For the month of January, we are featuring a post from the Sunscreen Doc as a guest feature. Read all about Endocrine Disruptors and how they affect our health, including in critical life stages like pregnancy. To read more, click here.
For the month of December, the Sunscreen Doc is our guest poster on why the chemical Oxybenzone might be one of the most dangerous chemicals in your life. Click here to read the full text of the blog.
For those who don’t know our company backstory, CyberDERM was created by one of its founding physicians to make sunscreens that were safe enough for pregnant women to use every day. The story goes that my father, Dr. Denis Dudley, a double board certified endocrinologist and OB/GYN specializing in high-risk pregnancy was asked by a patient about sunscreens. It would have been the early nineties and his honest answer was that he did not know. Fortunately, his lovely and very talented wife (and my mother) was a dermatologist so with the help of an amazing chemist as their partner- they began the decade long process of researching skincare and specifically sunscreens and its effect on our health and well-being.
I came to the company in 2008 and started with getting our first formula into a bottle that is now known as Every Morning Sun Whip SPF 25. Fast forward 7 years, and I’m now in the position of being pregnant with my first child. Our company ethos has all of a sudden become extremely personal. I know first hand what it’s like to stand in the pharmacy aisle, scouring ingredients of everything from Tums to shampoo and questioning whether it’s ok to use.
Pregnancy has the most stringent of all life stages when it comes to reconsidering everything that is part of our daily life. I’ve personally been reading the MotherRisk website like its my newfound manual to life. I appreciate how balanced and informative it is because there is a plentitude of information on the internet. I’ve learned forums are not the best source as you get a lot of anecdotal stories that’s often contradictory.
So, what’s the story with sunscreen in pregnancy? Should you be using it and what should you avoid?
I think you can guess that I’m going to say, yes, you should use it and you should be even more careful about applying it than before. Melasma is a real and very frustrating condition. Unlike what I read in some pregnancy forums, it does not just resolve always after pregnancy. Nor is it as simple as whisking away to your doctor for a light peel or laser treatment. I’ve helped first hand women suffering from melasma. Most are very self-conscious about it. Most have not found a ‘silver-bullet’ to treat it, even in our sister clinic that has 20 light based ‘lasers’, access to any peel and/or topical. It’s a process treating it- a slow and deliberate one. Most once they get it- are plagued with the prevention/treatment dance for the rest of their lives.
What to look for in Sunscreen?
Avoid oxybenzone, avobenzone, octocrylene and non-encapsulated octinoxate and any formula that contains parabens in its non-medicinal ingredients. That’s probably not a shocking recommendation if you’ve used our products for a while. We’ve been long time critics of oxybenzone especially. I’ve based that on it being a photo-allergen and since 2012, I’ve based it on the recommendations of the WHO report on Endocrine Disruptors. The report dismisses the idea that small doses of any potential endocrine disruptor can’t have a large impact on our health. It also states that fetal exposure, as well as childhood and adolescent exposure, are critical windows that can have life long effects. In simple terms- why risk it?
In pregnancy, we use the litmus test of whether a substance is absorbed into your body and whether levels are detectable. Oxybenzone clearly does get absorbed into the body- as confirmed by the CDC study that stated it was in 97% of a random sample of 2000 Americans. Avobenzone, octocrylene and non-encapsulated octinoxate all have smaller molecular weights than 500 Daltons. 500 Daltons is the generally accepted threshold for determining whether something can get absorbed past our outermost dead layer of skin.
Encapsulating smaller molecules in materials like silica can make them much larger-well past the 500 Dalton threshold. Our encapsulated octinoxate is roughly in the 5-7 micron range, making it act like a large particle based filter. Encapsulation can be a huge innovation in the future where even two normally incompatible ingredients, like avobenzone and octinoxate, could be combined in the same formula with no risk of photo-degradation. It’s unlikely though that we will see these new technologies on masse in commercially available sunscreens as they tend to be much more expensive than their non-encapsulated versions. If you see any of the above filters (oxybenzone, avobenzone, octinoxate, octocrylene)- you can most likely assume they are not encapsulated at this present moment unless they state specifically otherwise. If you’re not sure, reach out and ask the brand.
