Saturday, August 30, 2014

Sneaky Chemical Exposures - Sunscreen?

Is your sunscreen poisoning you?  The Environmental Working Group has a fabulous database ranking sunscreens in terms of the safety of their ingredients.  But it can feel a little overwhelming.  So let's break it down.

What's So Toxic About Sunscreen?  (Endocrine Disruption and Allergic Reaction)
Sunscreens block sun using either chemical or mineral (physical) filters.  Unfortunately, any of these filters can pose a risk to human health; fortunately, the mineral filters seem to pose much less of a concern. 

Several of the chemical filters are "endocrine disrupters," meaning they disrupt normal hormone function in the body, and several pose a high risk for allergic reaction.  The concerns with the mineral filters (zinc oxide and titanium dioxide) are limited, for now, to inhalation concerns (which is why spray sunscreens are not recommended, even if they are "safe" and "natural;" see below).  For more detailed information, refer to this chart put together by the EWG.

What's an Endocrine Disrupter?
This is an umbrella term for anything that throws off the normal hormone balance and functioning of the body.  The list of symptoms and disorders that can result from hormone dysregulation is vast.  Specifically, the sunscreen chemicals researched by the EWG were found:
  • To disrupt sperm production (animal studies);
  • To be associated (meaning not proven to cause) with endometriosis in women;
  • To mimic estrogen in the body (not just a problem for men);
  • To disrupt thyroid and reproductive system functioning (animal studies); and finally,
  • To cause behavioral problems (animal studies).

Mineral Sunscreen to the Rescue?
Not necessarily.  While mineral filters do have a better safety profile, you still have to be aware of the other ingredients in the sunscreen: certain ingredient combinations can cause a problem, and many "inactive" ingredients are less than ideal.  In fact, a whole host of problems can be associated with inactive ingredients.  The EWG database addresses the safety of inactive as well as active ingredients.  The EWG asserts that we need increased (FDA) regulation of these mineral sunscreens, and more research, before we can be sure that we are using the safest and most effective products.  But for now, it states that mineral sunscreens are nevertheless the safer option.  For more information on mineral sunscreen safety, read this article.

Bottom line: don't use them.   The FDA, Consumer Reports, and the EWG all have concerns regarding the safety of allowing kids to inhale the ingredients in these sunscreens, no matter how "safe" or "natural" they may be.  Why?  In a nutshell, these chemicals have been studied for safety as applied on the skin; they have not been adequately studied for exposure via inhalation, a much more direct exposure than skin absorption.  Some studies have shown them to be dangerous when inhaled.

Parents talk about how well their favorite sunscreen rubs in to the skin, and I'm sure some do better than others.  However, of the 4 that I have personally tried, none of them rub in any better than the other.  We look like ghosts for at least 10 minutes after applying.  So don't expect much - in my experience if it's a truly safe, natural product, it's not going to rub in well; it's going to absorb in slowly over time.  Take it as a reminder to apply well before going outside, which is what we should be doing for maximum efficacy anyway.

So How Do I Choose the Right Product?
The information available to us as sunscreen consumers is both vast and overwhelming, and frustratingly lacking.  I rely heavily on the research done by EWG in choosing sunscreens for my family.  I basically familiarize myself with their top rated products, and then make a final choice based on cost, availability, and what I do know of the ingredients.  They have not let me down yet.
What If I Use a Poorly Rated Sunscreen?
Don't get me wrong.  I believe that, in a pinch, any sunscreen is better than no sunscreen.  Skin cancer rates (melanoma) are on the rise.  Sun exposure does appear to increase risk for melanoma.  So if your choice that day is avoid the beach, get a sunburn, or wear a poorly rated sunscreen, then wear the poorly rated sunscreen.  But for the sunscreen that you will apply to your child, or yourself, day in and day out, I think it pays to find the safest one you can.

