What Not to Do When You Handle Receipts

The plastics chemical bisphenol A, commonly known as BPA, was banned for use in baby bottles in Canada in 2008, in France in 2010, in the European Union in 2011, and in the United States in 2012. Then, in 2015, France forbade the use of BPA in any food or beverage packaging, something the U.S. Food and Drug Administration had decided was not warranted. But, what about the more than 90 studies “reporting relationships between total BPA in [people’s] urine and a wide array of adverse health outcomes, including a significant increase in the likelihood of developing cardiovascular disease and type 2 diabetes, obesity, impaired liver function, impaired immune and kidney function, inflammation, reproductive effects in women…[and] in men…, altered thyroid hormone concentrations, and neurobehavioral deficits such as aggressiveness, hyperactivity, and impaired learning”?

Only a very small minority of studies appear to support the U.S. government’s assertions that there were no effects of BPA at low doses. Where is the disconnect? Governmental regulatory agencies determine safety levels of chemicals by sticking tubes down into the stomachs of lab animals. In these types of tests, BPA is released directly into the stomach, where it goes to the liver to be detoxified into an inactive form called BPA-glucuronide. So, very little active BPA gets into the bloodstream. But, that’s not what studies on humans show. People have active BPA in their blood. How did the FDA respond? By rejecting all such human studies as implausible.

The problem with a “blanket rejection” of human data is that there may be sources of BPA exposure that are not modeled by stomach tube exposure in rats. After all, “[t]his isn’t how food actually enters our bodies. We chew it, move it around in our mouths…before it enters the stomach.” It turns out “that BPA can be completely absorbed directly into the bloodstream from the mouth,” thus bypassing instant liver detoxification. The same would be the case for BPA absorbed through the skin, which you can see at 2:08 in my video BPA on Receipts: Getting Under Our Skin.

Thermal paper, often used for cash register receipts, luggage tags, and many bus, train, and lottery tickets, is 1 to 2 percent BPA by weight. Taking hold of a receipt can transfer BPA to our fingers, especially if they’re wet or greasy. Does the BPA then get absorbed into our system through the skin? Cashiers were found to have more BPA flowing through their bodies “[c]ompared with other occupations,” but that was based on only 17 people. “Strict vegetarians had lower urinary BPA concentrations compared with nonvegetarians,” but, once again, the sample size was too small to really make a conclusion. It’s been estimated that even cashiers handling receipts all day may not exceed the “tolerable daily intake” of BPA—however, that could change if they were using something like hand cream.

Indeed, “many skin-care products, including hand sanitizers, lotions, soaps and sunscreens,” contain chemicals that enhance skin penetration. So, using a hand sanitizer, for example, before touching a receipt could cause a breakdown of the skin barrier.

What’s more, we now know that “using hand sanitizer and handling a thermal receipt…prior to picking up and eating food with [our] hands” results in high blood levels of active BPA. Researchers at the University of Missouri, conducting a study to mimic aspects of the behavior of people in a fast-food restaurant found that when people handled a receipt right after using the hand sanitizer Purell, BPA was transferred to their fingers. Then, BPA was transferred from their fingers to their fries, and the combination of absorption through the skin and mouth led to significant levels of active BPA in their blood, as you can see at 3:45 in my video.

We can hold a receipt in our hand for 60 seconds and only come away with 3 micrograms of BPA in our body. In contrast, if we pre-wet our hands with hand sanitizer, we can get 300 micrograms in just a few seconds—a hundred times more BPA, as you can see at 4:05 in my video. “These findings show that a very large amount of BPA is transferred from thermal paper to a hand as a result of holding a thermal receipt for only a few seconds immediately after using a product with dermal penetration enhancing chemicals,” like hand lotion. This could explain why dozens of human studies show active BPA in people’s systems, contrary to the assumptions based on stomach tube studies in rodents.

When actual evidence contradicts your assumptions, you reject your assumptions. The FDA, however, rejected the evidence instead.


Watch my video to learn Why BPA Hasn’t Been Banned.

