Rebecca Ephraim

The Ugly Side of Pretty

"I don't pay much attention to the ingredient lists, I just know what works for me," said Shelley Carpenter, when asked what she looks for in her personal care products. Thinking a little harder, she adds, "I'm allergic to most perfumes, so I stay away from smelly stuff. But I couldn't pin it down." This begs the question, "Who can?" After all, how many of us have the time or inclination to scour the ingredient lists of our moisturizer, deodorant, body lotion and any of the other products we slather on daily?

Carpenter, 45, bases her choices of personal body care products primarily on how her skin immediately reacts to them, and second to that, their functionality. Her skin, beautifully clear and alabaster, erupts into a red, scaly rash at the slightest provocation and she's aware from years of trial and error that certain products set this in motion.

But beyond skin eruptions and rashes, emerging science suggests that untold numbers of cosmetics and personal care ingredients may be silently and insidiously promoting cancer, ravaging women's reproductive functions and causing birth defects. Known by hundreds of long, intimidating chemical names, these ingredients are in the products we shower and bathe with, rub, spray and dab on our bodies, unconsciously, day-in-and-day-out.

It's the day-in-and-day-out part that's of most concern, since these toxic ingredients leak their poisons through our porous skin and into our bodies bit-by-bit. "There's not one smoking gun that we can point to and say 'it's that personal care product, that deodorant, that nail polish that is going to give you cancer," said Jeanne Rizzo, the executive director of the San Francisco-based Breast Cancer Fund. "We can say the cumulative exposure -- the aggregate exposure that we all have to a myriad of personal care products containing carcinogens, mutagens and reproductive toxins, has not been assessed."

Categorically, the giant, mainstream personal care products companies continue to use known or suspected toxic ingredients in their product formulas. There are literally thousands of substances that have been used for decades without the slightest hint to consumers that they may be doing something more than making us squeaky clean and smell good. As activist Charlotte Brody points out, "Neither cosmetic products nor cosmetic ingredients are reviewed or approved by the Food and Drug Administration before they are sold to the public. And the FDA cannot require companies to do safety testing of their cosmetic products before marketing."

Hence, chemicals such as acrylamide (in foundation, face lotion and hand cream) linked to mammary tumors in lab research; formaldehyde (found in nail polish and blush) classified as a probable human carcinogen by the Environmental Protection Agency; and dibutyl phthalate (an industrial chemical commonly found in perfume and hair spray) known to damage the liver, kidney and reproductive systems, disrupt hormonal processes and increase breast cancer risk, are widely used in beauty products.

So should Shelley Carpenter be aware of this? She's certainly no slouch. She's a clinical hospital pharmacist advising doctors on the complex nuances of drug therapies; she's also working on her doctorate in pharmacy while being a mom and wife. Point is, like most of us, she's over-extended and assumes -- like most of us, that whatever personal care products we casually grab off the store shelf must be OK or, well, they wouldn't be sold. In other words, we think, "There's somebody watching out for us, probably some government agency."

"The public, bless our little democratic good government hearts, believes that there is some federal agency that makes sure that dangerous chemicals aren't put into the products we put all over ourselves. Sadly, it's just not true," quips Brody, who's executive director of Commonweal. It, along with Rizzo's Breast Cancer Fund and dozens of other social profit groups, are waging the Campaign for Safe Cosmetics. They're banging the drum to rouse consumers from our slumber of ignorance to realize the dangers lurking in personal care products and the failure -- or refusal -- of any power to change it.

The Innocents and the Knowing

If you believe that buying "natural" cosmetics and personal care products (those brands usually found in natural health stores and the like) guarantees toxin-free ingredients, you are wrong. The reasons for this are dicey with dollops of gray shading. It comes down to a spectrum that runs from 1) companies that know better but willfully use toxic ingredients to 2) well-intending natural products companies that heretofore operated out of ignorance.