Of course, once you remove these filters as options, you’re not left with many alternatives if you live in North America. In the future, I hope to see two European ingredients Tinosorb S and Tinosorb M get approval in North America. These are large particle based filters that offer excellent UVA/UVB protection. They’ll be a huge boon to our sunscreen market if and when they come. Due to their large particle size and excellent photo-stability, they are as controversy-free as I’ve seen of any sunscreen ingredient.
Until then, you are essentially left with zinc oxide as your main preferred ingredient. You need at least 10% of zinc oxide in your product and in pregnancy, I’d recommend to stick to higher concentrations for the added UVA protection. To me, the issue of nano versus non-nano is a bit of a red herring. It’s also well accepted that in the world of sunscreens, nano particles are huge compared to traditional low molecular weight filters. If you are still worried, repeated studies have shown that it does not go past the stratum corneum. You can look for the term non-nano on your label but since definitions of what constitutes nano vary- what might be non-nano to some could be nano to others. As proof of that, although we use the same form of zinc oxide in both formulas- it’s considered non-nano by one division in Health Canada but considered nano by another.
Zinc oxide can be combined with another filter like titanium dioxide or an encapsulated version of another non-mineral filter. Just remember- they are a bonus so to speak in terms of added protection mostly within the UVB range but the essential is to look for a high concentration of zinc oxide for truly balanced protection. Combine daily use with other sun protective habits like glasses, hats and seeking shade and you’ll be a healthy and happy mama-to-be in the sun protection department.
I’m not a scientist. As someone in the field of personal care products, the issue of endocrine disruption has been one of arch pragmatism. Cosmetics are a nice-to-have product, sunscreens are a need-to-have, but both have such a diversity of offerings that I can afford to be selective. I’ve always been of the mind that if I can choose between something that has some controversy associated with it and something that has no controversy- controversy-free will always win the day. As I said, practical thinking. However, I’ve never fully understood what endocrine disruption could mean for my body and thus it’s always been a bit of an abstract concept. It’s also one that emerged from a more fringe group of intellectualism and science. It’s only been the past 5 years or so that it’s started to get real mainstream traction.
The latest summary from the World Health Organization and the United Nations Environment Program, titled “State of the Science of Endocrine Disrupting Chemicals”, is actually from 2012. I’ll admit it’s my first time reading it but I think its impact has been largely lost otherwise there would be more of a collective freak-out going on. Detox has become a common word but do we understand what we are detoxing from, whether we fully can, and how it’s truly impacting our health across generations, eco-systems and species? I’ve heard physicians in different capacities dismiss the impact of Endocrine Disrupting Chemicals [EDC’s] repeatedly and often. Many claim, ‘We pee it out! Our bodies are adept at removing toxins on their own,”- their conclusion then is what we put on our skin is moot.
Here are some take-aways from the State of Science documents that dispute that claim. The document is roughly 30 pages but it’s well written and clear enough for all of us to understand. I think what gives this document the ultimate level of credibility is that it’s a survey of all published studies rather than presenting data from a single source. They also have no specific agenda- they’re merely showing what work has been done and what needs to further done. Below are some of the cliff-note snippets but I encourage everyone to read it for themselves.
