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 Phthalates: The Health Hazards Minimize

A subtle but profound health tragedy is unfolding due to the widespread use of hormone disrupting phthalates. As endocrine disrupting chemicals, phthalates interfere with expression of testosterone, the male sex hormone essential for the normal development of baby boys. These chemicals also harm thyroid hormones critical to healthy brain development in the fetus, and metabolic hormones related to fat processing and obesity.

A growing number of human health studies, animal research and biochemical experiments lead to the same conclusion – phthalates are toxic to multiple organ systems. Pregnant women exposed to the highest levels of phthalates more often give birth prematurely.[1] Higher prenatal exposure to phthalates produces more serious health problems in children, such as the following:

Abnormal development of male sex organs, including birth defects of the penis known as hypospadias;[2] smaller penis size and shorter anogenital distance, a sign of feminization,[3,4] which is associated with reduced semen quality in young men,[5] increased risk of prostate cancer;[6] and undescended testes,[7] which increases the risk of testicular cancer.

Harm to the brain, causing learning and behavior problems, including decreased alertness in baby girls,[8] poorer reflexes[9] and adverse behavior[10] in baby boys, more feminized play behavior in boys;[11] and in both sexes: lower cognitive scores and withdrawn behavior at age three,[12] poorer social behavior at ages seven to nine,[13] and poor attention and impulsive behavior.[14,15]

Sensitization of the immune system, increasing asthma and allergies, as measured by increased inflammatory response.[16]

Childhood exposure to phthalates interferes with normal sexual development and produces adverse effects similar to prenatal exposure on behavior, intellectual function and immune health. Human health studies have linked higher phthalate exposure to early puberty in girls,[17] breast growth in boys[18] and lowered intelligence.[19] Phthalates are also obesogens, with childhood exposure linked to increased body mass index and waist circumference.[20,21]

Although effects on the developing fetus and young children have received the most attention, adult exposure to phthalates also leads to adverse health outcomes, including low testosterone levels in males,[22] poor sperm quality,[23] increased endometriosis,[24] low thyroid levels in men[25] and pregnant women,[26] increased waist size and insulin resistance in men,[27] and immune problems such as allergies,[28] rhinitis and eczema.[29]

1 Meeker, J.D., Hu, H., Cantonwine, D.E., Lamadrid-Figueroa, H., Calafat, A.M., Ettinger, A.S., Hernandez-Avila, M., Loch-Caruso, R., Téllez-Rojo, M.M. (2009). Urinary phthalate metabolites in relation to preterm birth in Mexico City. Environ Health Perspect 117:1587-1592.

2 Choi, H., Kim, J., Im, Y., Lee, S., Kim, Y. (2012). The association between some endocrine disruptors and hypospadias in biological samples. J Environ Sci Health 47:2173-2179.

3 Swan, S.H., Main, K.M., Liu, F., Stewart, S.L., Kruse, R.L., Calafat, A.M., Mao, C.S., Redmon, J.B., Ternand, C.L., Sullivan, S., Teague, J.L., the Study for Future Families Research Team (2005). Decrease in anogenital distance among male infants with prenatal phthalate exposure. Environ Health Perspect 113:1056-1061.

4 Swan, S.H. (2008). Environmental phthalate exposure in relation to reproductive outcomes and other health endpoints in humans. Environ Res 108:177-184.

5 Mendiola, J., Stahlhut, R.W., Jørgensen, N., Liu, F., Swan, S.H. (2011). Shorter anogenital distance predicts poorer semen quality in young men in Rochester, New York. Environ Health Perspect 119:958-963.

6 Castaño-Vinyals, G., Carrasco, E., Lorente, J.A., Sabaté, Y., Cirac-Claveras, J., Pollán, M., Kogevinas, M. (2012). Anogenital distance and the risk of prostate cancer. BJU Int 110:E707-E710.

7 Swan 2005, 2008.

8 Engel, S.M., Zhu, C., Berkowitz, G.S., Calafat, A.M., Silva, M.J., Miodovnik, A., Wolff, M.S. (2009). Prenatal phthalate exposure and performance on the Neonatal Behavioral Assessment Scale in a multiethnic birth cohort. Neurotox 30:522-528.

9 Yolton, K., Xu, Y., Strauss, D., Altaye, M., Calafat, A.M., Khoury, J. (2011). Prenatal exposure to bisphenol A and phthalates and infant neurobehavior. Neurotoxicol Teratol 33:558-566.

10 Kim, Y., Ha, E.-H., Kim, E.-J., Park, H., Ha, M., Kim, J.-H., Hong, Y.-C., Chang, N., Kim, B.-N. (2011). Prenatal exposure to phthalates and infant development at 6 months: Prospective Mothers and Children’s Environmental Health (MOCEH) Study. Environ Health Perspect 119:1495-1500.

11 Swan, S.H., Liu, F., Hines, M., Kruse, R.L., Wang, C., Redmon, J.B., Sparks, A., Weiss, B. (2009). Prenatal phthalate exposure and reduced masculine play in boys. Int J Androl 32:1-9.