But to understand this, we need to go to Europe for some perspective. The European Union (EU), with its 25 member countries, is taking a more enlightened (or a less Draconian) approach to protecting its 450 million people from toxins in personal care products. As of this March, an EU "Cosmetics Directive," will require companies doing business in Europe to eliminate chemicals in personal care products known or strongly suspected of causing "harm to human health." Although there are thousands of questionable chemicals, the directive is targeting about 450, which is huge compared to the nine chemicals that the FDA has banned or restricted in personal care products.

The Campaign for Safe Cosmetics has seized upon the EU's Cosmetic Directive and is urging consumers to sign a petition that asks U.S. companies to commit to meeting the same standards as their European counterparts and then beyond. So far, some 50 companies have signed the campaign's compact -- all of them are natural products companies. Not one single, large, mainstream company has stepped forward, according to Janet Nudelman, coordinator of the Campaign for Safe Cosmetics. "We've had dozens of conversations with these companies and they are absolutely unwilling to admit there's a single chemical that represents harm or could be harmful to consumers in their products," Nudelman said.

Problem is, they don't have to. Major loopholes in federal law allow the $35 billion cosmetics industry to, basically, police itself, allowing unlimited amounts of chemicals into personal care products with no required testing, no monitoring of health effects and inadequate labeling requirements.

"The U.S. government, in relation to the FDA, has not been on the side of consumers and has not been on the side of public health," Nudelman said. "We certainly see that when we see industry representatives serving on government panels that are looking to the very issue that they are supposed to be regulating -- and that is consumer safety. Is the fox guarding the hen house? Yeah, absolutely in the U.S. without question."

However, consumers increasingly have a safe option in those "natural products" companies that have signed the Safe Cosmetics compact pledging to eliminate any questionable chemicals in the personal care products they sell. "The natural products companies may not be all pure and 100 percent where it is we want them to be, but the important thing is that they want to be there, and they're committed to getting there," Nudelman said. "We're talking about literally a massive reformulation on the part of many of these companies in order to meet the core components [of the compact]."

California-based Avalon Natural Products, with three different brands, including Avalon Organics, is one of those companies, reformulating more than 100 skin care products to eliminate questionable ingredients. For a casual observer, it's difficult to fathom why a "natural product" would even have this problem since chemicals like parabens aren't "natural" in the first place -- yet are pervasive in natural products.

Avalon brand manager Tim Schaeffer acknowledged the paradox, which stems from the complexity of preserving natural ingredients in packaged form. Parabens are used as preservatives to inhibit bacteria, yeast and mold growth.

"It's a big challenge to keep natural products from literally rotting. You buy them off a shelf in a store, where they were probably sitting for a month and before that in a warehouse for another month. Then you bring them home and put them in a warm, moist environment where they'll sit for six months or longer ... some things like a deodorant or cream you're putting your fingers in or rubbing in your armpit on a daily basis. That's a pretty tough environment to resist rotting. So preservation for products such as ours that have a lot of organic oils and herbs, is absolutely necessary."

Additionally, parabens (and thousands of other questionable ingredients), have always been legal to use in the U.S. and Canada, and only until recently, when studies have drawn correlations between their use and breast cancer, has concern been raised. Up to this time, many -- possibly most -- makers of natural personal care products were not aware of the hazards of these ingredients. Signers of the compact have scrambled to find effective natural alternatives.

Here's How to Check for Toxins in Your Products

In a massive undertaking, the Environmental Working Group (EWG) analyzed the health and safety reviews of 10,000 ingredients in personal care products. The EWG discovered that there is scant research available to document the safety or health risks of low-dose repeated exposures to chemical mixtures. But the absence of data should never be mistaken for proof of safety. The EWG points out that the more we study low-dose exposures, the more we understand that they can cause adverse effects ranging from the subtle and reversible, to effects that are more serious and permanent.

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First Do No Harm

"Integrative Medicine" has become a catch phrase in our society and most alternative health practitioners would probably say it's a no-brainer to define. A short operative definition of "Integrative Medicine" might characterize it as the combining of the best of conventional medicine and the best of alternative medicine usually beginning with the least invasive therapies first.

For example, if a patient's health problem allows, a health practitioner knowledgeable in "integrative medicine" would more than likely initially decide to hold off on prescription drugs which often have destructive and toxic side-effects. Instead, the practitioner would begin with a gentler approach that encourages the patient's body to mount a defense of its own to overcome the health challenge (leaving the immune system stronger and more vigorous).

As most of us who prefer living naturally know, gentler yet very effective approaches include an encyclopedic list from acupuncture to nutritional therapy (my personal favorite) to yoga. Of course, you wouldn't tell somebody to drink carrot juice if they were just carried in from a car wreck. I suspect we'd all want the marvels of drugs and surgery on our side in such a case. (I'd drink the carrot juice sometime after they wired my jaw and the pain meds wore off!)

A perfect case in point for the harmonious meshing of alternative and conventional medicine is the work of Chicago-based Jon Pangborn, Ph.D. Dr. Pangborn, a specialist in nutritional medicine as it relates to the mindboggling intricacies of metabolic pathways, works with physicians who prescribe surgery, radiation and chemotherapy for their cancer patients. Through sophisticated nutritional analysis, Dr. Pangborn consults with the patients before cancer treatment to get them into "tip-top nutritional condition" to weather the rigors of the therapy.

"We certainly do need the cancer treatment that we have," he says, "because we don't know how else to deal with it but the treatment can be very, very stressful on the body's physiology." Following the treatments, he then resumes nutritional therapy. Dr. Pangborn says of patients with whom he's worked, "Frankly, they were a nutritional disaster after the (cancer) program. They were certainly free of cancer and I must commend the doctors for absolutely wiping out the cancer but they also pretty much wiped out the individual's nutritional status and [the doctors] admittedly...acknowledge this."

Unfortunately, despite all the talk of the new and unbeatable combination of conventional and alternative medicine (CAM), there's still a vast schism between the fantasy and reality of it all. Research shows that over half of Americans entering the conventional medical system have already made forays into complementary medicine, yet many are reluctant to talk about alternative approaches with their conventional doctors. What's wrong with this picture? I think Dr. Tieraona Low Dog, M.D. and herbalist in Albuquerque, NM summed it up nicely when she mused that patients would be better off talking to their doctor's receptionist about herbs rather then asking the doctor himself. I'm sure this could apply to MD's knowledge of other alternative therapies as well.

As I see it, the problem with making "integrative medicine" an effective and inclusive dimension of our health care is multi-faceted. Despite the increased visits to alternative practitioners, conventional physicians still clearly form the backbone (so to speak) of our healthcare. If I can draw from personal experience, regardless of my "alternative" bent, nearly everyone in my family who has a health problem automatically speaks in terms of seeing a conventional physician first. Therefore, as the gatekeepers to other therapies, these physicians must learn to become comfortable with referring out to alternative practitioners just as they do to other MD specialists. (Granted, there are holistic medical clinics that house various health providers-including MD's- but it only goes to show that there is a "we have to stick together to survive" mentality.)

Obviously, how can a referral be given when a physician doesn't have a clue as to what a particular therapy is or how it might benefit a patient? I think we should look beyond the petty argument that physicians want to keep all the business for themselves. I believe most physicians are so saddled with the frantic pace of their practices that they have little time to investigate CAM therapies. And it may be a few years before we have oodles of informed MD's pouring out of the country's medical schools. A study from 1998 showed that 42 out of 117 U.S. medical schools do not require CAM courses or offer them as electives.

