Can We Protect Ourselves from Microplastics?

Microplastics are everywhere — from the ocean to our bloodstream — raising urgent questions about their impact on human health. How concerned should we really be? Sanjay sits down with Dr. Leonardo Trasande, the Director of Environmental Pediatrics at NYU School of Medicine, to talk about how to realistically reduce our exposure and the future of combating microplastics.

Dr. Sanjay Gupta

00:00:00

You know, you might be using a reusable water bottle. I certainly am. And probably because my wife encouraged me to make the switch from single use plastic bottles. It made a lot of sense. And now you’ve probably noticed the growing number of people carrying them around and figured it was time to join in. Now, you may be doing this for all sorts of different reasons. Maybe you’re doing it to help the environment. And sure, there are lots of environmental reasons to opt for stainless steel or glass over plastic. Plastic waste is a big problem. I think we all know this, but there are also health reasons to make the switch. And some of these may surprise you. You may have recently heard about microplastics, which are exactly what they sound like. They are tiny fragments of plastic and they can make their way into our bodies.

CBS

00:00:48

Those particles are about 400 thousands of an inch in zize and can pass through the bloodstream to reach almost every single organ.

NBC

00:00:55

These microscopic pollutants have been found in tissue in the human brain.

NPR

00:00:59

Now, new research adds to concerns that they could be affecting male fertility.

CBS

00:01:04

We’re now learning that it’s possible to take in these particles through the air that we breathe.

Dr. Sanjay Gupta

00:01:09

Microplastics have now been found in the brain, the arteries, lungs, placenta, even in breast milk and your blood. And these microplastics can come from all sorts of different sources, including those plastic water bottles. They can expose us to microplastics.

Dr. Leonardo Trasande

00:01:27

It’s much more pervasive than meets the eye.

Dr. Sanjay Gupta

00:01:30

‘That’s Dr. Leonardo Trasande. He’s the director of environmental pediatrics and the vice chair for pediatric research at the NYU School of Medicine. For the last two decades, he’s been studying how environmental exposures like to microplastics can impact our health and our well-being. The first thing he noticed was that plastics are everywhere.

Dr. Leonardo Trasande

00:01:53

Plastic is much broader in its use than I had even imagined through my college and medical school training.

Dr. Sanjay Gupta

00:02:02

So today, we’re going to hear from him about what exactly is known about microplastics in human health. What they are, how they’re getting into our bodies and the potential long term health effects…

Dr. Sanjay Gupta

00:02:14

What we really know and what we don’t know about that. And I think perhaps most importantly, what does it mean for you? How can you actually reduce your exposure to plastics?

Dr. Sanjay Gupta

00:02:25

I’m Dr. Sanjay Gupta, CNN’s chief medical correspondent, and this is Chasing Life.

Dr. Sanjay Gupta

00:02:36

Just to set the table here… what, what is plastic?

Dr. Leonardo Trasande

00:02:40

So plastic begins with fossil fuels. So ethane is turned into ethylene. Or propane is turned into propylene, either from oil or gas, respectively. And those are the core monomers. And then what happens is a big old chemistry reaction where these monomers are then made into chains. And then what has to happen from there, are they’r

e additives that are intentionally added. So we think of the crinkly polyvinyl chloride plastic that we’re so used to in food packaging as coming that way just on its own. But phthalates are added to polyvinyl chloride to make it softer.

Dr. Leonardo Trasande

00:03:22

Then there are not intentionally added substances. So there are things that are impurities or other materials that get into the mix. And so when we think of that final product, that is our plastic water bottle, our food packaging, our paint, which is plastic.

Dr. Sanjay Gupta

00:03:42

Fascinating. This industry has been around a long time and I’m curious about how it’s become so ubiquitous. But I think what’s been in the news a lot lately, Doctor, has been the concerns about microplastics and nanoplastics. So what are those?

Dr. Leonardo Trasande

00:03:58

So you get that plastic product. It’s this very well put together, polymer made to absorb heat substances that are added. But the reality is it breaks down and it breaks down into various sizes and shapes of the particles. What we’re dealing with when we’re dealing with microplastic and nanoplastic are various sizes. The definitions get a little bit debated where you draw the line between a microplastic and uh, nanoplastics, but we’re talking about microplastic as microscopic sized plastic things that you need to see under the microscope with nanoplastics being a little bit finer grain, but even some microplastics start to look visible.

Dr. Leonardo Trasande

00:04:46

And that’s where we start to talk about microplastic materials even. So the theme here is that they’ve broken down with time in the process before it even gets to the trash or that recycling bin.

Dr. Sanjay Gupta

00:05:00

So I want to underscore this point. Microplastics are tiny. They’re often smaller than a grain of sand. Nanoplastics even tinier. But you might be wondering what exactly causes these plastics to break down in the first place. Dr. Trasande says there’s a few ways this can happen.

Dr. Sanjay Gupta

00:05:17

For example, it can happen with heat. Like just leaving a plastic water bottle in a hot car or microwaving leftovers in a plastic container, even putting that plastic container in the dishwasher. Those probably make sense to you.

Dr. Sanjay Gupta

00:05:31

But it can also happen when plastic comes into contact with unexpected conditions.

Dr. Sanjay Gupta

00:05:37

For instance, acidity. Perhaps you’ve stored tomato sauce in a plastic container. Sometimes that’ll leave a red stain, which you can never quite get out. Well, that’s because the plastic is porous. That means it can let chemicals and particles in as well as out. And there are other conditions. For example, scratches in the plastic or unexpected friction, which can cause monomers the building blocks of the polymer to break off.

Dr. Sanjay Gupta

00:06:03

People have been hearing about microplastics a lot in the news. And I think what’s gotten people’s attention is this idea, which is very visual, of being able to imagine these microplastics in all these various organs in our body. How does that happen? I mean, how is it actually getting into our bodies?

Dr. Leonardo Trasande

00:06:21

We eat a lot of plastic. We inhale a lot of plastic. We literally use cosmetics that resorb in our body. Sometimes we’ve consciously use Microplastic to literally scratch away dead skin. We’ve just come to accept plastic as normal. And it’s not normal.

Dr. Leonardo Trasande

00:06:44

‘It’s so pervasive because there’s so many ways we don’t think something’s plastic, but we realize it actually is. So our nonstick cooking pans are metal with a plastic covering in the form mostly, unfortunately, of per and polyfluoroalkyl substances, the so-called forever chemicals that have gotten a lot of attention lately because they contaminate the water supply too. Then we also to think the entire lifecycle of plastic. When we use plastic, it breaks down and those absorb into our body. Some of it is actually in dust that we inhale and we ingest there in our carpeting there on our floors.

Dr. Sanjay Gupta

00:07:26

And we are just beginning to learn about what microplastics can do to us, the human body.

Dr. Leonardo Trasande

00:07:33

So what we know about microplastics and nanoplastics with respect to human health is still somewhat limited. I would say the flashpoint most recently was this New England Journal of Medicine article that found that levels of microplastics and nanoplastics in the carotid artery, the artery that feeds our brain through the neck, finding that the amount of microplastics in plaque was related steeply, a four fold increase in the composite of heart attacks, stroke and even death. That really further caught people’s attention. Microplastics can do two general things. They can irritate tissue. Let’s say in your gut, they can cause micro bleeding, if you will. They can sneak through little pathways in gut to get into the body, just like they can be inhaled and get into the lungs. They can further cause irritation, enhancing their flow. The same can be said for skin microplastics. We are intentionally adding microplastics to cosmetics for many years intentionally to get rid of dead skin. So that irritant effect is one of the key secret sauces about microplastics. But there’s something even more insidious that’s at play because these microplastics and nanoplastics are not just the polymer. They’re things that are hitching a ride, if you will. And that’s where there’s this complexity that we have to consider. It’s the chemicals that are along for the ride that may be the main problem.