Key Finding: “Numerous laboratory studies support the idea that chemical exposures contribute to endocrine disorders in humans and in wildlife. The most sensitive window of exposure to EDCs is during critical periods of development such as during fetal development and puberty”. (page 3)
Conclusion: We’ve always been sensitive as to what a pregnant woman uses on her body during that particular time in her life since we are very wary of its possible effect on her unborn child (CyberDERM sunscreens were first created with pregnant women in mind!). I don’t know that as much attention has been paid to children in the pre-adolescent phases. In either case, as the rest of the document goes on to explain, exposure that pre-date these phases might have serious implications.As well, this should affect how we test for endocrine disruption; “Instead of solely studying effects of exposures in adulthood, the effects of exposures during sensitive windows in fetal development, perinatal life, childhood and puberty require careful scrutiny” (page 3).
Key Finding: “A focus on linking one EDC to one disease severely underestimates the disease risk from mixtures of EDCs. We know that humans and wildlife are simultaneously exposed to many EDCs; thus, the measurement of the linkage between exposure to mixtures of EDCs and disease or dysfunction is more physiologically relevant. In addition, it is likely that exposure to a single EDC may cause disease syndromes or multiple diseases, an area that has not been adequately studied” (page 4).
Conclusion: We don’t have fully validated and all –encompassing testing methods to be able to detect these disruptions at these life stages. Endocrine disruption can have subtle effects that do not exhibit right away but can “lead to an increased incidence of diseases throughout life” (page 4). The summary makes mention of some real potential associations between EDC’s and current increases in physiological disorders. For example, there has been a studied association between exposure to dioxins and PCB’s in childhood to reduced semen quality in adult men. It states that there are many associations that have not been proven but there are significant knowledge gaps.
Many of the studies that have demonstrated links between endocrine disrupting chemicals and disorders and diseases are criticized by the scientific community for not being rigorous enough. This summary shows that it’s quite difficult to mount the type of rigorous studies that would normally be accepted, partially due to a lack of testing methodology. Dr. Denis Dudley, the CEO of CyberDERM and physician board certified in Endocrinology and High Risk Obstetrics/Gynecology, has always made the argument that these rigorous types of studies would also be impractical and unethical. Would we ask pregnant mothers to use a cocktail of alleged endocrine disruptors and then track their effects through the mother and child’s life?
Key Finding: “EDC’s act like hormones. Like hormones, which act via binding to receptors at very low concentrations [emphasis added], EDC’s have the ability to be active at low concentrations, many in the range of current human and wildlife exposures. EDC’s can exert effects on more than estrogen, androgen and thyroid hormone action. Some are known to interact with multiple hormone receptors simultaneously. EDC’s can work together to produce additive or synergistic effects not seen with individual chemicals. EDC’s also act on a variety of physiological processes in a tissue specific manner and sometimes act via dose response curves that are non-monotonic (non-linear). Indeed as with hormones, it is often not possible to extrapolate low-dose effects from the high-dose effects of EDC’s. [Page 6]
Conclusion: This is one of the most powerful criticisms against the typical dosage argument presented by most academics. Commonly, data from animal studies is extrapolated to what would be the equivalent human dose. You’ve probably heard the standard response that humans are never exposed to the equivalent amounts in their lifetime with normal use. We’ve all heard the guest expert on TV proclaim something like, “You would need to be exposed to 50x of Y chemical over the course of 50 lifetimes in order to get the same level of exposure”. However, the above finding suggests that low doses of EDC’s can sometimes have more serious effects than high doses. It is not dosage dependent and you can’t extrapolate the data in that way.
This final excerpt is panic inducing and yet hopeful all at the same time, “Timing of exposure is also critical, as exposures during development likely lead to irreversible effects, whereas the effects of adult exposures seem to go away when the EDC is removed” [Page 6]. We need to be incredibly critical of the products that we give to our children as their exposure to EDC’s can have ripple effects throughout their life. For adults, we have a little bit more leeway in recouping our health if we stop now. Therefore, in the words often repeated by Oprah, ‘when you know better, you do better’. We can impact the health of our families and ourselves if we choose to act now- so act now.
Stay tuned for a more technical examination of this issue from Dr. Dudley in his upcoming blog post from The Sunscreen Doc and for some practical tips on what you and your family can do