Phthalates
Phthalates are man-made chemicals used to make plastics more flexible. They are a concern because they act as endocrine disruptors and have been implicated in many negative health conditions including ASD and ADHD.
Quick Facts
Phthalates (pronounced tha-laytes), are a man-made chemical used to make plastics more flexible and durable. They are also known as plasticizers. [18]
We are exposed to phthalates when we inhale dust or fragrances, via our skin when we handle plastic materials, when children put plastic toys in their mouths, and when our food or drinks have come in contact with plastic via packaging or processing and then we consume them.
Children may be more at risk since they are often touching things and putting their hands in their mouths. Since they weigh less, the effects of the chemical may be more concentrated.
Phthalates are a chemical of concern because they act as an endocrine disruptor. This means they interfere with the body’s ability to make and send hormones, affect fertility and the reproductive system, affect birth outcomes and increase cancer risk.
Phthalates have been implicated in many negative health conditions including damage and abnormalities in male reproductive systems, neurodevelopmental impacts on infants and children, and respiratory problems like asthma[1]
When considering environmental toxins, we must consider the overall toxic load, or the cumulative effects of the many toxins to which we are exposed. It can be difficult to measure the cumulative impact of so many pollutants. The best strategy is to minimize toxins as much as possible to alleviate the total toxin burden on the body.
Foods/Products containing Phthalates
Foods:
Note: these food items may contain phthalates because they are in contact with them during processing or packaging. This doesn’t mean you should stop consuming foods (though limiting/reducing consumption of processed and fast foods is ideal). Instead, opt for non-plastic packaging, if possible.
Dairy products (due to plastic exposure during milk processing)
Meat and fish
Oils/fats
Baked goods
Infant formula
Processed foods (like powdered cheese mixes)
Fast food
Personal care products:
Personal care products (will be labeled as “fragrance”)
Hairspray
Nail polish
Shampoo
Body wash
Diapers and menstrual pads
Other items:
Vinyl building materials (flooring, lacquers, carpeting)
Medical equipment like IV bags and tubing
Paints and primers
Detergents and other cleaning products
Shower curtains
Toys
School supplies like binders or lunch boxes
Rain gear
Inflatable mattresses
Vinyl car interiors
Tips for Finding Alternatives without phthalates
Check the labels of your personal care products and look for the words “phthalate”, “fragrance” or “parfum”. Opt for products that are naturally scented with essential oils.
Choose organic when possible, since pesticides can contain phthalates.
Choose fresh, unprocessed foods because these have not been in contact with processing equipment or plastic packaging.
Limit or avoid use of air fresheners and other fragranced products.
Avoid plastic products with recycling codes 3 and 7. Recycling codes can generally be found at the bottom of the product container and they indicate the type of plastic. There are 7 categories. Code 3 indicates PVC or vinyl and 7 indicates miscellaneous.
Avoid using plastic containers, especially when storing foods that are hot or contain fat. Try glass, porcelain, stainless steel or ceramic instead.
Do not microwave plastic containers or put them in the dishwasher because the heat can cause phthalates to leach out of the plastic.
Avoid old plastic toys which can contain phthalates.
Dust regularly and use a high-quality air purifier in your home, such as the Air Doctor (ANL members get $300 off with this link!)
Drink filtered water
We suggest reverse osmosis (like AquaTru) or the Berkey.
AquaTru uses reverse osmosis to remove 82 toxic chemicals including lead, chromium 6, chlorine and chloramine, fluoride, pesticides and fertilizers, PFOA and PFOS, and others. [Aqua Tru link gives ANL Members $150 off]
Berkey uses a gravity-run special filter that remove over 99.99% of viruses, pathogenic bacteria, heavy metals, pharmaceuticals, and countless more contaminants, all while, leaving in the minerals that your body needs!
Wash hands regularly, especially children’s hands.
Phthalates & Autism in the Research
Phthalates and ASD
This literature review reveals evidence showing a connection between exposure to phthalates and ASD, in both prenatal and early childhood. However, of the studies considered, none provide a conclusive causal relationship. Further studies are needed to assess the effect of phthalate exposure in utero and throughout childhood years.[15]
Several chemical exposures such as air pollution, pesticides, bisphenol A, phthalates, mercury, and nutrition deficiency such as folic acid, vitamin D, or fatty acid may possibly be associated with an increased risk of ASD. [6]
Twenty-one studies examined estimated childhood exposures to toxicants and ASD with 19 (90%) reporting a positive association. The toxicants most implicated included pesticides, toxic waste sites, phthalates, air pollutants and heavy metals.[7]
Exposure to environmental chemicals may precipitate autism spectrum disorders (ASD) in genetically susceptible children. Differences in the efficiency of the glucuronidation process may substantially alter phthalate concentrations and effects. The glucuronidation pathway may differ in some children with ASD.[14, 15]
Phthalates & Childhood Development
Exposure to phthalates can impair brain development and increase risks for learning, attention, and behavioral disorders in childhood.[2]
Sufficient data exist to report that exposure to some endocrine disruptors is a risk factor for the emergence of neurodevelopmental disorders.[5]
Phthalates & Prenatal Associations
Phthalate exposures in mid- to late pregnancy were not associated with ASD in children from this high-risk ASD cohort.[3]
Higher gestational concentrations of some phthalate metabolites were associated with higher scores of autistic traits as measured in boys, but not girls; these small size effects were mitigated by first trimester-of-pregnancy folic acid supplementation.[4]
Prenatal phthalate levels and infant oxidative stress-related genetic vulnerability are associated with adverse neurodevelopment.[11]
The use of plastic containers in pregnancy was associated with higher urinary phthalate metabolites. Foods and dietary patterns associated with healthier food choices were generally associated with lower urinary phthalate metabolite and BPA concentrations. [16]
Phthalates & ADHD
Exposure to some endocrine-disrupting chemicals, particularly certain phthalates, during adolescence, may be associated with behaviors characteristic of ADHD.[9]
Among ASD and developmentally delayed boys, higher indoor dust concentrations of diethyl phthalate (DEP) and dibutyl phthalate (DBP) were associated with greater hyperactivity-impulsivity and inattention. These findings, along with evidence for increased risk of DD raise concerns that these chemicals may affect neurodevelopment in children.[10]
Phthalates & Immune Health
Di(2-ethylhexyl) phthalate (DEHP) causes further elevation in inflammatory signaling in ASD monocytes which could be due to existing inflammation in this group. These data suggest that the use of plasticizers such as DEHP should be minimized in order to avoid their potential effects on immune dysfunction associated with ASD. [12]
Ubiquitous environmental pollutants such as di(2-ethylhexyl) phthalate (DEHP) may be involved in the pathogenesis/progression of ASD through dysregulation of antioxidant-antioxidant balance in innate immune cells and cerebellum.[13, 17]
Epidemiological studies provide support for associations between phthalate exposures and airway, nasal, ocular, and dermal allergic disease outcomes, although the reported significant associations tend to be weak and demonstrate inconsistencies for any given phthalate. Rodent studies support that phthalates may act as adjuvants, inducing respiratory and inflammatory effects in the presence of an allergen. [17]
Chemical reactions
The body can respond to foods and/or chemicals in many different ways including allergies and sensitivities. If you suspect a chemical reaction, you can either choose to avoid the chemical or additional testing.
References
[1] Safer Chemicals, Healthy Families. 2021. Phthalates. [online] Available at: <https://saferchemicals.org/get-the-facts/toxic-chemicals/phthalates/> [Accessed 23 June 2021].
[2] Engel SM, Patisaul HB, Brody C, et al. Neurotoxicity of Ortho-Phthalates: Recommendations for Critical Policy Reforms to Protect Brain Development in Children. Am J Public Health. 2021;111(4):687-95.
