Is “Juliette” unintentionally poisoned in the current environment?

What could connect such disturbing and disparate health issues as precocious puberty, female depression and fatty liver disease? Endocrine disruptors (EDCs) are prime candidates for all of these health aberrations. Additionally, these chemicals have become ubiquitous in the contemporary American environment as well as around the world. Virtually all humans born today are exposed to a variety of chemicals, especially endocrine disruptors which are measurably detectable in everyday products and in most humans.

Despite the health risks, these chemicals have not received enough public attention. This warrants greater action by the medical and scientific community to ensure policy makers are informed.

The impact of endocrine disruptors on certain disease states

Early puberty

Studies show that the age of onset of puberty has decreased continuously for 3 decades, and evidence suggests that endocrine disruptors may play a role. Specifically, it may be related to the multitude of EDCs that include bisphenol A (BPA), polyfluoroalkyl substances (PFAS), and polybrominated diphenyl ethers (PBDEs). Experimental research suggests a causal role for these chemicals: in particular, endocrine disruptors actively disrupt function at multiple levels of the hypothalamic-pituitary-gonadal axis as well as peripheral tissues. EDCs disrupt the pulsatile release of gonadotropin-releasing hormone (GnRH) and also alter several epigenetic mechanisms that may have transgenerational effects.

One area warranting further study is whether endocrine disruptors are synergistic with each other. However, there is already substantial evidence that this is the case and that certain interactions may affect neurodevelopment. For example, one complex study found an increased risk of language delay in the offspring of more than half of the pregnant women in the study who had been exposed to an EDC mixture – a remarkably high prevalence.

Hormonal signaling and depression

Research suggests that endocrine disruptors interfere with hormone signaling and increase human vulnerability to neuropsychiatric disorders. Additionally, evidence is accumulating that they impair serotonergic neurotransmission, thereby contributing to the development of depression and its concomitants. There is growing evidence that these chemicals are associated with an increased risk of depression during the peripartum period of mothers, while other studies suggest that early exposure to endocrine disruptors, including in breast milk, may contribute to depression later in childhood and adolescence.

fatty liver disease

Endocrine disruptors have also been implicated in a range of physical disorders on the rise in the 21st century, including fatty liver disease and diabetes mellitus. Fatty liver disease includes non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH), which can progress to cirrhosis (end-stage liver disease) or even the highly fatal hepatocellular cancer. It should be noted that the United States is not alone in this epidemic. Recent research suggests that nearly one-third of adults worldwide have NAFLD, with prevalence in the United States as high as 38% of the adult population.

Endocrine disruptors working in concert with a high fat diet and high fructose and sucrose intake may further contribute to fatty liver disease and early exposure to endocrine disruptors may be crucial. Teens with NAFLD have an increased risk of developing depression between the ages of 15 and 17 compared to those without. Additionally, investigators in another study observed that 11.6% of teenage girls with NAFLD had suicidal tendencies. Over the past decade, NAFLD and its sequelae have become the leading cause of liver transplantation among women in the United States. This expensive and difficult procedure does not guarantee a normal life expectancy, although it is very effective in preventing immediate death from liver failure.

Spermatogenesis and Romeo Too

So far, we’ve focused exclusively on the impact of these ubiquitous toxic chemicals on women, suggesting that “Juliet” might be poisoned without realizing it. But “Romeo” is not spared either. Endocrine disruptors have been shown to impair spermatogenesis and may contribute to reduced male fertility. With the US birth rate down for the sixth consecutive year (echoing global trends), it is worth exploring further whether these may be interrelated phenomena.


Mounting evidence suggests that endocrine disruptors may be linked to more severe COVID-19 outcomes, as they can localize to lung tissue, contribute to immune dysregulation and promote neuroinflammation.

There are other health risks of endocrine disruptors that we have not mentioned in this brief essay.

Inform decision-makers and the public

Of course, not all chemicals have the same effects on various disease states and their severity: some are more toxic than others and have different health outcomes. But these chemicals are very prevalent – they are found in a wide range of food, water, personal products and packaging. In addition to phthalates, BPA, and PFAS, other environmental toxins, including air pollution, pesticides, and herbicides, can add to this burden of substance-related disorders.

Shouldn’t this raise serious questions among doctors, scientists and policy makers to ensure the public is better informed about the health risks? Given the dangers of these chemicals, it is indeed surprising that the public is not better informed. However, it is primarily up to the medical and scientific community to inform decision-makers of the risks involved. But scientists and medical practitioners tend to focus narrowly on issues concerning their specific disciplines while avoiding engaging with broader issues of health and disease. This has led to a lack of knowledge about the population health risks of environmental toxicants, among other complex issues. More attention should be given to the ideas of environmental health professors often found in schools of public health.

While the Biden administration recently moved to label certain “forever chemicals” as dangerous, there is still a long way to go. Without a better-informed public and decision-makers, efforts to mitigate the risks of chemical toxicity and develop sound public policy will not go far enough. It is essential to limit the manufacture and/or distribution of these harmful chemicals and to increase clinical research on how to minimize the adverse health effects of these unfortunately ubiquitous substances.

The future of man is heavy both chemically and climatologically. Can’t the medical scientific community more effectively direct this health issue at imminent peril?

Arnold R. Eiser, MD, MACP, is an adjunct scholar at the Center for Public Health Initiatives and adjunct principal investigator at the Leonard Davis Institute at the Perelman School of Medicine. He is the author of Preserving Brain Health in Toxic Times: New Perspectives from Neuroscience, Integrative Medicine, and Public Health. Barbara Demeneix, PhD, DSc, is Emeritus Professor of Comparative Physiology at the National Museum of Natural History in Paris and Chair of the Endocrine Society’s EU EDC Working Group. She is the author of Lose your mind, toxic cocktailand How fossil fuels are destroying our health, climate and biodiversity.

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