The Best Protection

Sunscreen is not the only factor in the sun safety equation.  Other important sun safety tips include:
  • Avoid it:  Avoid sun exposure between the hours of about 10 and 3.
  • Shade it:  Wear a broad brimmed hat that shades the face, ears, and neck.  They make great ones for kids that tie around the chin, contain SPF, and can be worn in the water.
  • Wear it:  Wear protective clothing - long sleeve shirts and light pants are your best bet when possible.  There are long sleeve "rash guards" for kids that can be worn in the water and contain SPF.
  • Protect the eyes:  Wear UV blocking sunglasses.
  • Do it right:  Sunscreen should be "broad spectrum" meaning it blocks UVA and UVB rays.  It should be applied at least 15 minutes before going outside.  It should be reapplied frequently, as per package directions.  
  • Don't tan:  All the evidence points to tanning beds being dangerous; don't use them, and don't allow your kids to use them.

Note:  The long held belief that using sunscreen decreases your risk for melanoma has become slightly controversial of late.  The controversy is outside the realm of this post, and I believe that protecting your child from prolonged sun exposure, and using sunscreen that blocks both UVA and UVB rays, is one of the best ways to keep her safe from melanoma.  

I have no affiliations or financial interests to disclose.  This post does not constitute medical advice.

Wednesday, August 13, 2014

First Food Choices - To Rice Cereal, or Not?

Everyone asks about it.  Some doctors still recommend it.  A lot don't. So what's so special about rice?

Iron Supplementation
When babies hit about 6 months of age, they start absorbing less iron from breast milk.  This happens about the same time that iron stores from birth drop.  This will be a problem for some babies, but not all.  There are symptoms of iron deficiency anemia, but most babies with low iron will show no symptoms at all.  So there's no way to know if your baby needs extra iron-rich foods or iron supplementation.  The idea behind rice cereal was to address this issue by supplementing every baby; add iron to rice, which is a food that most babies will not react to, and give it to every baby as a first food. 

The Problem
When you add iron, a constipating nutrient, to rice, a constipating food, you get a lot of constipated babies.  Furthermore, white rice turns to sugar quite quickly in the body.  Feeding babies rice cereal may be associated with problems such as diabetes and obesity in later life.   Note that this is certainly not a proven fact, and it is a hot and controversial topic right now.  One of the most noted rice cereal opponents is Alan Greene, MD.  You can read his piece on rice here.

Most importantly, there is arsenic in rice.  Brown rice used to be a good alternative to white rice, including for babies: it does not turn quickly to sugar in the body and has health benefits that white rice lacks.  However, there is more arsenic in brown rice than in white.  The FDA, Consumer Reports, and The American Academy of Pediatrics (AAP) all advise parents to provide a variety of grains to children, rather than just rice.  The AAP goes on to advise that it is best to provide children with a varied diet in general, and that vegetables, meat, and other grain cereals are all reasonable alternatives to rice cereal as a first food for baby.

The Solution
I do not recommend rice cereal, or any cereal as a first food.  I think cereals are a fine and necessary food for children, but they are not super foods like yams, spinach, blueberries, and salmon are.  Eventually you will introduce your child to grains; I just don't think there's any rush.  I recommend starting grains once you've established a good variety of vegetables, meat, and fruits.  At that point, whole grains can be a tasty, nutritious, and filling supplement to your child's diet.  Once you do introduce grains, limit rice, both white and brown, until the arsenic issue is resolved. 

Finally, let me be clear: some babies do need extra iron.  Some may even need supplementation.  This is something you really should discuss with your child's provider.  BUT, there are iron-rich foods that are not rice cereal.  Meat, broccoli, and dark leafy greens are all high in iron and great choices for first foods.   Note, however, that meat may also cause constipation in your little one.

I typically recommend yams / sweet potatoes (these are always mislabeled in the store - I'm talking about the ones with reddish skin and orange flesh), winter squash, and avocado as first foods.  Yams and winter squash are high in nutrients and lend themselves quite easily to baby food.  Avocado is rich in fats and also lends itself well to baby food. 

I do think it's a good idea to give vegetables before fruits.   Although there is no scientific proof to the idea of discouraging the sweet tooth by starting with veggies, it certainly doesn't hurt to try.  There's no limit to the veggies and fruits you can offer, but here are some factors to keep in mind:  broccoli, cauliflower, brussels sprouts, and cabbage may cause gas; bananas and apples may cause constipation.

There is evidence that baby's preferences for certain foods begin developing in utero, based on exposure via the placenta, and continue through exposure via the breast milk, and on through early food experiences.  For more on this idea, see this article.  In other words, now is the time to expose baby to a wide variety of foods and spices.  Keep this in mind as you are choosing first foods.