[3] Shin HM, Schmidt RJ, Tancredi D, et al. Prenatal exposure to phthalates and autism spectrum disorder in the MARBLES study. Environ Health. 2018;17(1):85.
[4] Oulhote Y, Lanphear B, Braun JM, et al. Gestational Exposures to Phthalates and Folic Acid, and Autistic Traits in Canadian Children. Environ Health Perspect. 2020;128(2):27004.
[5] Rivollier F, Krebs MO, Kebir O. Perinatal Exposure to Environmental Endocrine Disruptors in the Emergence of Neurodevelopmental Psychiatric Diseases: A Systematic Review. Int J Environ Res Public Health. 2019;16(8):E1318.
[6] Fujiwara T, Morisaki N, Honda Y, Sampei M, Tani Y. Chemicals, Nutrition, and Autism Spectrum Disorder: A Mini-Review. Front Neurosci. 2016;10:174.
[7]Rossignol DA, Genuis SJ, Frye RE. Environmental toxicants and autism spectrum disorders: a systematic review. Transl Psychiatry. 2014;4:e360.
[8]Radke EG, Braun JM, Nachman RM, Cooper GS. Phthalate exposure and neurodevelopment: A systematic review and meta-analysis of human epidemiological evidence. Environ Int. 2020;137:105408.
[9]Shoaff JR, Coull B, Weuve J, et al. Association of Exposure to Endocrine-Disrupting Chemicals During Adolescence With Attention-Deficit/Hyperactivity Disorder-Related Behaviors. JAMA Netw Open. 2020;3(8):e2015041.
[10] Philippat C, Bennett DH, Krakowiak P, Rose M, Hwang HM, Hertz-Picciotto I. Phthalate concentrations in house dust in relation to autism spectrum disorder and developmental delay in the CHildhood Autism Risks from Genetics and the Environment (CHARGE) study. Environ Health. 2015;14:56.
[11]Ponsonby AL, Symeonides C, Saffery R, et al. Prenatal phthalate exposure, oxidative stress-related genetic vulnerability and early life neurodevelopment: A birth cohort study. Neurotoxicology. 2020;80:20-8.
[12]Nadeem A, Ahmad SF, Al-Harbi NO, et al. Ubiquitous plasticizer, Di-(2-ethylhexyl) phthalate enhances existing inflammatory profile in monocytes of children with autism. Toxicology. 2020;446:152597.
[13] Nadeem A, Ahmad SF, Al-Harbi NO, et al. Aggravation of autism-like behavior in BTBR T+tf/J mice by environmental pollutant, di-(2-ethylhexyl) phthalate: Role of nuclear factor erythroid 2-related factor 2 and oxidative enzymes in innate immune cells and cerebellum. Int Immunopharmacol. 2021;91:107323.
[14] Stein TP, Schluter MD, Steer RA, Ming X. Autism and phthalate metabolite glucuronidation. J Autism Dev Disord. 2013;43(11):2677-85.
[15]Jeddi MZ, Janani L, Memari AH, Akhondzadeh S, Yunesian M. The role of phthalate esters in autism development: A systematic review. Environ Res. 2016;151:493-504.
[16] Pacyga DC, Sathyanarayana S, Strakovsky RS. Dietary Predictors of Phthalate and Bisphenol Exposures in Pregnant Women. Adv Nutr. 2019;10(5):803-15.
[17] Bølling AK, Sripada K, Becher R, Bekö G. Phthalate exposure and allergic diseases: Review of epidemiological and experimental evidence. Environ Int. 2020;139:105706.
[18] Phthalates. U.S. Food and Drug Administration. https://www.fda.gov/cosmetics/cosmetic-ingredients/phthalates#cos. Published 2001. Accessed June 23, 2021.
Authors
Brittyn Coleman, MS, RDN/LD, CLT
