Interview with Dr. Leo Trasande: “We can be the change we seek.”

Interview with Leo Trasande, MD, MPP  “We can be the change we seek.”

We'll be the first to admit it: we're biased. We've designed performance sportswear that's 100% plastic-free because we understand the damaging impact synthetic materials have, first and foremost on our bodies, and on the environment. But you don't have to take our word for it. We sat down with Dr. Leonardo Trasande, MD, MPP, an internationally renowned expert in environmental health, whose groundbreaking research on endocrine-disrupting chemicals and their effects on human development, particularly in children, is cited worldwide. As a pediatrician, endocrinologist, and seasoned marathoner with 26 races under his belt (and his sights set on completing the Abbott World Marathon Majors) Dr. Trasande brings both facts and lived athletic experience to the conversation. Who better to ask about the real impact of synthetic fabrics on our bodies, especially when we're pushing them to perform?

As both an endocrinologist and 26-time marathoner, can you explain what's actually happening to our skin when we wear synthetic fabrics during exercise?

Well, I've run marathons all across the world. And over the years I have seen first hand the extent to which plastic is a part of running. In general, at each of these races, you see different approaches to sustainability taken, and it tells me that we have to do a better job of communicating what we can do to prevent toxic exposures from plastic. Because here’s the biology of it: when we run, we generate heat, and that heat evaporates through our skin. We also use sweat as a cooling mechanism, and at that point, the pores are very open, which then enhances the flow of chemicals that are in synthetic materials and in direct contact with our skin. So it's no secret that when you have chemicals that disrupt hormones in the materials themselves, they can more readily absorb under those conditions — so that's a source of vulnerability to these toxic chemical exposures. 

What's the simplest place to start?

There are proactive steps we can all take as runners and athletes to reduce our exposure.

One of the simplest steps to take is making sure you have a natural fabric-based layer underneath first, that will be a barrier for absorption. My general strategy is, if I have to wear a plastic — let's say I have to wear a particular bib or particular material — at least I'm wearing a natural fabric layer underneath, because then the skin is not a vehicle for these chemicals to go straight into our bodies. 

Let's break this down: our bodies produce natural chemicals — hormones — to function. How do these synthetic chemicals interfere with that system?

Hormones are our natural signaling molecules. They send traffic signals from different organs to each other, from thyroid to brain, from heart elsewhere or back to the heart. So the consequences of these low-level, chemical exposures, are for good. They keep our body functioning, like a nice symphony. 

The problem is, over the past, especially 80 years, we've introduced new synthetic chemicals, not natural chemicals, into our body at levels similar to the natural hormones that live in our bodies. And these affect the natural hormones that are so important to temperature, metabolism, salt and sugar levels. 

We know that the chemicals that hack our hormones include flame retardants, pesticides, Bisphenol S (BPS), used aluminum can linings and thermal paper receipts, phthalates used in personal care products, cosmetics and food packaging. We know there are around 16,000 of these chemicals, and yet we only know about 4000 of them. The remainder, we have no information about them yet. 

You mentioned these chemicals 'hack' our hormones: what does that actually mean for our health?

Well, these chemicals affect us from cradle to grave, from womb to tomb. We're talking about babies born too soon, babies with growth restriction during pregnancy. And when babies are born too small, for instance, their metabolism is rewired, such that they come out of the womb wanting to keep calories in the body. They keep calories as fat, or they put it around the heart. 

These chemicals in early life reprogram the body to maladapt to the external environment. We know that these chemicals may contribute to early puberty, and that means it can have effects on reproductive development. They can also affect reproductive development at birth, and contribute to heart disease and diabetes as well. Certain cancers, especially thyroid, breast, ovarian, even prostate, can be identified in relationship to these chemicals. I'm a pediatrician by training, and as much as I'm going to tell you that kids are especially vulnerable to these chemicals, we are, in fact, all susceptible. 

Is it the dose that makes the poison, to quote Paracelsus? 

I'm not trying to make Paracelsus roll over in his grave. (Laughs) But the fact is that science has taught us new things about nature since then. In fact, over the past 20 years in particular, we've had over 500 studies tell us that there are some chemicals for which the dose doesn't always make the poison. It's genetics. It's the mixture of chemicals we live in. It's the susceptibility we have for other reasons, and these chemicals behave in unusual relationships, particularly for our hormones. This is because many of our hormones don't follow straight line relationships. That's really a human construct placed upon biology.

So we've oversimplified how these chemicals work…

Exactly, biology is much more complicated than that. There are super linear relationships, or non linear relationships, where the lowest levels of exposure are, for instance, where the biggest effects occur. And then there are non-monotonic or U-shaped functions, where you can have some effects early on, no effect in the middle levels of exposure, and then effects that are even greater at the higher levels of exposure. And that's because there are sometimes competing hormones in the body, or competing receptors that respond differently to different levels of exposure.

What can people actually do to reduce their exposure, without needing a chemistry degree?

The immediate steps one can take don't require a PhD in chemistry, and they don't have to break the bank. In my household, for instance, we drink from glass containers as opposed to plastic containers. We don't microwave from machine dish wash plastic, because that can facilitate the leaching of synthetic chemicals. We also avoid canned food consumption, and buy glass or stainless steel containers instead, because the linings of those cans can reach levels of BPS that are estrogenic, and can make fat cells bigger and disrupt the function of proteins that are crucial for heart function and contribute to cardiovascular disease. We also recirculate the air in our homes. Ventilation is very important, because synthetic chemicals can deposit on dust, and when that dust gets kicked back up, we inhale it, and we ingest that dust which can lead to chemical contamination as well.

What should we look out for? 

Well, I always say knowledge is power. It's important to equip consumers with the information they need, to be the change that we see. I recommend scanning the labels of personal care products and cosmetics, and looking for words like phthalate, or fragrance, where there can be other synthetic chemicals snuck in that may be toxic to human development. 

Am I telling you that I'm perfect at this? No, no one's perfect. Let's be very clear. I think people get very anxious about being perfect.

And people often feel defeated by this—like their individual choices won't make a difference. Does reducing exposure actually have measurable effects?

In fact, we know that if you reduce your exposure to plastic, you can rapidly reduce your levels in days that can be detectable in urine. It changes very rapidly, because most of these chemicals have what we call “short half lives.” They get excreted rapidly by the kidneys or by the liver, through the gut. Then the hormone changes come in weeks or months. So there are medium-term benefits as well, and then in the long term, you prevent that risk for chronic disease as a result of these exposures. 

But the system isn't exactly set up to make this easy, is it?

The system is rigged, exactly. It will give you plastic in many different points of life. That doesn't mean you should feel additional guilt. That means you should be conscious of your steps to reduce toxic exposure. I bring that into my running. There are times where I may have to have a gel, or I may have to have fluid in a plastic container. I don't obsess about those things, but I control and I take the steps that I can. 

What will it actually take to drive systemic change, in your opinion?

I think first and foremost, we need independent science. We know that industry-funded science, and its results, can be biased substantially; collaboration with non-governmental organizations to communicate the impacts from local to global of plastic production and consumption is critical. I was at the global plastics treaty negotiations in Geneva in August and despite what people say, to me it was a success: we saw companies who are doing the right thing, leaning in, saying, “We want an ambitious treaty.” We just have to keep pushing for the change around which there's a lot of alignment.

Out of curiosity, when you talk about this with the running community in particular, what's the pushback you hear?

Well, I think there are people who will say, “it's impossible to get rid of plastic.” And I'm not somebody who is such a flat purist. I do believe in the role of essential uses of plastic when there are no other materials available, and at least the technology does not allow for other options: the medical care is a good example of that. I practice in the medical care arena and there are plastics without which devices cannot function: that's a “special use”. And there may be special use cases in running, for instance, in running sneakers. But there are clearly many non-essential steps in which plastic has been introduced, that are absolutely not necessary, driven by companies that want to use the plastic as the cheapest material possible. So I'm not suggesting we put glass containers all over marathon races, or have people run on glass, that just doesn't make any sense. Ideally, we should develop a conscious, thoughtful approach to running that will be aligned with the future, especially as the sport continues to grow. 

Consumer choice is the leverage point.

Exactly, and insofar as we're more conscious consumers, we will be the change that we see. Because I firmly believe in the power of the wallet. That is, that we all, as consumers, see ourselves as relatively small components in a larger force. But it is through consumer activism and consumer change that we can drive companies to do the right thing, because if we align profit motive with reducing toxic chemical exposure, companies will respond. 

When there is a market, a demand, for these materials, then that market will also drive prices down eventually. I'm not suggesting that companies shouldn't profit from doing the right thing. Quite the opposite. It's just that when you get market share, there are economies of scale that start to kick in even more, that reduce the price point. 

Look at organic food as an analogy. In the United States, people would say to me 10 years ago, “Oh, you're making people take difficult decisions and not eat as much fruits and vegetables, because they’re not organic.” Now in the big supermarkets, I see organic fruits and vegetables side by side with conventional agriculture, and the price points are the same or close to each other. The price is no longer the problem. 

We’re hopefully working towards this with sportswear. 

I see a similar phenomenon going on with running, in that runners are, as far as I can tell, among the most conscious, health conscious people you would know. And so when they learn about this, they make changes. They make small changes to start, and those small changes add up and lead to bigger changes. And that's where I see a tremendous amount of hope.