Another issue involves patient compassion. As health providers at last year's International Conference on Integrative Medicine so elegantly pointed out, the toolbox of therapies is getting bigger but that doesn't make very much difference if it's still being served up in the same quick, cold and impersonal manner for which our medical system has become known. Two giants in this area of concern, Elliott Dacher, MD, researcher/author (Whole Healing and Intentional Healing) and Harvard Medical School's Arthur Kleinman, MD bemoan a healthcare system in which its healers are short on patient empathy, compassion and moral engagement. After all, they contend, these qualities are vital underpinnings to the healing process. Evidence shows that patients have turned to alternative healing, in part, for the quality of the relationships which they expect to be less dehumanized than those found in conventional medicine. But Dacher and Kleinman worry that the alternative healing arts, which are also steeped in a culture that rewards efficiency and profit, may become fraught with the same impersonality. Of course, discussing the blending of alternative and conventional medicine always brings up the much-debated aspect of insurance coverage. But, once CAM therapies gain momentum, I suspect the insurance companies will gladly fall into line. A handful of insurance companies have already stepped forward to cover CAM therapies. In addition, there are also a few brave and forward-thinking MD's (specializing in CAM) who have refused to kowtow to the insurance companies. These healers feel they can't let insurance company manuals dictate how they treat patients. So they simply stopped taking insurance reimbursements and work on a cash basis to apply the healing techniques they believe best serve their patients. Interestingly, patients have beaten a path to their doors.

If only we could wake up tomorrow and experience a world in which healers had mutual respect and understanding for one another. A world where health insurance would cover the most effective therapy of choice. And a world where the Rights of a Health Consumer always included a healer who treats you like family (or better!).

Wipe Your Way to Good Health

It seems we all have our pet names for it:.dodo, poop, number 2 or others not quite fitting for a family magazine. But no matter how you say it, regular, bulky but soft and easy bowel movements are vital to good health. Oh sure, most all of us have a little problem now and then. But something is seriously wrong when four-and-a-half million people in the U.S. say they are constipated most or all of the time.

As a nutritionist, I am as interested in what comes out of the human body (or if it comes out) as what goes in. Unfortunately, as most everything in the health arena, there are big disagreements as to how one should maintain bowel regularity. Conventional medicine generally pooh-poohs the use of anything beyond a high-fiber diet, more fluids and more exercise. Yet, complementary approaches embrace numerous other therapies based on theories that conventional medicine hasn't fully accepted.

Depending on whom you ask for advice, the gamut of recommendations can run from "don't worry if you only have two or three bowel movements a week" to "transit time for waste material should be no longer than eighteen to twenty-four hours." The latter means we should all be having at least one bowel movement a day. Generally, the health practitioners who say it doesn't matter that you don't dodo everyday are accepting the fact that most people eat a highly refined, high-fat and low-fiber diet: a sure-shootin' recipe for constipation.

Eating more fiber to induce bowel regularity is the golden rule. But there's a lot of consumer confusion over what constitutes heavy-duty fiber sources. Nutritional biochemist Ruth DeBusk, PhD, RD, is a forward-thinking specialist in bowel dysfunctions and works closely with six gastroenterologists in a Tallahassee, Florida digestive disease clinic. She has a four-part "anti-constipation" program that she's never seen fail. Her first directive is to increase fiber intake to 25 to 35 grams a day by eating fruits, vegetables, dried beans and peas. Talking in grams can be a foreign language if you don't have a nutritionist's education but it's easy to add up when you estimate that a serving of fruit or vegetables has about two-to-three grams of fiber. In addition, you can use the "dietary fiber" count on the Nutrition Facts label of food products. DeBusk points out that a half-cup of bran cereal gives 11-13 grams of fiber, about half the day's worth in one sitting!

DeBusk doesn't recommend whole grains as part of her fiber formula as she finds too many people are wheat and/or gluten sensitive. So it's imperative to learn if you are intolerant or sensitive to gluten as eliminating this from your diet can make all the difference. Moreover, it's always a good idea to avoid products with refined white flour. As one colonic therapist so aptly points out a mixture of white flour and water makes a very effective plaster and can do the same in your GI tract.

