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:

How to Avoid BPA

The purported link between obesity and hormone-disrupting plastics chemicals like bisphenol A (BPA) was initially based in part on observations that the rise in chemical exposure seemed to coincide with the rise of the obesity epidemic, but that may only be a coincidence. Many other changes over the last half century, like an increase in fast-food consumption and watching TV, would seem to be simpler explanations. But why are our pets getting fatter, too? Fido isn’t drinking more fries or drinking more soda. Of course, the more we watch Seinfeld reruns, the less we may walk the dog, but what about our cats? They’re also getting fatter. Are we giving both them and our kids a few too many treats? That would seem to be an easier explanation than some pervasive obesity-causing chemical in the environment building up in the pet and person food chains.

How then do we explain the results of a study of more than 20,000 animals from 24 populations, showing they are all getting fatter? The odds that this could happen just by chance is about 1 in 10 million. The study’s “findings reveal that large and sustained population increases in body weight” are occurring across the board, even in those without access to vending machines or getting less physical education in schools. Perhaps some environmental pollutant is involved. I discuss this in my video How to Avoid the Obesity-Related Plastic Chemical BPA.

We’re exposed to a whole cocktail of new chemicals besides BPA, but the reason researchers have zeroed in on it is because of experiments showing that BPA can accelerate the production of new fat cells, at least in a petri dish. This was at more than a thousand times the concentration found in most people’s bloodstream, though. We didn’t know if the same thing happened at typical levels…until now. Most people have between 1 and 20 nanomoles of BPA in their blood, but even 1 nanomole may significantly boost human fat cell production. So, even low levels may be a problem, but that’s in a petri dish. What about in people?

Why not just measure the body weights of a population exposed to the chemical compared to a population not exposed to the chemical? There is virtually no unexposed population: BPA is everywhere. In that case, how about those with higher levels compared to those with lower levels? This is what researchers at New York University did, and the amount of BPA flowing through the bodies of children and adolescents “was significantly associated with obesity.” However, since it was a cross-sectional study, a snapshot in time, we don’t know which came first. Maybe instead of the high BPA levels leading to obesity, the obesity led to high BPA levels, since the chemical is stored in fat. Or, perhaps BPA is a marker for the same kinds of processed foods that can make you fat. What we need are prospective studies that measure exposure and then follow people over time. We never had anything like that…until now! And indeed, researchers found that higher levels of BPA and some other plastics chemicals were significantly associated with faster weight gain over the subsequent decade. So, how can we stay away from the stuff?

Though we inhale some from dust and get some through our skin touching BPA-laden receipts, 90 percent of exposure is from our diet. How can we tell? When we have people fast and drink water only out of glass bottles for a few days, their BPA levels drop as much as tenfold.

Fasting isn’t very sustainable, though.

What happens with a three-day fresh foods intervention, where families switch away from canned and packaged foods for a few days? A significant drop in BPA exposure. If we do the experiment the other way, adding a serving of canned soup to people’s daily diet, we see a thousand percent rise in BPA levels in their urine compared to a serving of soup prepared with fresh ingredients. That study used a ready-to-serve canned soup, which, in the largest survey of North American canned foods, was found to have about 85 percent less BPA than condensed soups, but the worst was canned tuna.


I previously touched upon bisphenol A in BPA Plastic and Male Sexual Dysfunction. Some companies make canned foods without BPA, for example, Eden Foods. (See Do Eden Beans Have Too Much Iodine? for more information.) You can also buy aseptic packaged beans or boil your own. Personally, I like pressure-cooking them.

For more on BPA, see:

Phthalates are another concerning class of plastics chemicals. I covered those in Avoiding Adult Exposure to Phthalates and What Diet Best Lowers Phthalate Exposure?.

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: