Educating the public about toxic chemicals that we unknowingly consume: A potential important role for the practicing pharmacists

Abstract

Although lifestyle factors are important in determining the overall health of the general public, the impact of endocrine-disrupting chemicals and other environmental toxins is often underestimated. There is growing evidence indicating that these substances have a significant influence on metabolic health, cancer risks, and fertility. Therefore, it is the shared responsibility of public health officials and health care professionals, including pharmacists, to educate the public about the potential exposure to harmful toxins present in our immediate surroundings, particularly toxic chemicals that we unknowingly consume. Pharmacists play a crucial role in promoting and maintaining public health. This article reviews a selection of common toxins and their significant health risks. Pharmacists can prepare educational materials, hold presentations at public libraries, and participate in scientific meetings to disseminate knowledge about the potential exposure to these toxins, their detrimental impact on health, and strategies and recommendations to minimize exposure.

Pharmacists play a crucial role in the advancement and upkeep of public health. It is the duty of pharmacists to actively engage in endeavors that advocate and incorporate public health measures within their profession. Collaboration with public health authorities is imperative for pharmacists to ensure their involvement in the strategic planning, progression, and execution of public health initiatives. The American Public Health Association has outlined the role of pharmacists in public health through various statements and publications.^1–4 In 2013, the role of pharmacists in public health was recognized by the American Association of Colleges of Pharmacy by including population-based care and reducing health disparities and inequalities in the Center for Advancement in Pharmaceutical Education (CAPE) Educational Outcomes.⁵ These outcomes also stressed the pharmacist’s role in the public health by designing prevention, intervention, as well as educational approaches so as to be used by communities and individuals to improve health and wellness and manage chronic diseases.⁵ Along these lines, the American Society of Health-System Pharmacists has outlined various roles that pharmacists can fulfill in public health-related activities. These encompass areas such as immunization,⁶ smoking cessation,⁷ birth control,⁸ antimicrobial stewardship,⁹ prevention, education, and treatment of substance abuse,¹⁰ prevention of controlled substances diversion,¹¹ management of medication shortages,¹² as well as emergency preparedness and response.¹³

Importantly, pharmacists have a vital role in driving public health-related research and educational endeavors. They actively engage in conducting research studies and educational programs to share new knowledge. Moreover, pharmacists play a crucial part in providing training programs that cover key tools for population health, such as statistical analysis, disease surveillance techniques, and strategies for reducing risks.^1,14 In this regard, it is essential for pharmacists to prioritize raising public awareness about the presence of toxic chemicals in everyday products, which individuals often unknowingly consume.

Considering the U.S. population, life expectancy is unfortunately declining.¹⁵ Almost 75% of Americans are overweight or obese,¹⁶ 50% are patients with diabetes or prediabetes,¹⁷ and in fact, the majority are metabolically not well.¹⁸ Surprisingly, the rates of allergic, inflammatory, and autoimmune diseases are also growing at annual rates of 4%-9%.¹⁹ Despite lifestyle factors playing a prominent role in the aforementioned trends, the impact of endocrine-disrupting chemicals and environmental toxins is often underestimated. Growing evidence suggests that these substances significantly affect metabolic health, cancer risks, and even fertility.^20,21 While some carcinogens have been identified and regulated, many others persist in the environment without restrictions. Consequently, it becomes a shared responsibility of public health officials and health care professionals, including pharmacists, to educate the public about potential exposure to hazardous toxins present in our immediate surroundings. This article aims to examine a selection of common toxins (Table 1) and others which are less common (Table 2) and their substantial health risks while providing guidance to pharmacists on advising the public to minimize their exposure to these dangers.

Table 1.

Major toxic chemicals that we unknowingly consume: Methods of exposure and health effects

Chemical	Exposure	Health effects	References
BPA	*Main exposure to BPA comes from its presence in food and drink. *BPA can migrate into food from the internal epoxy resin coatings used in canned foods, as well as from consumer products like polycarbonate tableware, food storage containers, water bottles, and baby bottles. *BPA has been found in breast milk. *Short-term exposure may occur during dental procedures involving BPA-containing sealants. *Workers involved in the manufacture or handling of products containing BPA can also be exposed.	*Animals studies revealed alterations in the expression of estrogen and androgen receptors. *It also alters the expression of genes related to sexual differentiation and neuroendocrine function in the hypothalamus, hippocampus, and amygdala, along with limited sex-specific effects on learning and memory, among other findings. *Female rats exhibited increased cancer rates following exposure to the lowest dose of BPA due to its impact on mammary gland development. *Male rats had a smaller urethra following exposure to BPA, which also increased cancer risk in male rats when exposed to later-life estrogen, mimicking the aging human male.	25–29
DLCs	*The main route of human exposure to dioxins is through the consumption of contaminated food, specifically animal products, and high-fat foods (such as milk products, meat, eggs, and certain fish). Dioxins are absorbed into the body and stored in fatty tissues, thus accumulating as they move up the food chain. *Food intake accounts for over 90% of human exposure to dioxins. *Occupational exposures can occur in industries involved in waste incineration or the manufacturing of DLCs.	*DLCs are widely recognized as carcinogenic substances. *Dioxins exposure has been linked to type 2 diabetes, ischemic heart disease, and chloracne, an acne-like skin disorder. *Dioxins have the capacity to harm the immune system, disrupt hormone functions, cause developmental issues in children, contribute to reproductive and fertility problems in adults, and even increase the risk of miscarriages. *The effects of dioxin exposure have been observed across various vertebrate species and potentially at every stage of development.	31–33
Microplastics	*Microplastics are infiltrating widely consumed food items through the ingestion of microplastics by animals in their natural habitat, as well as contamination during food production and plastic packaging processes.	*Several studies indicated that microplastics can contribute to obesity through various mechanisms. *Microplastics with a size below 20 μm, capable of penetrating cellular membranes, have the potential to trigger immune responses and potentially cause cellular damage. *They induce oxidative stress and disrupt fatty acid metabolism. *Accumulation of microplastics in the liver and kidney has been observed to promote the growth and accumulation of fat cells, leading to disturbances in energy balance that can ultimately impact body weight. *Microplastics can serve as carriers of toxic chemicals due to the presence of cocontaminants in plastic additives. These cocontaminants include substances like organotins, phthalates, bisphenols, and toxic metals, which can have harmful effects at the cellular and molecular levels.	35–39
PFAS	*The consumption of water or food contaminated with PFAS, utilization of products containing PFAS, or inhalation of air containing PFAS particles.	*Human exposure to PFAS has been linked to altered metabolism, fertility issues, decreased fetal growth, increased risk of obesity, certain cancers, and compromised immune system function.	40–44
Pesticides	*The primary source of exposure is believed to be related to food consumption.	*Certain types of organochlorine insecticides have been linked to an increased risk of autoimmunity among male farmers, rheumatoid arthritis, renal cell carcinoma, impaired kidney function among male pesticide applicators, and shingles in farmers, particularly with repeated or recurrent use. * They are also linked to high risk of hypothyroidism, thyroid cancer, and long-lasting damage to our olfactory senses. *Pesticides have been found to disrupt the normal biological pathways that safeguard brain cells, either directly or indirectly. They are also linked to high risk of Parkinson’s disease, Alzheimer’s disease, and attentiondeficit hyperactivity disorder.	49–67
Phthalates	*Consumption of food and beverages that have come into contact with phthalate-containing products. *Exposure can also occur through the inhalation of phthalate particles present in the air.	*Phthalates disrupt hormone activity, and exposure to them has been linked to abnormal brain development and sexual development in children, as well as lower testosterone levels in men.	68–73

Abbreviations used: BPA, Bisphenol A; DLC, Dioxins and dioxin-like compound; PFAS, Per and Polyfluoroalkyl Substances

Table 2.

Other toxic chemicals that we are exposed To: Methods of exposure and health effects

Chemical	Exposure	Health effects	References
Acrylamides	*It is utilized in the production of dyes, paper, and various industrial products. *It is employed in the creation of chemicals used for water purification, sewage treatment, paper manufacturing, as well as certain cosmetics and soaps. *Baking, frying, or roasting certain foods such as potatoes or grains can lead to the production of acrylamide. Potato chips and French fries are known to contain significant levels of acrylamide. *Acrylamide can also be found in cigarette smoke.	*It is considered a potential carcinogen. It irritates the skin and may act as a tumor initiator, increasing the risk of skin cancer. *Symptoms also include dermatitis in the exposed area and peripheral neuropathy. *Inhaling acrylamide also causes irritation in the respiratory passages. *Long-term animal studies demonstrated that it could lead to reproductive issues, nerve damage, and cancer.	74–76
Cadmium (Cd)	*Dietary intake, as it gets absorbed by plant and animal foods. *Inhaling cigarette smoke. *In occupational settings such as battery manufacturing, metal soldering, or welding.	Cd can cause significant irritation to the stomach, causing vomiting and diarrhea. *Inhalation of Cd is detrimental to lung and can be fatal. *Prolonged exposure to low levels of Cd leads to kidney disease and weakened bones. *Cd is classified as a carcinogenic.	77–79
Inorganic arsenic (IAs)	*The primary source of IAs is contaminated drinking water. *It can also be found in certain foods, including rice and certain types of fish, as a result of its presence in soil or water.	*IAs is recognized as a human carcinogen and has been associated with various cancers, including skin, lung, bladder, kidney, and liver cancers. *Studies have indicated a potential link between low to moderate levels of IAs and metabolic disorders, such as diabetes. *Even at low concentrations, IAs has been found to act as an endocrine disruptor.	80–83
Lead (Pb)	*Touching old paint dust, and contaminated soil. *Drinking contaminated water. *Occupations related to mining, ironwork or welding, construction including building renovation and remodeling, smelters, shooting ranges, manufacture and disposal of car batteries, automobile radiator repair, and manufacture of pottery or stained glass.	*Concentration-dependent Children: Delayed puberty, reduced postnatal growth, decreased academic achievement, IQ, specific cognitive measures, and hearing as well as increased incidence of attention-related behaviors. Adults: Decreased kidney function and reduced fetal growth in pregnant individuals as well as increased risk of high blood pressure and tremor.	84,85
Perchlorates	*Drinking contaminated water, milk, and by eating certain plants with high water content (e.g., lettuce), if those plants washed with perchlorate-containing water. *Manufacturing perchlorate-containing products.	*Large amounts of perchlorate have been used medically to treat overactive thyroid in humans. *Animal studies showed that perchlorate can decrease the production of thyroid hormones.	86–88
Chlordane and heptachlor	*Eating foods high in fat (meat, fish, and dairy products). *Pregnant women may pass them to the fetus. *Can be passed to infants via breast milk.	* Short-term significant exposures can cause seizures and injure the liver. *They are considered potential cancer-causing chemicals in humans.	89,90

Bisphenol A

Bisphenol A (BPA) is a chemical compound that received initial approval from the FDA in the early 1960s. It belongs to the diphenylmethane group and consists of two hydroxyphenyl groups. BPA is among the most widely produced chemicals, with an annual production volume of approximately 2–3 million metric tons. It is primarily utilized in the manufacturing of polycarbonate plastics, which are durable and transparent. These plastics find application in various consumer products such as beverage containers, plastic dinnerware, compact discs, impact-resistant safety equipment, toys, and automobile parts. Moreover, BPA epoxy resins are commonly employed in the protective linings of food cans, dental sealants, and other related products.^22–24

Exposure to BPA can occur through various sources such as air, dust, water, and primarily through food and beverages. BPA can migrate into food from the internal epoxy resin coatings. The extent of BPA leaching from polycarbonate bottles into liquids may be influenced more by the temperature of the liquid or bottle rather than the age of the container. It is noteworthy that human exposure to BPA is widespread. A Center for Disease Control and Prevention (CDC) study, the 2003–2004 National Health and Nutrition Examination Survey III (NHANES III), detected measurable levels of BPA in 93% of 2517 urine samples obtained from individuals aged 6 years and older. The data from CDC’s NHANES are representative of exposure levels in the U.S. Another cause for concern, particularly for parents, is that certain animal studies have reported adverse effects on fetuses and newborns exposed to BPA.^22–24

Structurally, BPA functions as an estrogen mimic, also known as an endocrine disruptor, and has been linked to cardiovascular disease,²⁵ obesity,²⁶ and male sexual dysfunction.²⁷ The use of BPA in sippy cups and baby bottles has been prohibited since 2012. However, there is ongoing debate regarding the safety of its replacements, such as bisphenol S and bisphenol F, as they exhibit similar hormonal effects to BPA.²⁸ Recently, the compendium report from the Consortium Linking Academic and Regulatory Insights on the Toxicity of BPA²⁹ was released on October 29, 2021, and some of its results are provided in Table 1.

Recommendations include refraining from using polycarbonate plastics, which are often labeled with recycle codes 3 or 7, as they may contain BPA. It is also advisable to minimize contact with thermal papers like tickets and receipts whenever possible. Opting for glass, porcelain, or stainless-steel containers is encouraged for storing food and beverages. When using plastic containers, it is preferable to choose options that are free from polycarbonate and polyvinyl chloride. It is important to never microwave or reheat food or beverages in plastic containers or wraps. Canned foods, particularly canned tuna and condensed soups are best avoided, but if purchased, it is recommended to opt for BPA-free varieties. It is also advisable to select baby bottles that are BPA-free.

Dioxins and dioxin-like compounds (furans, and polychlorinated biphenyls)

Dioxins and dioxin-like compounds (DLCs) are a class of chemical substances that persist in the environment as organic pollutants. Virtually all living organisms have encountered dioxins or DLCs at some point. Industrial practices are the primary source of dioxins, with their production occurring as byproducts of certain incineration processes, particularly improper municipal waste incineration and unregulated trash burning.³⁰ Dioxins can also be emitted into the air through natural events like volcanic eruptions and forest fires. Polychlorinated biphenyls (PCBs), which share some structural similarities with dioxins, were previously present in products like flame retardants, coolants, and insulating fluids. However, they were banned in 1979. Prior to the ban, PCBs were used as heat-exchanger and transformer insulator fluids, hydraulic fluids, and additives in paints, oils, and caulks.^31–33

Dioxins and PCBs are frequently classified together as “persistent organic pollutants” due to their slow breakdown and ability to persist in the environment even after their production and emissions have been limited. These compounds enter the food chain and accumulate in larger organisms. Notably, stringent regulatory measures have resulted in a 90% reduction in dioxin emissions compared to 1987 levels. However, dioxin contamination remains a growing concern in developing nations, where unregulated burning, dismantling, and recycling of electronic products continue at elevated rates.^31–33

The late 1970s and early 1980s witnessed a significant recognition of the public health risks associated with dioxins. Media outlets extensively covered the stories of ailing veterans who had been exposed to dioxins through the usage of Agent Orange, an herbicide and defoliant employed during the Vietnam War. Another notable event occurred in 1982 when the town of Times Beach, Missouri, was deemed uninhabitable due to dioxin contamination. The Missouri incident, along with similar occurrences, played a pivotal role in the enactment of Superfund legislation, which established an environmental program aimed at addressing abandoned hazardous waste sites.^31–33 In the present day, the main route of human exposure to dioxins is through the consumption of contaminated food.

Within the group of dioxins and DLCs (more than 600 compounds in total), the term “dioxin” specifically refers to the most hazardous compound known as tetrachlorodibenzodioxin. Recent research has established that dioxin interacts with intracellular protein called the aryl hydrocarbon receptor (AhR).³⁴ Upon activation, AhR has the ability to alter gene expression and function, leading to disturbances in regular cellular processes that can have adverse health effects (Table 1).^31–33 To minimize exposure to dioxins and DLCs, it is advisable to reduce the consumption of fish, meat, and dairy products. It is recommended to trim the skin and fat from meat before cooking. The levels of dioxins and DLCs in these animal-based products are approximately 5–10 times higher compared to plant-based foods. Studies have indicated that farmed salmon may be the protein source in the American diet with the highest potential for PCB contamination. However, newer methods of land-based and sustainable aquaculture have the potential to reduce this exposure.^31–33

Microplastics

Microplastics refers to tiny particles or fragments of plastic that result from the breakdown of larger plastic items or microbeads commonly found in household or personal care products. These particles are smaller than 5 mm in length. Current projections indicate a concerning trend: if the current rate of accumulation continues, it is estimated that by 2050, there will be a staggering 12 billion metric tons of plastic waste in landfills or the natural environment, compared to the 4.9 billion metric tons recorded in 2015. This projection implies that, by weight, there will be more plastic in the oceans than fish. Mounting evidence suggests that microplastics are infiltrating widely consumed food items.^35–39

The persistent exposure to microplastics and plastic additives poses significant concerns for human health. While it is true that most microplastics are eliminated through fecal excretion, it should be noted that particles smaller than 150 μm have the ability to penetrate the intestinal epithelium, and those under 20 μm can reach organs such as the liver and lungs through systemic circulation. Inhalation of microplastic particles can also directly deposit them in the lungs. Furthermore, microplastics within the size range of 0.1–10 μm have the potential to cross the placenta and the blood-brain barrier. Although the full extent of health risks posed by microplastics in humans is not yet fully understood, studies conducted on animals and cell cultures have indicated that microplastics can contribute to obesity through various mechanisms. Accumulation of microplastics in the liver and kidney has been observed to promote the growth and accumulation of fat cells, leading to disturbances in energy balance that can ultimately impact body weight.³⁷ The global rise in obesity and overweight has become a significant concern, as it raises the risk of various health problems such as cardiovascular disease, diabetes, hypertension, and certain types of cancers. Coinciding with this increase in obesity rates is the growing exposure to microplastics and plastic additives. As a result, a potential link between the two has been proposed.³⁸ Furthermore, microplastics can serve as carriers of toxic chemicals due to the presence of co-contaminants in plastic additives.

A recent study provided evidence of the presence of microplastics in the bloodstream of the majority of 22 healthy participants. Moreover, another study assessed the caloric intake of approximately 15% of the American population and estimated that the annual consumption of microplastics ranges from 39,000 to 52,000 particles depending on age and sex. These estimates increase to 74,000 and 121,000 particles when considering inhalation as well. Furthermore, individuals who rely solely on bottled sources to meet their recommended water intake may be ingesting an additional 90,000 microplastics annually, in comparison to 4000 microplastics for those who consume only tap water.³⁹ According to the Environmental Working Group, microplastics have been extensively found in fish, seafood, and various products including bottled water, beer, honey, and tap water. Currently, there are no official advisories on fish consumption to minimize exposure to microplastics. There is increasing pressure to prohibit the use of microbeads in personal care products. In the absence of such bans, it is recommended to avoid single-use plastics, choose reusable tote bags instead of plastic bags for grocery shopping, and opt for loose leaf tea or paper tea bags rather than those made of mesh materials.^35–39

Per and polyfluoroalkyl substances

Per and polyfluoroalkyl substances (PFAS) forms a vast category of synthetic chemicals containing fluorine. They were first identified in the 1930s and have been widely employed in consumer goods across the globe since approximately the 1950s. These substances serve as components in a wide range of everyday items, such as stain-resistant clothing and carpets, packaging, and cookware coatings to prevent food from adhering and enhanced firefighting foam formulations. 3M employed these substances to produce Scotchgard, a product used for carpet and fabric protection, while Dupont utilized them in the creation of Teflon, a nonstick coating for pots and pans. Although perfluorooctanoic acid (PFOA) was eliminated from nonstick cookware in 2013, PFAS continues to be prevalent in fast-food packaging, water- and stain-resistant garments, firefighting foam, and personal care items. PFAS are released into the environment during the degradation of these consumer and industrial goods, as well as through disposal in waste facilities.^40–44

PFAS compounds consist of a chain of interconnected carbon and fluorine atoms, forming a resilient structure. Due to the exceptionally strong carbon-fluorine bond, these substances exhibit resistance to degradation, earning them the label of “forever chemicals” as they persist in the environment for extended periods. Furthermore, PFAS possesses properties that render them highly durable even at high temperatures and impart water-repellent characteristics. The prevalence of human exposure to PFAS is widespread, as they find application in various industries such as automotive, aerospace, electronics, and construction. As time progresses, PFAS has the potential to seep into the soil, water, and air.^40–44

Exposure to these substances occurs through various means (Table 1). According to a report by CDC, based on data from the NHANES, PFAS were found in the blood of 97% of the American population. The presence of PFAS has even been detected in rainwater samples from remote locations like Tibet and Antarctica.⁴⁵ In terms of their impact on human health, current research suggests potential associations between human exposure to PFAS and altered metabolism, fertility issues, decreased fetal growth, increased risk of obesity, certain cancers, and compromised immune system function.^40–44

To minimize or mitigate exposure to PFAS, pharmacists can recommend the utilization of reverse osmosis or activated carbon filters to purify tap water, as well as avoiding fast food and take-out meals whenever possible. It is also advisable to steer clear of consumer products that are labeled as “water resistant,” “stain-resistant,” or “nonstick.” The recent revision of lifetime health advisories by the U.S. Environmental Protection Agency (EPA) underscores the severity of the risks associated with these chemicals. For instance, the recommended limit for PFAS such as PFOA has been significantly reduced to 0.004 parts per trillion, which is more than 10,000 times lower than the previous threshold of 70 parts per trillion. Additionally, the EPA has proposed the formal designation of certain PFAS compounds as “hazardous substances”.^40–44

Pesticides

The expansion of modern agriculture in the U.S. throughout the last century has been accompanied by a significant increase in the utilization of industrial pesticides. These substances are employed to eliminate, repel, or manage various forms of animal and plant life that are deemed detrimental or bothersome in agricultural and domestic settings. Pesticides encompass a range of chemical agents, including herbicides, insecticides, and fungicides. More than 800 pesticides are officially registered for usage in the U.S., with certain substances being employed in substantial quantities, thereby raising concerns about potential health risks. Annually, approximately 1 billion pounds of pesticides are utilized across the country, with nearly 300 million pounds consisting of glyphosate, a substance that has been identified as a possible carcinogen. Astonishingly, over 90% of the U.S. population exhibits traces of pesticides in their urine and blood, irrespective of their geographical location. The primary source of exposure is related to food consumption.^46–48

Numerous studies have provided compelling evidence of significant adverse impacts on human health resulting from pesticide exposure (Table 1).^49–53 For instance, certain types of organochlorine insecticides have been linked to an increased risk of autoimmunity among male farmers,⁴⁹ rheumatoid arthritis,⁵⁰ renal cell carcinoma,⁵¹ impaired kidney function among male pesticide applicators,⁵² and shingles in farmers,⁵³ particularly with repeated or recurrent use. There has been persistent suspicion regarding the disruptive effects of numerous pesticides on thyroid function. Exposure to certain pesticides has been significantly associated with an increased risk of hypothyroidism.⁵⁴ Furthermore, a separate study observed a heightened risk of thyroid cancer linked to the use of specific pesticides such as metalaxyl, a fungicide, and lindane, an insecticide.⁵⁵ In fact, lindane has been classified as a human carcinogen by the International Agency for Research on Cancer. An agricultural health study indicated that individuals who reported experiencing high pesticide exposure events were more likely to report a loss of sense of smell even after 20 years. Such events with elevated pesticide exposure may result in long-lasting damage to our olfactory senses. Researchers funded by National Institute of Environmental Health Sciences (NIEHS) also discovered that male mice exposed to the widely used pesticide paraquat through inhalation experienced a reduction in their sense of smell lasting several months.⁵⁶

Pesticides have been found to disrupt the normal biological pathways that safeguard brain cells, either directly or indirectly.⁵⁷ Researchers funded by NIEHS discovered that the accumulation of DOPAL, a toxic byproduct of dopamine, in the brain can heighten the risk of developing Parkinson’s disease. Pesticides like dieldrin and benomyl can induce dopamine degeneration and impede the biological mechanism responsible for converting DOPAL into a less toxic acid, thereby increasing the susceptibility to Parkinson’s disease.⁵⁸ The Parkinson’s Disease, Environment, and Genes study demonstrated that certain pesticides, including paraquat, maneb, ziram, benomyl, diazinon, chlorpyrifos, and various organophosphate pesticides, contribute to the onset and progression of Parkinson’s disease. Other studies have corroborated the progression of motor, cognitive, or depressive symptoms associated with Parkinson’s disease in relation to the exposure of these pesticides.⁵⁹ Additionally, the National Toxicology Program has identified paraquat exposure as a contributing factor to Parkinson’s disease.⁶⁰

An extensive prospective cohort study conducted in Europe revealed a reduced risk of cancer among individuals who reported a higher frequency of consuming organic food.⁶¹ In addition to cancer risk, elevated blood levels of beta-hexachlorocyclohexane, a pesticide, have been associated with increased all-cause mortality.⁶² Moreover, exposure to dichlorodiphenyldichloroethylene, a metabolite of dichlorodiphenyltrichloroethane—a chlorinated pesticide extensively used in the 1940s–1960s and still persistent in the environment—has been linked to a higher risk of Alzheimer’s-type dementia and overall cognitive decline.^63,64 Since these chlorinated pesticides tend to accumulate in animal products due to their fat solubility, individuals following a vegetarian diet tend to have lower levels of beta-hexachlorocyclohexane. Consequently, it is recommended that consumers prioritize organic produce over conventional options.

Other significant findings from various studies concerning pesticides exposure include the elevated risk of prostate cancer among farmers, the effectiveness of chemically resistant gloves in reducing pesticide exposure by 50% to 80%, and the association between the use of organophosphate insecticides and allergic asthma in adults.⁶⁵ Studies have further indicated that young children who experience exposure to glyphosate, a widely used herbicide, may encounter liver inflammation, and develop metabolic disorders. The research focused on participants residing in Salinas Valley, California. The findings suggest that a child’s cumulative exposure to this prevalent weed killer could amplify the risk of conditions associated with liver cancer, diabetes, and cardiovascular disease during young adulthood.⁶⁶

Observations have indicated that adolescents who engage in the spraying of chemicals on crops may experience adverse effects on lung function and neurobehavioral development, such as attention-deficit hyperactivity disorder.⁶⁷ To mitigate these risks for both the general public and farmers, pharmacists can recommend certain practices that can be adopted. These include refraining from entering recently sprayed fields, utilizing a stick or tool instead of hands when mixing pesticides, and taking a thorough bath and wearing clean clothes after pesticide application.

Phthalates

Phthalates, referred to as plasticizers, are chemical compounds utilized to confer flexibility and durability to plastics, as well as to bind fragrances. They are frequently present in everyday household items, including vinyl flooring, vinyl shower curtains, fragrances, air fresheners, and perfumes. Phthalates can also be found in lubricating oils and personal care products like soaps, shampoos, and hair sprays. Certain phthalates serve the purpose of dissolving other materials, while others are utilized in the production of polyvinyl chloride (PVC) plastics, commonly used in the manufacturing of products such as plastic packaging, garden hoses, and medical tubing.^68–73

The general public is exposed to phthalates through the consumption of food and beverages that have come into contact with phthalate-containing products. Exposure can also occur through the inhalation of phthalate particles in the air. Considering that children often crawl around and come into contact with various objects before putting their hands in their mouths, they may be at a higher risk of exposure to phthalates than adults, especially through phthalate particles found in dust. Phthalates are recognized as chemicals that disrupt hormone activity, and exposure to them has been linked to significant abnormalities in children and adults. While exposure can occur through inhalation, ingestion, and skin contact, studies indicate that a significant portion of exposure is likely to be food related.^68–73

During the 2003–2004 period, the CDC conducted a study in which they analyzed the urine of 2636 individuals aged 6 years and older who participated in NHANES. The study aimed to measure approximately 13 different phthalate metabolites. The results revealed that the general population had detectable levels of various phthalate metabolites, indicating that phthalate exposure is prevalent across the U.S. population. Adult women exhibited higher levels of metabolites in their urine compared to men, particularly for phthalates commonly found in personal care products like soaps, body washes, shampoos, and cosmetics. Non-Hispanic Blacks had higher levels of exposure to several phthalates compared to non-Hispanic Whites.^68–73

To minimize phthalate exposure, recommendations include avoiding the use of PVC plastics, especially in items like food containers, plastic wrap, and children’s toys, which can be identified by the recycle code number 3. It is also advised to steer clear of air fresheners and products with added fragrances as a precautionary measure against phthalate exposure.

Other chemicals

Other toxic chemicals that we consume include acrylamide,^74–76 cadmium,^77–79 inorganic arsenic,^80–83 lead,^84,85 perchlorates,^86–88 chlordane, and heptachlor^89,90 (Table 2). Preventive measures appear to be the best approach to minimize their effects on human health. For instance, to minimize the exposure to acrylamide for your family, it is recommended to promote a healthy and well-rounded eating regimen that incorporates a variety of fruits and vegetables, lean meats, fish, high-fiber grains, and beans. Furthermore, the following guidelines can be followed: 1) temperature should be kept at 120°C (248°F) or lower when frying foods; 2) potato strips are to be cooked to a golden yellow color rather than a deep golden-brown; 3) bread is to be toasted to the lightest shade possible; 4) raw potato slices are to be soaked in water for 15–30 minutes prior to frying or roasting; and 5) refrigerating raw potatoes should be avoided.^74–76 To mitigate the health risks associated with arsenic, various water treatment methods can be considered. In addition, research has shown that folic acid supplements can reduce blood arsenic levels in individuals exposed to arsenic-contaminated drinking water.⁸³ In the U.S. dimercaprol and 2,3-dimercaptosuccinic acid are available for the treatment of arsenic poisoning.

Conclusion

Given the evolving role of pharmacists as it relates to the public health, an important rising role can be educating the public about the potential exposure to harmful toxins present in our immediate surroundings, particularly toxic chemicals that we unknowingly consume. Pharmacists can prepare educational materials, hold presentations at public libraries, and participate in scientific meeting to disseminate knowledge about the potential exposure to these toxins, their detrimental impact on health, and strategies and recommendations to minimize exposure. This is a shared responsibility among public health officials and healthcare professionals including pharmacists.