12 Whyatt, R.M., Liu, X., Rauh, V.A., Calafat, A.M., Just, A.C., Hoepner, L., Diaz, D., Quinn, J., Adibi, J., Perera, F.P., Factor-Litvak, P. (2012). Maternal prenatal urinary phthalate metabolite concentrations and child mental, psychomotor, and behavioral development at 3 years of age. Environ Health Perspect 120:290-295.

13 Miodovnik, A., Engel, S.M., Zhu, C., Ye, X., Soorya, L.V., Silva, M.J., Calafat, A.M., and Wolff, M.S. (2011). Endocrine disruptors and childhood social impairment. Neurotoxicol 32:261-267.

14 Kim, B.N., Cho, S.C., Kim, Y., Shin, M.S., Yoo, H.J., Kim, J.W., Yang, Y.H., Kim, H.W., Bhang, S.Y., Hong, Y.C. (2009). Phthalates exposure and attention-deficit/hyperactivity disorder in school-age children. Biol Psychiatry 66:958-963.

15 Engel, S.M., Miodovnik, A., Canfield, R.L., Zhu, C., Silva, M.J., Calafat, A.M., Wolff, M.S. (2010). Prenatal phthalate exposure is associated with childhood behavior and executive functioning. Environ Health Perspect 118:565-571.

16 Tsai, M.-J., Kuo, P.-L., Ko, Y.-C. (2012). The association between phthalate exposure and asthma. Kaohsiung J Med Sci 28:S28-S36.

17 Qiao, L., Zheng, L., Cai, D. (2007). Study on the di-n-butyl phthalate and di-2-ethylhexyl phthalate level of girl serum related with precocious puberty in Shanghai. Wei Sheng Yan Jiu 36:93-95.

18 Durmaz, E., Ozmert, E.N., Erkekoglu, P., Giray, B., Derman, O., Hincal, F., Yurdakök, K. (2010). Plasma phthalate levels in pubertgal gynecomastia. Pediatrics 125:e122-e129.

19 Cho, S.-C., Bhang, S.-Y., Hong, Y.-C., Shin, M.-S., Kim, B.-N., Kim, J.-W., Yoo, H.-J., Cho, I.H., Kim, H.-W. (2010). Relationship between environmental phthalate exposure and the intelligence of school-age children. Environ Health Perspect 118:1027-1032.

20 Teitelbaum, S.L., Mervish, N., Moshier, E.L., Vangeepuram, N., Galvez, M.P., Calafat, A.M., Silva, M.J., Brenner, B.L., Wolff, M.S. (2012). Associations between phthalate metabolite urinary concentrations and body size measures in New York City children. Environ Res 112:186-193.

21 Desvergne, B., Feige, J.N., Casals-Casas, C. (2009). PPAR-mediated activity of phthalates: A link to the obesity epidemic? Mol Cell Biol 304:43-48.

22 Joensen, U.N., Frederiksen, H., Jensen, M.B., Lauritsen, M.P., Olesen, I.A., Lassen, T.H., Andersson, A.-M., Jørgensen, N. (2012). Phthalate excretion pattern and testicular function: A study of 881 healthy Danish men. Environ Health Perspect 120:1397-1403.

23 Witorsch, R.J., Thomas, J.A. (2010). Personal care products and endocrine disruption: A critical review of the literature. Crit Rev Toxicol 40:1-30.

24 Buck Louis, G.M., Peterson, C.M., Chen, Z., Croughan, M., Sundaram, R., Stanford, J., Varner, M.W., Kennedy, A., Giudice, L., Fujimoto, V.Y., Sun, L., Wang, L., Guo, Y., Kannan, K. (2013). Bisphenol A and phthalates and endometriosis: the Endometriosis: Natural History, Diagnosis and Outcomes Study. Fertil Steril 100:162-169.

25 Meeker, J.D., Calafat, A.M., Hauser, R. (2007). Di(2-ethylhexyl) phthalate metabolites may alter thyroid hormone levels in men. Environ Health Perspect 115:1029-1034.

26 Huang, P.C., Kuo, P.L., Guo, Y.L., Liao, P.C., Lee, C.C. (2007). Associations between urinary phthalate monoesters and thyroid hormones in pregnant women. Hum Reprod 22:2715-2722.

27 Stahlhut, R.W., van Wijngaarden, E., Dye, T.D., Cook, S., Swan, S.H. (2007). Concentrations of urinary phthalate metabolites are associated with increased waist circumference and insulin resistance in adult U.S. males. Environ Health Perspect 115:876-882.

28 Hoppin, J.A., Jaramillo, R., London, S.J., Bertelsen, R.J., Salo, P.M., Sandler, D.P., Zeldin, D.C. (2013). Phthalate exposure and allergy in the U.S. population: Results from NHANES 2005-2006. Environ Health Perspect 121:1129–1134.

29 Jurewicz, J., Wojciech, H. (2011). Exposure to phthalates: Reproductive outcomes and children’s health. A review of epidemiological studies. Int J Occup Med Environ Health 24:115-141.


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