For more on BPA, see:

Interested in other examples of Food and Drug Administration failings? Check out:

Phthalates are another class of concerning plastics compounds. For more, see:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

Why Hasn’t Bisphenol A (BPA) Been Banned Completely?

“The number of new chemicals is increasing exponentially, with approximately 12,000 new substances added daily…”—yet data aren’t available on the hazards of even some of the high-volume chemicals. Bisphenol A (BPA) is one of the highest volume chemicals, with billions of pounds produced each year. Studies have raised concerns about its possible implication in the cause of certain chronic diseases, such as diabetes, obesity, reproductive disorders, cardiovascular diseases, birth defects, chronic respiratory diseases, kidney diseases, and breast cancer. Given this, BPA is the topic of my video Why BPA Hasn’t Been Banned.

A new study on the health implications of BPA comes out nearly every week. BPA was first developed over a hundred years ago as a synthetic estrogen, but it wasn’t until the 1950s that industry realized it could be used to make polycarbonate plastic, and “BPA rapidly became one of the most produced and used chemicals worldwide, even though it was a recognized synthetic estrogen” with hormonal effects. About a billion pounds are also used to line food and beverage cans, especially for tuna and condensed soups.

Today, nearly all of us, including our children, have BPA in our bodies, but not to worry: The government says up to 50 µg/kg per day is safe. Even those working in Chinese BPA factories don’t get exposed to more than 70 times lower than that so-called safety limit. Why then did exposure seem to affect male workers’ sperm counts? In the United States, the general population gets less than a thousand times lower than the safety limit, yet, even at those incredibly low doses, we still seem to be seeing adverse effects on thyroid function, weight control, blood sugar control, cardiovascular disease, liver function, and immune function. Indeed, “[t]he fact that there are significant adverse effects in populations exposed to BPA at concentrations [thousands of] times lower than the TDI [tolerable daily limit]…indicates that the safe exposure to BPA may be much lower than previously thought in humans.” Despite this, the limit hasn’t been changed. BPA has been banned from “baby bottles and sippy cups,” but nearly unlimited doses are still apparently okay for everyone else. What’s the disconnect?

It has to do with the fascinating world of low-dose effects of hormone-disrupting chemicals. “For decades, studies of endocrine-disrupting chemicals (EDCs) have challenged traditional concepts in toxicology, in particular the dogma of ‘the dose makes the poison’”—that is, the concept “that lower exposures to a hazardous compound will therefore always generate lower risks.” Indeed, that is the core assumption underlying our system of chemical safety testing. Researchers start giving animals in laboratories a super-high dose and then keep lowering the dosage until whatever adverse effects that had occurred disappear. Then, they add a safety buffer and assume everything below that dose should be okay, assuming a straight line showing the higher the dose, the higher the effect. However, hormone-disrupting chemicals can have all sorts of curious curves. How is it possible that something could have more of an effect at a lower dose?

A study was done to see whether BPA suppressed an obesity-protective hormone in fat samples taken from breast reduction and tummy tuck patients. At 100 nanomoles of BPA, hormone levels were no lower than they were at 0nM of BPA. And, since most people have levels between 1 and 20, BPA was considered to be safe. But, although there was no suppression at 0 and no suppression at 100, at the levels actually found in people’s bodies, BPA appeared to cut hormone release nearly in half.

As the world’s oldest, largest, and most active organization devoted to research on hormones concluded, “even infinitesimally low levels of exposure—indeed, any level of exposure at all—may cause [problems].” In fact, it may come to nearly $3 billion in problems every year, counting the estimated effects of BPA on childhood obesity and heart disease alone. There are alternatives the industry can use. The problem, though, is that they may cost companies two cents more.


Related videos about BPA include BPA on Receipts: Getting Under Our Skin and Are the BPA-Free Alternatives Safe?

 BPA isn’t the only problem with canned tuna. Check out:

What can we do to avoid endocrine-disrupting chemicals? See, for example, Avoiding Adult Exposure to Phthalates and How to Avoid the Obesity-Related Plastic Chemical BPA.

Alkylphenols are another group of endocrine-disrupting chemicals. To learn more about them, see:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

What About Canned Fruit?

Food cans used to be soldered with lead compounds—so much so that people living off of canned food may have died from lead poisoning. Thankfully, this is no longer a problem in the United States. Lead contamination was one of the first priorities of the Food and Drug Administration back in 1906, before it was even called the FDA. Newspapers now have online archives going back a century so we can read about landmark historical events like “FDA Proposes Lead-Soldered Cans Be Banned” from way back yonder in…1993. So even though it was a priority in 1906, the ban didn’t actually go into effect until 1995. Evidently it was complicated because lead solder was “grandfathered” in as a “prior-sanctioned” substance.

Now that the lead is gone, though, are canned foods healthy? It depends primarily on what’s in the can. If it’s SPAM or another processed meat product, for instance, I’d probably pass.

What about canned fruit? We know fruits and vegetables in general may help protect us from dying of cardiovascular disease, and, when it comes to preventing strokes, fruit may be even more protective. But whether food processing affects this association was unknown, as I discuss in my video Is Canned Fruit as Healthy? One study found that unprocessed produce, mostly apples and oranges, appeared superior to processed produce. But that study focused mainly orange and apple juice. It’s no surprise whole fruit is better than fruit juice.

What about whole fruit when it is in a can? Dietary guidelines encourage eating all fruit whether it’s fresh, frozen, or canned, but few studies have examined the health benefits of canned fruit…until now. Canned fruit did not seem to enable people to live longer. In fact, moving from fresh or dried fruit to canned fruit might even shorten one’s life. Therefore, perhaps dietary guidelines should stress fresh, frozen, and dried fruit rather than canned.

Why the difference? While there’s no longer lead in cans these days, there is bisphenol A (BPA), the plastics chemical used in the lining of most cans. BPA can leach into the food and might counterbalance some of the fruits’ benefits. Recently, for example, blood levels of this chemical were associated with thickening of the artery linings going up to the brains of young adults. Canned fruit is often packed in syrup, as well, and all that added sugar and the canning process itself may diminish some nutrients, potentially wiping out 20 to 40 percent of the phenolic phytonutrients and about half of the vitamin C.

Maybe one of the reasons citrus appears particularly protective against stroke is its vitamin C content. It appears the more vitamin C in our diet and in our bloodstream, the lower the risk of stroke. And the way to get vitamin C into the bloodstream is to eat a lot of healthy foods, like citrus and tropical fruits, broccoli, and bell peppers. “Therefore, the observed effect of vitamin C on stroke reduction may simply be a proxy for specific foods (eg, fruits and vegetables) that causally lower stroke” risk. How could the researchers tell? Instead of food, they gave people vitamin C pills to see if they worked—and they didn’t.

This might be because citrus fruit have all sorts of other compounds associated with lower stroke risk, proving that the whole is greater than the sum of its parts. You can’t capture Mother Nature in a pill. It’s like the apocryphal beta-carotene story. Dozens of studies showed that people who ate more beta-carotene-rich foods, like greens and sweet potatoes, and therefore had more beta-carotene circulating in their system, had lower cancer risk. What about beta-carotene supplements instead of whole foods? Researchers tried giving beta-carotene pills to people. Not only did they not work, they may have even caused more cancer. I assumed the National Cancer Institute researcher who did this study would conclude the obvious: produce, not pills. But, no. Instead, the researcher questioned whether he should have tried lower dose pills, alpha-carotene pills, pills with other phytochemicals, or maybe multiple combinations. After all, he said, “[i]t is likely that neither the public nor the scientific community will be satisfied with recommendations concerned solely with foods…”


Check out my other videos on the can-lining chemical BPA, including:

Is fresh fruit really that healthy? See:

Is it possible to get too much of a good thing? See How Much Fruit Is Too Much?.

Now that there’s no more lead in the cans, are there any other ways we’re exposed to the toxic heavy metal? I did a whole series on lead, which you can watch. See also:

I close with yet another screed against reductionism. For more on that, see my videos Why Is Nutrition So Commercialized? and Reductionism and the Deficiency Mentality.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: