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:

Should We Tax Meat and Dairy Like We Do Cigarettes?

One of the most effective ways to decrease the harms of smoking is by increasing the cost of cigarettes through tobacco taxes. Indeed, an increase in the cost of cigarettes by only 10 percent could prevent millions of tobacco-related deaths. What about taxing unhealthy food? In general, public health decision makers have had three main options: inform through labeling, nudge with incentives, or directly intervene in markets using more heavy-handed approaches like instituting regulations or taxes.

“Policy approaches have proven crucial for other public health priorities, such as reducing tobacco use, alcohol abuse, and deaths from motor vehicle crashes.” In fact, installing air bags, for example, helped more than either “driver education alone or by labeling cars with information on crash risk.” Given that heart disease kills more than ten times more people than injuries on the road, maybe the “current epidemic of nutrition-related disease requires a similar multifaceted approach…[E]ven modest resulting dietary improvements could help reduce the burden of chronic disease significantly.” Perhaps a national system of subsidies for good foods, as well as taxes for bad ones, could “facilitate more sensible dietary choices.” Would they work? I discuss this in my video Would Taxing Unhealthy Foods Improve Public Health?.

A systematic review of the available evidence suggests such taxes and subsidies would in fact work. As I show in my video at 1:30, it seems the more unhealthy foods are taxed, the more consumption drops. Likewise, the more healthy foods like fruits and vegetables are subsidized and their prices drop, the more consumption increases. A small price difference between leaded and unleaded gasoline, for example, succeeded in decreasing our exposure to lead. What about a tax to decrease our exposure to saturated fat? As you can see from the data at 1:52 in my video, such a tax could potentially save thousands of lives.

Wouldn’t such a tax disproportionally affect the poor, though? Yes, it would benefit them the most—just like cigarette taxes. The classic tobacco industry argument is that cigarette taxes are “unfair” and “regressive,” burdening the poor the most. The public health community’s response? “Cancer is unfair” and “[c]ancer is regressive,” disproportionately burdening the poor such that a cigarette tax could result in the greatest health gains for the least well-off. The so-called Committee Against Unfair Taxes was actually just a front, “organised and funded by the tobacco industry,” one front group among many, as you can see at 2:42 in my video. This is a common tactic used by the industry to hide its role in fighting tobacco taxes, in addition to trying to overtly buy off politicians. The fact that the industry fights tooth and nail suggests that tobacco taxes can indeed affect consumption. Much of the data on food taxes and subsidies, however, have been based on models or “stated preferences” to hypothetical scenarios where people merely say they’d change consumption patterns based on prices. There hasn’t been as much real world data.

Researchers have put people through high-tech, 3D supermarket simulators, which you can see depicted at 3:15 in my video, and found that a 25 percent discount on fruits and vegetables appears to boost produce purchases by 25 percent. That’s nearly two pounds a week, but virtual fruits and veggies don’t do you any good. Does this work out in the real world? Yes. In fact, South Africa’s largest health insurance company started offering up to 25 percent cash back on healthy food purchases to hundreds of thousands of households—up to $500 USD a month. Why would the insurance company do that? Why give money away? Because it works. The healthy food cash-back program was associated with an increase in the consumption of fruits, vegetables, and whole grains, as well as a decrease in  foods high in added sugar, salt, and fat, including processed meats and fast food.

Subsidies are more common than taxes, though, in Europe, where a number of countries have instituted taxes on foods that are sugary or salty. Denmark was the first to introduce a tax on saturated fat, such as meat, dairy, and eggs, but it only took the food industry about a year to squash it, demonstrating that “public health advocates are weak in tackling the issues of corporate power.”

There’s “an enormous imbalance” between the influence exerted by public health professionals compared to the political might of the food industry. It brings to mind the fight over proposed “traffic light labelling” on food in the European Union. Apparently, it was much too easy to understand, simple and straightforward, so the industry lost its mind and spent more than $1.4 billion USD killing it in favor of the confusing “daily amount” labeling guidelines that require a “bring-your-calculator-to-the-grocery-store” approach to make grocery shopping as confusing as possible, as you can see at 4:51 in my video.

Denmark ended up canceling the fat tax and shelving their sugar tax because the farming and food company interests claimed too many jobs would be lost if people ate healthier. Apparently, a healthy economy was more important than a healthy population. Ironically, it was abolished just when evidence of its effects started to appear. Researchers “conclude[d] that the introduction of the saturated fat tax contributed to reducing the intake of saturated fat among Danish consumers” from some meat and dairy products—but not from sour cream, though. The public ate so much more low-fat sour cream that it outweighed the smaller reduction in consumption of high-fat sour cream.

Indeed, we always have to think about the unintended consequences. Swapping out sugary cookies for salty chips, for example, might not do the public’s health many favors. One field study of a tax on soda found that it may drop soft drink purchases, at least in the short term, but households may just end up buying more beer.


This idea is the flip side of sorts to my video Taxpayer Subsidies for Unhealthy Foods.

For more on how the food industry has borrowed from the tobacco industry playbook, see

What about those who insist that sodium really isn’t bad for you? Check out:

And those who insist that saturated fat really isn’t bad for you? See The Saturated Fat Studies: Buttering Up the Public and The Saturated Fat Studies: Set Up to Fail.

What about those who insist that sugar really isn’t bad for you? Watch Big Sugar Takes on the World Health Organization and Does Diet Soda Increase Stroke Risk as Much as Regular Soda?.

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:

How to Lower Your Sodium Intake

Reduction of salt consumption by just 15 percent could save the lives of millions. If we cut our salt intake by half a teaspoon a day, which is achievable simply by avoiding salty foods and not adding salt to our food, we might prevent 22 percent of stroke deaths and 16 percent of fatal heart attacks—potentially helping more than if we were able to successfully treat people with blood pressure pills. As I discuss in my video Salt of the Earth: Sodium and Plant-Based Diets, an intervention in our kitchens may be more powerful than interventions in our pharmacies. One little dietary tweak could help more than billions of dollars worth of drugs.

What would that mean in the United States? Tens of thousands of lives saved every year. On a public-health scale, this simple step “could be as beneficial as interventions aimed at smoking cessation, weight reduction, and the use of drug therapy for people with hypertension or hypercholesterolemia,” that is, giving people medications to lower blood pressure and cholesterol. And, that’s not even getting people down to the target. 

A study I profile in my video shows 3.8 grams per day as the recommended upper limit of salt intake for African-Americans, those with hypertension, and adults over 40. For all other adults the maximum is 5.8 daily grams, an upper limit that is exceeded by most Americans over the age of 3. Processed foods have so much added salt that even if we avoid the saltiest foods and don’t add our own salt, salt levels would go down yet still exceed the recommended upper limit. Even that change, however, might save up to nearly a hundred thousand American lives every year.

“Given that approximately 75% of dietary salt comes from processed foods, the individual approach is probably impractical.” So what is our best course of action? We need to get food companies to stop killing so many people. The good news is “several U.S. manufacturers are reducing the salt content of certain foods,” but the bad news is that “other manufacturers are increasing the salt levels in their products. For example, the addition of salt to poultry, meats, and fish appears to be occurring on a massive scale.”

The number-one source of sodium for kids and teens is pizza and, for adults over 51, bread. Between the ages of 20 and 50, however, the greatest contribution of sodium to the diet is not canned soups, pretzels, or potato chips, but chicken, due to all the salt and other additives that are injected into the meat.

This is one of the reasons that, in general, animal foods contain higher amounts of sodium than plant foods. Given the sources of sodium, complying with recommendations for salt reduction would in part “require large deviations from current eating behaviors.” More specifically, we’re talking about a sharp increase in vegetables, fruits, beans, and whole grains, and lower intakes of meats and refined grain products. Indeed, “[a]s might be expected, reducing the allowed amount of sodium led to a precipitous drop” in meat consumption for men and women of all ages. It’s no wonder why there’s so much industry pressure to confuse people about sodium.

The U.S. Dietary Guidelines recommend getting under 2,300 milligrams of sodium a day, while the American Heart Association recommends no more than 1,500 mg/day. How do vegetarians do compared with nonvegetarians? Well, nonvegetarians get nearly 3,500 mg/day, the equivalent of about a teaspoon and a half of table salt. Vegetarians did better, but, at around 3,000 mg/day, came in at double the American Heart Association limit.

In Europe, it looks like vegetarians do even better, slipping under the U.S. Dietary Guidelines’ 2,300 mg cut-off, but it appears the only dietary group that nails the American Heart Association recommendation are vegans—that is, those eating the most plant-based of diets.


This is part of my extended series on sodium, which includes:

If you’re already cutting out processed foods and still not reaching your blood pressure goals, 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: