Archives for December 2011

Aluminum in Antiperspirant

As a cause of human illness?

“Doctor, what do you know about the risks of using antiperspirant?” asked my 26-week pregnant patient, “Should I be worried?”

Feeling pretty uninformed, I told her, “if it makes you feel better, switch to a natural deodorant instead”.

I also told her she just gave me my next homework assignment.

Aluminum basics. ~

Aluminum is the most common element in the earth’s crust and third most common element in nature.  Because it is so reactive, aluminum is primarily bound to other elements. (Verstraeten et al, 2008).

What are the health risks of aluminum? ~

In humans, there is no known physiologic need for aluminum but it can be absorbed from the GI tract, the mucosa, and across the skin (the concern with antiperspirants).  In individuals who have normal kidney function, the aluminum absorbed is removed. When the kidneys don’t function well the aluminum can accumulate.  It then competes with other essential elements we do need, such as magnesium, calcium, and iron (Bernardo, 2010). Therefore, its negative effects have to do with displacing these important elements, resulting in effects seen in the central nervous system, bone, and skeletal muscle.

How much aluminum do we actually absorb from antiperspirants?  ~

If you look at the back of any antiperspirant, an aluminum-based compound is the main/active ingredient.  The maximum aluminum compound permitted is 25% of the product, with an average range of 10-25% (FDA, 2009). This ingredient functions to clog the sweat glands to reduce the amount of sweating that occurs.

Based on a small radioactive isotope tagging study, we absorb very little through the skin. In this study, 84 mg of labeled Aluminum chlorohydrate (ACH), the active ingredient in many antiperspirants, was applied to a single underarm of two adult subjects with blood and urine samples being collected over 7 weeks.  They also did skin cell collection for the first 6 days. They found only 0.012% of the applied aluminum was absorbed through the skin. At this rate, about 4 micrograms of aluminum is absorbed from a single use on both underarms. This is about 2.5% of the aluminum absorbed on average by the gut in food over the same time period. Therefore, they concluded that a single use of ACH applied to the skin does not appear a significant contribution to the body burden of aluminum (Flarend et al, 2001).  However, there study only included two individuals and each person may absorb and eliminate differing amounts of aluminum as demonstrated by another case report.

In this case report a 43-year-old woman applied around 1-gram of an aluminum chlorohydrate-containing cream on each underarm daily for four years providing circumstantial evidence of potential harm.  After experiencing bone pain and fatigue without another found cause, she discontinued her antiperspirant.  A couple months later the aluminum levels in her blood plasma and urine had decreased and at eight months her symptoms resolved. The authors of this study suggest that, “although individual variations in aluminum absorption are likely, one should apply aluminum containing antiperspirants with caution” (Guillard et al, 2004).

Aluminums effect in humans.  ~

As mentioned before, the main risks of elevated aluminum levels are that they displace similarly sized elements that have physiologic purpose in our bodies, but can it cause some of our familiar diseases?

There are a number of discussions going on about the potential influence of aluminum on Parkinson and Alzheimer’s, as it has been shown to cross the blood-brain barrier, and in Breast cancer, due to absorption near the breast tissue.

An example often cited to refute aluminum as a cause of these disease, is that individuals on dialysis have higher levels of aluminum [when compared to those with normal functioning kidneys] and they don’t have any higher risk of developing these diseases (Brown et al, 2008).  There is concern, however, that when the digestive tract is bypassed there may be a higher risk of accumulation.

Does aluminum cause Parkinson’s? ~

The link between these diseases and aluminum come from many different conflicting studies.

For instance, people who live in areas with high aluminum concentration in the water have been found to have higher rates of Parkinson’s (Muhlenberg, 1998).  High aluminum concentrations have also been found in post-mortem brain specimens of patients with Parkinson’s and there is suggestion from animal models where aluminum administration caused a decrease in dopamine content, that via this mechanism it may influence development of the disease. (Bolt & Hengstler, 2008) However, simply because there is a presence and at supra-physiologic doses causes harm, does not indicate it is the cause.

Does aluminum cause Alzheimer’s? ~

Aluminums suspect involvement in the development of Alzheimer’s disease was introduced in the 1960’s (Terry & Pena, 1965 and Klatzo et al, 1965).  Since that time, no causal relationship has been established and a link seems more unlikely.

Again, some studies have found higher levels of aluminum in the brains of people with Alzheimer’s (Crapper et al, 1976), but other researchers have found no difference (Trapp et al, 1978).  Again, even if present this does not indicate cause and is more likely a secondary effect.  No positive association of antiperspirant use with Alzheimer’s disease has been shown (Flaten & Odegard, 1988).

Does aluminum cause Breast Cancer? ~

 Some research suggests that aluminum-based compounds have estrogenic properties and can alter DNA replication by increasing the rate of errors during replication (Darbre, 2005).  Therefore, it was concluded that aluminum in antiperspirants may influence the development of breast cancer given its proximity to breast tissue (Fakri et al, 2006).

Two studies, one in 2002 and another in 2006 interviewed women with or without breast cancer and evaluated their use of antiperspirants and shaving practices.  These studies found no difference between the groups (Fakri et al 2006, Mirick et al 2002).  While these two studies found no apparent link, a study in 2003 seemed to suggest earlier diagnosis of breast cancer in women who shaved and used antiperspirants.  This effect was especially noted in women who started younger than 16 years of age (McGrath, 2003).

So, while there have been a number of studies examining this question, overall the research seems to suggest a potential for earlier development of breast cancer, potentially in women who are susceptible to breast cancer, but not necessarily the cause of the breast cancer.

What will I tell my patient? ~

The risks are not fully supported.  In fact, it is likely there are multiple factors contributing to the development of these human illnesses.  There is definitely a risk of aluminum toxicity due to displacement of other elements; however, the amount absorbed via the skin is so miniscule it would require excessive application of aluminum antiperspirants and a poor functioning renal system for toxicity to occur.

For both Parkinson’s and Alzheimer’s, it seems that aluminum is most likely a secondary findings and not the cause of the disease.

In women who are susceptible to the development of estrogen-positive breast cancer, anything that has an estrogen-stimulating effect may lead to earlier development of the disease.  As mentioned in an earlier post about parabens, the cumulative effect of estrogenic like substances in our environment may lead to earlier development, but are in all probability not the only cause.  Other risk factors such as genetics, hormone replacement therapy, and long-standing obesity are greater contributors to risk.

So, what will I tell my patient who is pregnant about risks to the fetus?  Since aluminum has been shown to cross the blood-brain barrier by hijacking the iron transport system, it is also the case that aluminum could use the same mechanism to travel across the placenta to the developing fetus and displace essential elements during growth.  If the cumulative amount is significant enough, this could make a difference during critical periods of time.  From antiperspirants alone though, the amount one would have to absorb is so great that this is highly unlikely to have any influence on development.

As with all things, there is a risk/benefit analysis that has to take place.  Based on available research, the risk from the aluminum in antiperspirants appears so low in general that even during pregnancy, if you perspire heavily and need an antiperspirant, don’t hesitate to use it.  However, if a natural deodorant will suffice and it makes one feel better about limiting their aluminum exposure, then switch to that on lower activity days.

The amount of aluminum through other sources such as drinking water and aluminum pots and pans through the gastrointestinal tract is significantly greater and generally one can rid this if they have well-functioning kidneys.  However, that is for another blog post.

As for this patient, I have a feeling the next question coming from her will be…do you think aluminum antiperspirant is safe to use during breastfeeding?

Hmmmm, while I now know potential risks and absorption amount have to review amount in breast milk and newborn’s ability to eliminate aluminum.  I’ll be getting back to this question, off to review the research!



Bernardo J (2010).  Aluminum toxicity.  Medscape Website.  Accessed: November 15, 2011

Bolt HM, Hengstler JG (2008). Aluminum and lead toxicity revisited: mechanisms explaining the particular sensitivity of the brain to oxidative damage. Archives of Toxicology; 82(11): 787-8.

Brown RO, Morgan LM, Bhattacharya SK, Johnson PL, Minard G, Dickerson RN (2008). Potential aluminum exposure from parenteral nutrition in patients with acute kidney injury. Annals of Pharmacotherapy; 42(10): 1410-5.

Crapper D R, Krishnan S S and Quittkat S (1976).  Aluminum, neurofibrillary degeneration and Alzheimer’s disease. Brain; 99: 67-80.

Darbre PD (2005). Aluminum, antiperspirants and breast cancer. Journal of Inorganic Biochemistry; 99(9):1912–1919.

Exley C (2001).  Aluminum in antiperspirants: more than just skin deep.  Food Chemical Toxicology; 39(2): 163-8.

Fakri S, Al-Azzawi A, Al-Tawil N. (2006). Antiperspirant use as a risk factor for breast cancer in Iraq. Eastern Mediterranean Health Journal; 12(3–4): 478–482.

FDA Website (Last updated 2009).  Accessed: December 21, 2011

Flarend R, Bin T, Elmore D, Hem SL (2001).  A preliminary study of the dermal absorption of aluminum from antiperspirants using aluminum-26.  Food Chemical Toxicology; 39(2): 163-8.

Flaten, T., and Odegard, M. (1988). Tea, aluminum and Alzheimer’s disease. Chemical Toxicology; 26: 959-960.

Guillard O, Fauconneau B, Olichon D, Dedieu G, Deloncle R (2004).  Hyperaluminemia in a woman using an aluminum-containing antiperspirant for 4 years.  American Journal of Medicine; 117(12): 969-70.

Klatzo I, Wisniewski H and Streicher E (1965).  Experimental production of neurofibrillary pathology: 1. Light microscopic observations. Journal of Neuropathology and Experimental Neurology; 24: 187-99.

McGrath KG. An earlier age of breast cancer diagnosis related to more frequent use of antiperspirants/deodorants and underarm shaving (2003). European Journal of Cancer; 12(6): 479–485.

Mirick DK, Davis S, Thomas DB (2002). Antiperspirant use and the risk of breast cancer. Journal of the National Cancer Institute; 94(20): 1578–1580.

Muhlenberg, W (1990). High aluminum concentrations in well water of southern Lower Saxony sandy soil areas caused by acid precipitation: evaluation from the public health and ecologic viewpoint. Offentliche Gesundheitswesen; 52, 1-8.

Terry R D and Pena C (1965).  Experimental production of neurofibrillary pathology: electron microscopy, phosphate histochemistry and electron probe analysis’. Journal of Neuropathology and Experimental Neurology; 24: 200-10.

Trapp G A, Miner G D, Zimmerman R L, Mastri A R, Heston L L (1978).  Aluminum levels in brain in Alzheimer’s disease. Biological Psychiatry; 13 (6): 709-18.

Verstraeten SV, Aimo L, Oteiza PI (2008). Aluminum and lead: molecular mechanisms of brain toxicity. Archives of Toxicology; 82(11):789-802


Organization information:

National Parkinson Foundation –

Alzheimer’s Society –

National Cancer Institute (fact sheet) –


Can Clothes Really Be Static & Toxin Free?

What About Fresh?

After some reading, I’ve decided to give up my dryer sheets, not because I was swayed by activists or significantly by recent research touting dryer sheet emissions.  However, after researching I do believe in the potential for cumulative harm from all the additives, including dryer sheets, that we spew into our environment.

There is indeed much being said about dryer sheets on-line and in the press.  However, because of my training background, first at Harvard Medical School and then at the University of California, San Francisco for residency, I can’t help but ask, “What’s the research show?”

The answer is that there is very little.  Initial studies on the topic analyzed volatile organic compounds (VOCs) in dryer sheets and found them to be present.1-3  The next question is: Does this translate into absorption into our clothing, our skin, or even environmental emissions?  Even further: Does this lead to increased risk of poor outcomes, like respiratory problems or cancer?

It appears that no one is denying that the VOCs are present, but there is opposition as to if there is harm.  No studies seem to demonstrate absorption from dryer sheets in our clothing or skin.  However, a recent study suggests that there may be increased emissions of VOCs from the vent when dryer sheets are used.

The study from the University of Washington, published in 2011, attempted to quantify emissions that come out of a dryer vent. This study took place in two different homes and they tested three scenarios.  The homes varied in that the first home used dryer sheets rarely and the second home frequently.  The first group consisted of wet towels run through the laundry, the second detergent but no dryer sheets, and the last group was washed with detergent and a scented dryer sheet.  In the home that used dryer sheets on a regular basis, 24 volatile organic compounds (VOCs) were emitted in the combined detergent and dryer sheet group, 19 in the detergent group, and 16 in the wet towel alone group.4  This means that at baseline, there are VOCs emitted just by using your dryer.