Dr. Sanjay Gupta

00:09:14

Those are chemicals like phthalates, bisphenols and PFAs, which are used in things like food, packaging, nonstick cookware, stain resistant fabrics, water repellent, clothing, even our medicine. Think of time release capsules. Once you start to think about it, it gets concerning really quickly.

Dr. Leonardo Trasande

00:09:34

I work with colleagues in the neonatal intensive care unit. We have plastic materials that save lives. Breathing tubes, feeding tubes and such. We probably need to take a step back and think about the design of those materials more broadly. But there’s lower hanging fruit here and that lower hanging fruit are all these materials that were not designed directly for human good that are creating this peril.

Dr. Sanjay Gupta

00:10:05

I got to tell you now, you know, just imagining a plastic breathing tube going into a neonate, into a tiny baby, I’m probably never going to think about that the same way again. Just imagining those microplastics sort of shedding into that tiny baby’s body is… It’s it’s troublesome. And at the same time, I’m someone who, for example, worries about heart disease. So when I read that New England Journal article and it said my risk of having a cardiovascular problem can be dramatically affected by microplastics, that got my attention. I do all these things, I exercise, I eat right. I even take a statin drug for my cholesterol to try and mitigate my risk of heart disease. I had not really considered plastics and it may be as big or close to as big a risk factor.

Dr. Leonardo Trasande

00:10:53

And that’s not to say the New England Journal study was completely definitive. It didn’t consider phthalates in urine. It didn’t consider other chemical exposures that derive from plastic. So there’s been this steady drumbeat of science where I think we have it maybe done as effective a job and I blame myself in that way, is to really make that invisible visible. And now when you see microplastics in tissues, you have to immediately say, wow, that means there’s a billion fold more of synthetic chemicals underneath that tip of the iceberg. We need to be curious as much about the invisible as the visible. It’s just that the visible microplastics have really caught and gripped our attention.

Dr. Sanjay Gupta

00:11:44

Next up, a closer look at what’s beneath the tip of the iceberg and what you can do about it. We’ll be right back.

Dr. Sanjay Gupta

00:11:58

‘The point you’re making is that there’s a lot more going on because if you’re seeing the plastic, that means that there’s all these other chemicals in the body by definition, because they sort of ride along with the plastic. What do those other chemicals do then? This is a big area of your work, the so-called endocrine disruptors. Is that what we’re talking about here?

Dr. Leonardo Trasande

00:12:20

Yes. We know that these chemicals, particularly the evidence, is strongest for phthalates used in personal care products, cosmetics and food packaging. We’re talking about bisphenols used in aluminum cans, linings and thermal paper receipts. You’ve covered perfluoroalkyl substances, PFAs. These forever chemicals that are in the water supply of Americans, those come from nonstick cooking and oil and water resistant clothing. And then we need to talk about flame retardants. But now, you know, we carry around electronic devices that have phosphorous based flame retardants that seem to be as problematic with all these chemicals do, is they hack our hormones.

Dr. Leonardo Trasande

00:13:04

And I’m going to adapt a quote that’s not really Vince Lombardi’s quote. Winning isn’t everything. It’s the only thing. The endocrine system isn’t everything. It’s the only thing. And that’s because endocrine is hormone. Hormones are signaling. Molecules are master conductors of body communication, from heart to brain, from gonads to heart to brain. The connections are diverse and many, and they regulate everything from temperature, metabolism, salt, sugar and even sex. So when you mess with hormones, you end up having multiple effects at the same time. So people look at our research and say, how can you have an effect on brain, ovary, testis, heart all at the same time? That’s nonsense. I say, wait a minute. When you look at the laboratory studies, hormones that these chemicals affect affect all these different organ systems at the same time.

Dr. Sanjay Gupta

00:14:13

In medicine and public health, it’s always hard to draw these cause and effect relationships. More microplastics, more nanoplastics leading to X, Y, or Z. But where are we with that? I mean, how good is the science around this?

Dr. Leonardo Trasande

00:14:27

I’m going to make a distinction between the invisible and visible as a thing. So with respect to chemicals used in plastic materials, the phthalates, the bisphenol, the flame retardants, the per and polyfluoroalkyl substances, the evidence is really robust. So this started with the Endocrine Society, with its first scientific statement in 2009, really the first landmark, 17,000 scientists, hundred 20 countries saying, hey, this is a problem, particularly in the laboratory. Then the World Health Organization, United Nations Environment Program put out a report calling these chemicals a global public health threat. Those are their exact words. Report was endorsed subsequently by an international U.N. body on chemicals. In 2015, the Endocrine Society came back six years after its first report. That takes a lot of work to do that. That had to really people had to be really upset and worried. 1300 scientific references documenting particularly in humans, the effect of these chemicals on a variety, of course, of effects from cradle to grave. The American Academy of Pediatrics in 2018 documented that chemicals, intentionally and unintentionally added to food were having those same kinds effects, ultimately from plastic largely. So you have these multiple independent entities raising the alarm. So it’s not just scientists like me who are documenting a substantial burden of disease.

Dr. Sanjay Gupta

00:16:01

These microplastics can cross the placenta and get into the into the womb. That was a study that I read as well. I mean, it’s not even just cradle to grave. I guess it is womb to tomb, right? I mean, it is. You’re born with these plastics. You can be.

Dr. Leonardo Trasande

00:16:17

Yes. Years before, we had known that phthalates and bisphenols cross the placenta and are identified in the baby. And we’ve known that these chemicals have their effects on particularly brain development. So just go back to phthalates for a moment. Phthalates mess with thyroid hormone through multiple different ways.

Dr. Leonardo Trasande

00:16:40

And baby relies on mom’s thyroid hormone through about the second trimester of pregnancy. The baby’s thyroid hormone doesn’t come online until second trimester. And this is the frightening part. Even within the clinically normal range of thyroid hormone, subtle shifts like those are being produced by phthalates. Are associated not just with cognitive deficits in kids followed up at age seven, but autism and attention deficit hyperactivity disorder. So these are long term clinical effects and the obstetrician can’t do anything about it through the current kit and caboodle of interventions.

Dr. Sanjay Gupta

00:17:24

And the fact that these chemicals in plastic are having a major effect on our endocrine system, our hormones, even that might not be the complete picture.

Dr. Leonardo Trasande

00:17:32

Particularly when we come to heart disease. There could be two things going around with microplastics and nanoplastics. One is that they are carrier pigeons for toxic chemicals that do direct damage to the linings of the heart. But they could also just be irritating and scratching and making lipids pop up and blood clots forming that thereby contribute to narrowing of the coronary arteries even further… Setting in motion a worsening of heart disease that could lead to stroke or even death.

Dr. Sanjay Gupta

00:18:07

So what with all you know and all the work you’ve done for decades now, what do you do? I mean, how do you live your life based on all that?

Dr. Leonardo Trasande

00:18:17

So the first thing I have done is to reduce my plastic footprint. So let’s just take something as simple as traveling or flying on an airplane. I’ve got my stainless steel water bottle in hand. It’s empty before TSA. I get it through and I go right to fill it with water before I get on the plane so I can say no to that plastic water bottle. The point that I’m emphasizing is the top line is there. There’s a lot of nonessential plastic out there in a house. You can use glasses, stainless steel. That’s one step.

Dr. Leonardo Trasande

00:18:52

‘Also, reading the recycling number is still important because there are certain plastic still out there that are especially problematic. Three is for phthalates. Six is for styrene, a known carcinogen. And seven includes the best phenols. If you must use plastic, there are things you should avoid doing. Machine dishwashing and microwaving plastic is at the top of the list. The biggest thing is the heat and harsh conditions that you’re creating that will where that plastic, if it’s etched or scratched, please throw it away. And many materials were not designed for re-use, particularly the single use plastic materials. But I try to avoid buying anything that single use plastic when possible.

Dr. Leonardo Trasande

00:19:41

We live in a rigged system, don’t get me wrong, and that we need to work on system change. And I do want to talk about some hopeful messages that I’ve taken away as I’ve navigated this journey. Because companies are trying to do the right thing and are stepping into the void. And they will win market share because people really are feeling this at a human and personal level.

Dr. Sanjay Gupta

00:20:06

It can feel overwhelming. It can feel overwhelming in our modern world that these plastics are unavoidable. So what do you say to those people who say, what’s the point?

Dr. Leonardo Trasande

00:20:18

Well, there are studies that have proven you can rapidly reduce your levels of these chemicals used in plastic materials. Again, through those safe and simple steps. They don’t require a Ph.D. in chemistry. They don’t have to break the bank. They’ve worked in low income as well as high income populations. For example, one study did intervene to reduce the plastic contact with food, reduced levels of phthalates and Bisphenol A in days. Just reading the label on cosmetics in a Latina population of adolescent girls reduced phthalates and phenols in three days. Now you need to sustain those interventions. So we’ve talked about short term you can reduce chemical exposures. Medium term, you can change hormone levels. And then the long term, you can change those chronic disease risk profiles that we’ve talked about. So it really is a journey in which we need to sustain benefits.

Dr. Leonardo Trasande

00:21:19

Now, some people come to me and I’m sure they come to you in this regard. I already have a problem. Why should I change my behavior? And that’s a …that’s a teachable moment. Because the same disease processes that are leading to the origin story of a disease are those that contribute to the progression of disease. For example, we’ve shown that phthalates and this phenols accelerate the decline of kidney disease. So it’s not just that a lot of us epidemiologists tend to focus on the origins of disease as the main part of the story here. But if you have a chronic disease already, it’s all the more important that you take these steps.

Dr. Sanjay Gupta

00:22:03

Let me just ask you one final question again, because I think about heart disease a lot. Should doctors do doctors think about this generally the way that you think about it? Meaning in addition to telling me to exercise, eat right, possibly take a statin medication for cholesterol, will we start to hear from doctors that, look, plastic exposure is a risk factor for these things as well. So in addition to those things, here’s a prescription and how to reduce your plastic exposure.

Dr. Leonardo Trasande

00:22:34

Yes, they should. The endocrinologists and pediatricians have started to lead the march in the direction where this broader awareness. But you and I know that continuing medical education with a generation of doctors and health care providers who’ve already been through their training is a slow change model. And we don’t have a ready made prescription that we get reimbursed for, for suggesting, well, hey, you shouldn’t use so much plastic in your life. So we’re going to need continuing medical education. We’re going to need to fundamentally change the mode of medical education to embrace environmental medicine at a deeper level and embrace the reality that plastics are an important platform for prevention in our leaders.

Dr. Sanjay Gupta

00:23:20

Yeah. And, you know, I don’t know that a medical establishment necessarily needs to wait for reimbursement to tell people to drink out of stainless steel water bottles, though. Microwaves are plastic and don’t, don’t heat it up in the dishwasher either. You know, so simple things like that, as you say, can make a difference. And I’ll just you know, I’ll end with something that I think came up in one of the papers. I think you were an author on, which I thought was hopeful in a way. The body is very biodynamic, which means that it can be affected badly, quickly, but it can also improve quickly as well, which I think, you know, I think people tend to think about things like plastics and say, that’s, you know, 30, 40 years down the line. That may be affecting me. Maybe parts of it are 30 or 40 years down the line, but some of it is much more immediate. You can get bad quickly and you can improve quickly. And I think, you know, maybe that inspires people to modify their behaviors more immediately.

Dr. Leonardo Trasande

00:24:16

Yeah. And I just want to add that health care providers have historically been leaders in environmental prevention. Think of medical waste incinerators. Years ago, we used to have metals spewing out of these hospitals and facilities, and now health care without harm is leading the way with hundreds of health care provider institutions. So I agree we don’t have to wait for reimbursement. And I also agree that we have, as part of our mission, a need to not just improve individual health, but think about a broader public health footprint.

Dr. Sanjay Gupta

00:24:56

That was a really fascinating conversation with Dr. Trasande. Because even though this information about plastics and the chemicals that are added to them and how they can affect our health is alarming, maybe even difficult to process. It is important to challenge ourselves to learn as much as we can about the topic. We owe that to ourselves and then we can make informed decisions based on that knowledge.

Dr. Sanjay Gupta

00:25:19

As Dr. Trasande pointed out, and I think this is important… It does not mean we need to panic, does not mean we need to feel hopeless because we can make small, but at the same time very meaningful changes like choosing to microwave leftovers on a plate or in a glass container instead of in plastic, or swapping out our nonstick pans or stainless steel when we’re ready for an upgrade. The point is we can control what’s within our power and demand better from the companies and systems around us. At the same time, that’s what Chasing Life is all about, taking charge where we can and always striving for better.

Dr. Sanjay Gupta

00:25:59

Alright. Up next, our segment On Call. I get to answer one of your questions. We’ll be right back.

Dr. Sanjay Gupta

00:26:12

Now it’s time to answer a question from one of you, a listener named Dimple called in to ask about PFAs for us in drinking water and water safety.

Listener

00:26:22

Hi, Dr. Sanjay Gupta. Thank you for taking our calls. And I’m a long time listener. I was just struggling, finding the right kind of water filter for our drinking water at home. I wanted to know if you have any suggestions on what long you have to filter that we can recommend. That would be helpful. Thank you so much for all that you do.

Dr. Sanjay Gupta

00:26:48

Thank you very much for taking the time to call in with your question. As you heard in this podcast, plastics and some of the chemicals added to plastics can be potentially harmful to our health, and they can be very hard to avoid. Now, without recommending a specific product, keep in mind a couple of things. A carbon filter or reverse osmosis system, carbon filter or reverse osmosis system. They’re both good at removing PFAs. Those are the kind of things we use in our own home.

Dr. Sanjay Gupta

00:27:19

Now just to get into PFas. That again is one of the chemicals added to plastics. PFAs stands for perfluoroalkyl substances. And there are more than 9000 PFAs chemicals to date. You may have heard these chemicals referred to as forever chemicals because they take a long time to break down and leave the environment and also a long time to leave the human body.

Dr. Sanjay Gupta

00:27:45

According to the nonprofit Environmental Working Group, thousands of communities across the United States, potentially affecting 200 million Americans, have been drinking water contaminated with PFAs. Now back in April, Dimple, you may remember this. The EPA, the Environmental Protection Agency, finalized strict new regulations on six types of fast and public water systems. But to be fair, it’s going to take years until they take effect. And not every household’s even going to be covered by the new rules. And that’s why your question is such an important one. You can reduce your exposure to PFAs today in drinking water by switching to a stainless steel water bottle and then using one of those filters at home.

Dr. Sanjay Gupta

00:28:30

‘If you want more information about this? You can visit the websites of either the Environmental Protection Agency at EPA.gov or the Environmental Working Group at ewg.org. I really hope that helps. We can all raise a glass to clean drinking water. And if you have a question for me, record a voice memo and email it to ask sanjay@cnn.com or you can give us a call. (470) 396-0832 and leave a message. That’s all for this week. Thanks for listening. And of course, keep chasing life. We’ll see you next Friday.

00:29:08

Chasing Life is a production of CNN Audio. Our podcast is produced by Eryn Matheswon, Jennifer Lai, Grace Walker and Jesse Remedios. Andrea Kane is our medical writer. Our senior producer is Dan Bloom. Amanda Sealy is our showrunner. Dan Dzula is our technical director and the executive producer of CNN Audio is Steve Lickteig. With support from Jamus Andrest, Jon Dianora, Haley Thomas, Alex Manasseri, Robert Mathers, Leni Steinhardt, Nichole Pesaru and Lisa Namerow Special thanks to Ben Tinker and Nadia Kounang of CNN Health and Katie Hinman.