epididymal cysts Semen abnormalities Reduced fertility Testicular cancer 9. Lessons from DES The placenta is not a barrier Exposure to the mother can have unexpected, delayed effects in the offspring Exposure to a hormonally-active chemical may result in a variety of adverse health effects Unusual diseases are easier to trace to an environmental cause than are common diseases 10. Embryonic Development & Vulnerability 11. Children are More Vulnerable to All Toxins Immature brain, blood/brain barrier; Eat, breathe & drink more per kg; GI & skin 2x surface area v. adult; Outside more & closer to ground; Hand/mouth behaviors; Mouth breathers; Lower enzyme levels. 12. Wts of after in utero exposure to 1 part per billion DES Estrogenic agents and obesity Newbold, et al. 2005. Developmental Exposure to Estrogenic Compounds and Obesity. Birth Defects Research (Part A) 73:478480. 13. Common Endocrine Disruptors Banned in US PCBs Pesticides DDT DBCP Chlordecone (Kepone) Hexachlorobenzene Not intentionally made Dioxins Furans PAHs Still in use Pesticides Atrazine Endosulfan Lindane Flame retardants PBDEs BFRs/CFRs Plasticizers phthalates bisphenol A Heavy Metals Lead Mercury 14. Biomonitoring Increasingly being used to determine what contaminants are in biological tissues Gauge of how effective policy initiatives to limit exposure are Where is it happening? CDC NHANES State initiatives California Non-governmental Organizations 15. Individual v. Population Effects Almost always impossible to pinpoint the cause of a human health condition to one chemical or exposure Timing Dose Mixtures I wonder ? 16. The Significance of Small Effects: 160140120100806040 70 130 I.Q. mean 100 6.0 million "gifted" 6.0 million "mentally retarded" 17. 5 Point Decrease in Mean IQ 160140120100806040 mean 95 70 130 2.4 million "gifted" 9.4 million "mentally retarded" 57% INCREASE IN "Mentally Retarded Population I.Q. 18. Fish Important source of nutrition Common contaminants PCBs Mercury FDA/EPA Advisory tilefish, king mackerel, shark, and swordfish Tuna 19. Fish recommendations Eat a variety of fish types Know about fish advisories for your region www.epa.gov/ost/fish/ Use fish guides for ocean fish NRDC fish guides and Mercury calculator http://www.nrdc.org/mercury) Monterey Bay Aquarium (http://www.mbayaq.org/) When cooking remove fatty portions of fish 20. Other Dietary advice Dioxins and other fat-soluble contaminants in fatty tissue PCBs, PBDEs - Limit consumption of high fat meat & dairy Eat organic produce when possible 21. Pesticides Can contaminate food or drinking water Are also frequently used in and around homes Pets Indoor pests Lawns and Gardens Head lice and scabies Rural areas 22. Neurotoxicity of Pesticides in Children 23. Recommendations Eat a variety of produce Buy organic produce when possible Review guides of products most likely to be contaminated www.foodnews.org/walletguide.php Wash and peel outer leaves Utilize IPM in the home, at work, school, other Use non-pesticide approaches for head lice and scabies 24. Bisphenol A Phthalates 25. Bisphenol A Over 6 billion pounds produced each year Developed as estrogenic drug 1930s Building block of polycarbonate plastic Food can lining Dental sealant 7 PC 26. Animal studies Reproductive toxin Lower sperm counts Prostate hyperplasia/cancer Mammary cancer Developmental toxin - altered onset of puberty - decreased anogenital distance - oocyte anueploidy Neurological toxin Obesogen/Insulin Resistance 7 PC 27. Policy BPA has not been banned in any state or country although legislation has been introduced FDA has approved BPA as a food additive National Toxicology Program draft report Health Canada - dangerous substance 7 PC 28. Public perception Market for baby bottles changed Walmart, Sears "Baby Bargains," a best-selling guide to baby products, have advised parents to stop using bottles made of polycarbonate plastic. "If you are shopping for bottles, choose an alternative made from BPA-free plastic or glass," "If you have polycarbonate bottles, throw them out." 7 PC 29. What are the alternatives? Non-polycarbonate plastic or glass baby bottle Born-Free (polyamide) Polypropylene Unlined stainless steel bottle Eat fresh food when possible, - frozen over canned Buy processed food in cardboard or brick containers 30. Bisphenol A Phthalates 31. Phthalates and PVC Make PVC flexible and soft Not tightly bound, migrates with use Ubiquitous exposure General Uses - Building materials - Toys - Clothing - Childcare Products - Packaging - Cosmetics and - Medical Devices personal care products - Air fresheners PVC3 32. Phthalates: Anti-Androgens Phthalate Syndrome Absent testes, prostate gland, seminal vesicles Testicular atrophy Decreased sperm count Decreased fertility Cryptorchidism Hypospadias decreased AGD Fisher J. Reproduction.127:305-15, 2004 33. What can you do? Avoid buy PVC vinyl products Avoid using synthetic scents to mask odors Avoid exposure to phthalates Fragrance free cosmetics and personal care products Soft pliable plastic toys for children Support legislation in California that would limit exposure to these chemicals. 34. Chemicals in Breast milk PCBs Pesticides banned and currently in use Dioxins Flame retardants Plasticizers Heavy metals Solvents http://www.nrdc.org/breastmilk 35. Recommendations Benefits of breast feeding outweigh the risks from pollution. Breastmilk is superior to formula because provides vital trace nutrients and antibodies not found in formula benefits the mother by promoting weight loss and bone strength promotes brain and nervous system development can lessen the effects of some toxic exposures 36. Baby formula is not an equivalent substitute for breast milk. Formula is lacking in many of the vital trace nutrients and antibodies found in breast milk. babies get sick more often than breast fed babies. Infant formula may contain other toxins or be diluted with contaminated water Soy formulas can have very high levels of plant- derived estrogens (phytoestrogens) the long term health effects are not very well studied. 37. Take home messages Hormonally-active agents exist in drugs, cosmetics, dietary supplements, pesticides, consumer products, and industrial chemicals. Laboratory animal experiments suggest that exposures to these agents could be impacting reproductive health. The developing fetus, infants and children are most vulnerable because their organs are still developing 38. Take home messages, contd Consequences of early life exposures are sometimes manifest until adulthood and can be permanent and irreversible Chemicals can have multiple sites of action with multiple effects. The impacts of exposures to mixtures of chemicals is not understood 39. Resources Natural Resources Defense Council www.nrdc.org Simple Steps www.simplesteps.org


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