They identified seven VOCs in the dryer vent emissions classified as hazardous air pollutants by the Environmental Protection Agency.  The study concluded, “two of these identified compounds (acetaldehyde and benzene) are classified as carcinogenic with no safe exposure level”. The authors concluded that acetaldehyde might be due to a reaction between product ingredients. It also could be a residual from prior use of products, from heating and reactions of fragranced products in machines, or other factors.  Additionally, benzene was not found in the home that rarely used dryer sheets, even when the dryer sheet was used during this study.  In the home with normal use of dryer sheets, it was noted in greater quantity in the wet towel group alone.  Potentially, this is due to error in measurement, within the range of error, due to environmental effect of the home, or a cumulative effect of the dryer sheets.

Ultimately, does this mean anything for our health?  Not surprisingly, the cleaning industry claims its products are safe.  The cigarette industry used to claim the same thing.  I’m not convinced these emissions lead directly to a bad health outcome.  However, it is not disputed that they are present in the products.  In my mind, it seems a detriment to our environment and our health that these chemicals are used in the production of the dryer sheets and are present in them.  For these reasons and the fact that manufacturers are not required to list all ingredients, in my home I’ve decided to seek out alternatives to the dryer sheet.

I wondered if there were ways to reduce static cling and to have fresh smelling clothes?  Here’s a list of ideas I found:

  • Natural fibers.  Purchase clothing made of natural fibers as they have less static cling.
  • Line Dry. Often I hang dry my clothing to keep them lasting longer and this is an alternative mentioned while searching.  At least your synthetic fibers should be hung because they dry fast and will reduce your static cling when natural fibers are placed in the dryer.  Even hanging for the last 10% of drying and not over drying should reduce the static cling.
  • Less detergent.  Use ½ of the amount the company suggests.
  • Vinegar.  Add a 1/4 cup of vinegar to the wash is a natural fabric softener, just be sure not to add it with bleach or you can end up with a toxic mix.
  • Aluminum foil.  A ball of aluminum foil in the dryer is thought to dissipate static.
  • Safety Pin.  Similar to the aluminum foil.
  • Dryer Balls.  There is talk that the rubber balls may work but given what they may be made of, that the spikey one’s may ruin your clothes and I am trying to minimize my environmental impact, I don’t think I’ll try these. However, there were comments that Nellie’s Dryer Balls work and reduce drying time. Just be sure to purchase PVC-free ones. Seems a number of people recommend using wool dryer balls to cut down on static cling.
  • Shake out clothes.  When you remove your clothes from the dryer, shaking them will shake out the static cling.

I just came across another recommendation for when your clothes are already dry, which is to put the item on and use a metal hanger along the fabric to collect the static.

I love when someone actually does a research project on these types of questions.  I came across another Andrea (at ‘Simple Organized Living’) who did her own experiment of 347 loads of laundry and concluded that using vinegar and attaching a couple safety pins to garments in the dryer had the biggest impact.  She did the experiment so you don’t have to (see for her experiment).

For a fresh scent place a rag with a small amount of essential oils in the dryer with your clothes while they dry.  Experiment with anywhere from 10-20 drops of essential oil (depending on strength of the oil) on a t-shirt rag and throw in the dryer.

Good-bye dryer sheets!  I’m converting to vinegar, safety pins, and when deemed a nice addition, essential oil.

So, what to do with the rest of that box of unused dryer sheets?  Kansas State University found that Bounce dryer sheets repel fungus gnats! 5



1.     Wallace L, Nelson W, Pellizzari E, Raymer J, Thomas K (1991) Identification of polar volatile organic compounds in consumer products and common microenvironments. Paper #91-62.4 presented at the 84th Annual Meeting of the Air and Waste Management Association, Vancouver, BC, June

2.     Cooper S, Raymer J, Pellizzari E, Thomas K, Castillo N, Maewall S (1992) Polar organic compounds in fragrances of consumer products. Final Report, Contract # 68-02-4544, Research Triangle Park, NC, US EPA

3.     Rastogi SC, Heydorn S, Johansen JD, Basketter DA (2001) Fragrance chemicals in domestic and occupational products. Contact Dermat 45(4):221-225