DeBusk's other anti-constipation recommendations include drinking eight to ten (eight ounce) glasses of water everyday. She also insists that because caffeine is a powerful diuretic that flushes water out of your system, you should drink a cup of water for every cup of caffeinated beverage you drink, such as coffee, cola or tea. Thirdly, DeBusk pushes regular aerobic exercise to tone the muscles of the intestines to keep them in shape for moving their contents along.

Her final recommendation has been used by alternative practitioners for years and is now being recognized among conventional medicine types as a vital component to digestion and good health. This is the use of live active cultures acquired by eating yogurt (certified living cultures) or taking high quality probiotic supplements. These cultures, or probiotics, are the friendly bacteria in our gut that are key to maintaining or restoring a healthy intestinal tract environment. The large intestine alone contains about three pounds of bacteria- both beneficial and detrimental. The unfriendly bacteria, under certain circumstances, will overcome the beneficial bacteria and produce toxins and carcinogens in the bowel. Constipation can result from an upset in this microflora balance and may even be a symptom of parasitic infection.

Another approach to relieving constipation, but generally scorned by conventional medical practitioners, is colon hydrotherapy or colonics. A licensed or certified hydrotherapist gently pumps gallons of filtered water in and out of your colon via the rectum to dislodge accumulations of stagnating fecal waste believed to produce toxins that can poison the body. Naturopath Mark Groven, supervisor of physical medicine at the Bastyr University natural health clinic in Seattle considers colonics a part of a total general wellness program, "We use colon hydrotherapy to tonify the bowel to help produce a better elimination practice for the body." However, he emphasizes that the treatment is not appropriate for people with medical problems such as appendicitis, hepatitis and ulcerative colitis and should be used only under the supervision of a naturopathic or traditional doctor. There's little in the way of scientific research documenting the benefits of colonic therapy but I've talked with many who are convinced that the procedure is pivotal to their continuing good health. Nonetheless, that sort of measure is considered anecdotal:. personal accounts that have not been verified by science.

There are a number of other approaches to ease constipation that also have no clear scientific evidence to support them yet appear anecdotally to be quite effective in aiding bowel movements. Complementary therapists often recommend a riser that sets in front of the toilet. When you sit on the toilet and place your feet on the riser, your knees are well above the level of your hips and makes for a squatting posture that's very conducive to elimination. Hand-in-hand with this is making sure you respond to the call of nature. Repressing your urge to defecate can weaken the signal and make matters worse. In addition, a little straining is a natural part of moving one's bowels but doing it to excess can contribute to hemorrhoids.

Using laxatives, even herbal laxatives, can be tricky because if used routinely and excessively, they can damage nerve cells in the wall of the colon. Laxatives act as chemical irritants stimulating the muscular walls of the colon to abnormally contract to expel the irritating substances. However, complementary practitioners do recommend several food sources that are natural laxatives and can become part of a daily routine. For instances, lemon juice is said to be very cleansing to the intestinal tract. Drinking a cup of hot water (always filtered!) with the juice of half a lemon first thing in the morning can add a capital R to regularity. You should rinse your mouth immediately as lemon juice can erode teeth enamel.

A tablespoon of ground flaxseeds, which can be added to juicing ingredients, yogurt or the like, can be a great intestinal lubricant. Aloe vera juice is another intestinal helper that aids in forming soft stools. Drinking a half-cup of aloe juice in the morning and at night can make life more pleasant for those who are bowel movement-challenged. Have you tasted aloe? It's very palatable. And let's not forget the old standby prune and its less potent cousin, the fig. Don't confuse yourself by trying all these at once; introduce one at a time, note any changes that take place and, if needed, add the others gradually.

Of course, constipation, in some cases, can be the result of complications that go beyond the scope of this column. Yet, as I tirelessly preach (nag?!) "listening" to your body is a first rate approach to good health. And if it says, "I need help" I urge you to find an integrative-minded healer who can coach you to inspire your body's natural healing energies.