4.     Steinemann, Anne et al. “Chemical Emissions from Residential Dryer Vents During Use of Fragranced Laundry Products.” Air Quality, Atmosphere and Health. 25 August 2011. <>

5.     Raymond A. Cloyd. Bounce Fabric Softener Dryer Sheets Repel Fungus Gnat, Bradysia sp. Nr. Coprophila (Dipter: Sciaridae), Adults. HortScience, 2010; 45: 1830-1833


Adjustment of Bikram Sequence for Pregnancy

For Preggers

In general, no postures should be done that compress the heart, diaphragm or abdomen, with backbends avoid pushing hips forward of knees, and separate feet slightly in standing and forward bend poses for balance.  No standing head to knee, separate leg forehead to knee, rabbit, cobra, locus, full locust, or floor bow.  These are substituted with pregnancy safe postures.  In Savasana pregnant women rest on their side and utilize long, deep, slow breathing.

Here’s a compilation of Rajashree’s pregnancy video and review of other Bikram yoga websites for maintaining a Bikram yoga practice during pregnancy safely and with integrity in your current class:

First Breathing Exercise:  Pranayama breathing – does not change, feet together as comfortable as one can, this may be adjusted for balance as the pregnancy progresses.

Posture #1:  Half-Moon/Back Bend – feet opened to hip width distance, during the back bend hips do not go forward beyond your toes.

Posture #2:  Hands to Feet – feet hip distance and grasp back of heels with hands, bringing head between legs.

Posture #3 & #4:  Awkward & Eagle Poses – essentially the same.

Posture #5:  Standing Head to Knee – can be altered by simply raising a bent leg up or taking this time to rest, remember to be considerate of your fellow yogis by standing or sitting still as possible, drink water if you feel you must.

Posture #6-9:  Standing Bow, Balancing Stick, Standing Separate Leg Stretching, & Triangle are all done the same, being aware that balance may be more difficult in the standing bow posture and doing near a wall/balancing bar may be needed.

Posture #10:  Standing Separate Leg Head to Knee – adjusted by bending at the waist and leaning forward only slightly with arms on back, stretching without compression.

Posture #11 & #12: Tree and Toe Stand Posture – no change

Posture #13:  Savasana (ie. Dead Body Pose) – initial Savasana is done on back with knees bent before wind removing pose and then remainder is done on the side, alternating sides between the postures.

Posture #14: Wind Removing Pose – each side is done regularly but when both legs are brought up during the first set the legs are pulled to side, around abdomen, on second set the knees are brought up, feet grasped with hands and the soles brought together and knees drop out without any pressure on abdomen.

In between postures in Bikram a sit up is conducted, in pregnancy getting up you simply push yourself up with your arms from the side.

The spine segment of the series is where most of the changes of the original Bikram series are altered to avoid pressure on the abdomen but continuing to strengthen the spine.

Posture #15-18: Cobra, Locust, Full Locust, and Floor Bow are not done.  Instead these are substituted with the following:

Posture #15: Half-fish posture in place of Cobra- lie on back, arms are brought over head and palms placed flat on floor at shoulder by the ears, fingertips pointing down and palms are pushed with the upper body being brought toward the ceiling and top of head placed on floor, arms are brought down to side of body, hands on floor palms facing down, both legs are kept straight on the floor from hips to heels and chest brought toward the ceiling as high as possible.  To release bring hands next to head again, push against the floor and release head.

Posture #16 & 17: Kneeling Locust pose in place of Locust and Full Locust – come on all fours, knees below heels and arms below shoulders, chin up, inhale and lift right leg up as far as goes, then left leg, role forward.  Between these postures, practitioner sits back on heels. Rest on heels during Full Locust and move to side Savasana when the remainder of class moves to Savasana prior to Floor Bow.

Posture #18: Bridge replaces Floor Bow – bend both knees, separate feet hip distance apart and bring to hips, grab heels from side, lift hips off the floor, neck straight and shoulders on the ground, hold.  Push arms and elbows against the floor.  To come out slowly bring hips down and legs down.

Posture #19:  Fixed Firm Pose – the same.

Posture #20:  Half-Tortoise – sit down with knees open, otherwise, no change.

Posture #21 Camel – done without change, just be gentle with pushing your hips forward.

Posture #22:  Bound angle or Cat-Cow can be done in place of Rabbit. Rajashree in her video does Bound Angle – sit and bring soles of the feet together and gently press knees down.
 A Denver yoga studio suggests substituting Cat-Cow – start on all fours, bringing the wrists underneath the shoulders and knees under the hips, head in neutral position.  On an inhale curl the toes under, drop the belly, gaze toward the ceiling working from spine to tailbone, so neck is the last movement.  On the exhale, the feet tops are released to the floor, the spine is rounded, head is dropped, and eyes look toward the navel.  Repeat.

Posture #23:  Head to Knee – adjusted by grasping feet and bending to side, avoiding compression.

Posture #24:  Stretching pose is done as separate leg stretching on first set.  Legs are separated apart as much as possible and toes are grasped, bend knees if necessary.  Second set is completed with Gentle Pose- sit and bring soles together to body, hands on knees, push and lift shoulder up one by one, until both elbows are straight.

Posture #25 Spine Twist – done with a straight leg on the ground.

Posture #26 and final breathing exercise:  Blowing in Firm Pose is the same.
Instead of a final Savasana on the back, her yoga pregnancy video is completed with another breathing exercise.  Sitting in lotus position with relaxed breathing in and out, each to a count of six and between a brief pause, completing this with the rest of your class.


Bikram Yoga Website.  (Accessed: August 15, 2011)

Choudhury R. Pregnancy Yoga Video.

This Holiday Season…

Think Green

As the shopping frenzy unfurled on Thanksgiving Day (what happened to that holiday is for another blog) I began to compose the list of things I needed to get done for Christmas, my gift purchase list, and my own Christmas “want” list.

Americans throw away 25% more trash between Thanksgiving and New Year’s, essentially 1million extra tons a week.1  If everyone made some small changes together we could considerably decrease this number.

In the madness of consumerism that surrounds this holiday season, I “want” others to consider the impact they have with the gifts they buy and the items they want for themselves.

Maybe it’s wishful thinking but I found some nice suggestions that I plan to incorporate into my own “green” holiday season:


  • Send holiday greetings via e-mail. It’s a great way to share photos and keep in touch more frequently. I have a hard time with this one because this is the one time of year where I like to send and receive “snail mail”.
  • Make cards or buy recycled cards.
  • Purchase cards from a charity organization. At least your money is going toward supporting a cause.  I ended up purchasing recycled card from the American Cancer Society this year because I didn’t have enough cards left from last year to make anything.
  • Remind the recipient to re-use or recycle too!


  • Buy a live tree.
  • Buy a cut tree over a fake tree.
  • Recycle when the holidays are over. Waste Management collects Christmas trees from its residential customers. Be sure the tree is cut into three-foot sections and remove any tree stands, nails, tinsel and decorations.  If you can find somewhere that mulches the trees that is the best reusable plan for your greenery.


  • Give no-waste gifts.  Support your local community services by giving music or sports lessons, memberships to a gym, concert symphony or museum (Bankhead Theater tickets anyone?), sporting event tickets.  There are free things you can offer such as babysitting.
  • Purchase gifts made of recycled content. Be sure to buy durable, reusable products that will last.
  • Use No-waste wrapping options. Place a bow directly on a gift; put gifts in a reusable bag such as a backpack or purse; or package small, themed gifts in a larger item – such as plates or table service inside placemats or a tablecloth or kitchen utensils in an apron or decorative dishtowel.
  • Make your own wrapping paper.  Use newspaper or magazines, decorating paper shopping bags or cutting pieces from maps or posters. Recycled-content wrapping paper is also available. Save bags and bows to use in the future.
  • Donate old items.  If you receive new items that will replace current possessions, donate them to a local charity.


  • Package gifts/food for hosts in a reusable container.  If the item is a gift, place it on a decorative holiday plate, in a washable kitchen container or wrap with a holiday towel.
  • Use washable items.  Utensils, plates, glasses, napkins and table coverings should all be reusable. Decorate with plants (that your guests may take home and plant in their yards as a commemoration of the holiday celebration) or candles. Be sure to have containers available where your guests can put recyclable cans and bottles. If you have leftover food, send it home with your guests in reusable containers or donate it to a local homeless shelter.
  • Compost. Take advantage of food waste recycling services where they are offered.

 Have a Happy and Green Holiday Season!



1.  Waste management website. Accessed November 30, 2011.  Website address –