A new study shows that using hand sanitizer (and other skin products) before handling receipts increases BPA absorption by as much as 185 times and leads to BPA levels associated with obesity, diabetes, CVD, infertility, and cancer.
Imagine the following scenarios:
- You go to the gas station and fill up your tank. You use the hand sanitizer next to the pump to clean your hands, then grab the receipt from the payment terminal before getting back into your car.
- You go for lunch at a fast-food or take-out restaurant. Just before ordering, you use the hand sanitizer positioned near the counter. The cashier hands your order to you with the receipt stapled on top of your bag, which you carry out with you.
- You work as a cashier at a retail store. You keep a bottle of hand sanitizer next to the register, and use it frequently throughout the day as you ring customers up.
These scenarios aren’t uncommon; they happen millions of times each day all over the industrialized world. Recent estimates suggest that 50 million people in the USA alone eat in a fast-food restaurant each day.
That’s why I was so alarmed by a new study, published in the journal PLOS One, suggesting that using hand sanitizer prior to handling receipts can dramatically increase exposure to a chemical called BPA. (1)
What is BPA (and why should you care?)
Bisphenol-A (BPA) is a chemical that has been used in consumer goods since the 1950s. It’s found in plastic containers, food cans, DVDs, cell phones, eyeglass lenses, automobile parts, sports equipment, and in the thermal paper used for airline ticket, gas, ATM, cash register, and other types of receipts.
New study shows holding receipts for as little as 2 seconds after using hand sanitizer dramatically increases BPA exposure.
BPA is incredibly prevalent in our environment. Over 15 billion pounds of it are produced each year, and nearly all of us are exposed: according to a 2008 study, 93% of Americans have detectable levels of BPA in their urine. (2)
Why is this a problem? We’ve known for decades that BPA can mimic the effects of estrogen. The best way to think of chemicals with estrogenic activity is as a counterfeit key fitting into a loose lock. When these chemicals activate the estrogen receptor, they produce an increase in circulating estrogen, which in turn can wreak havoc on both male and female reproductive and endocrine systems.
Over 60 studies have linked BPA to a wide range of diseases, including:
- PCOS, infertility, premature delivery, miscarriage, and other reproductive effects in women
- Reduced libido and sperm quality, and altered sex hormone concentrations in men
- Altered thyroid function
- Obesity and diabetes
- Cardiovascular disease
- Impaired liver and kidney function
- Impaired immune function
- Neurobehavioral deficits such as aggressiveness, hyperactivity, and impaired learning (3)
Though it’s difficult to prove causation with epidemiological research, and there is still significant controversy regarding the health effects of BPA, I believe both the volume of evidence and the magnitude of our exposure warrant caution. This is yet another situation where the precautionary principle applies. We have no biological need for BPA, and there’s considerable evidence that it may cause serious harm, so the most prudent approach would be to limit our exposure as much as possible.
How does using hand sanitizer (and other personal care products) increase your exposure to BPA?
BPA, and a related compound called BPS that also has significant estrogenic activity, are used in thermal receipts as a heat-activated print developer. Virtually all thermal receipts contain either BPA or BPS, and it has been shown that BPA is readily transferred to other materials that come into contact with receipts. (4)
Although it’s well-known that BPA can pass through the skin, regulatory agencies like the EPA have typically downplayed the risk of BPA exposure from handling receipts. However, they haven’t considered the important role that hand sanitizers and personal skin care products might play in increasing the absorption of BPA through the skin.
Hand sanitizers and other skin products (e.g. soaps, sunscreens, lotions) contain “dermal penetration enhancers” that are designed to enhance the delivery of the active ingredients they contain. Previous studies have found that dermal penetration enhancers can increase the absorption of estradiol, a chemical very similar to BPA, by as much as 100-fold. (5)
If BPA can be transferred from receipts to human skin, and hand sanitizer and other personal care products dramatically increase the absorption of BPA, then might using these products prior to handling receipts lead to potentially toxic levels of BPA exposure? That’s exactly the question the authors of the PLOS One study set out to answer.
They observed people in fast-food restaurants, food courts, and shopping malls in Columbia, Missouri. They also performed experiments in their own lab with volunteers. And what they found was, frankly, quite disturbing:
- If hand sanitizer is used prior to holding a receipt for even a few seconds, a large amount of BPA is transferred to the skin. (Holding a receipt for 45 seconds led to maximum BPA transfer, but holding it for only 2 seconds led to absorption of 40 percent of the maximum amount.)
- Absorption of BPA from the skin happens rapidly due to the dermal penetration enhancers in the hand sanitizer (and other skin care products). In fact, the data showed that there was 185-times more BPA transferred to a wet hand after using hand sanitizer than to a dry hand.
- There was a “dramatic” increase in serum BPA levels after using hand sanitizer, holding a receipt, and then eating with the BPA-contaminated hand. The primary route of exposure was the thin skin in the mouth, not the GI tract.)
- The levels of BPA measured in the urine 90 minutes after using hand sanitizer and holding a receipt were consistent with levels that have been associated with a significant increase in cardiovascular disease and diabetes (along with numerous other diseases) in humans.
Previous studies have shown that handling receipts for long periods (i.e. continuously for 2 hours, as a cashier at a retail establishment might do) leads to increased levels of BPA in urine, and studies of actual cashiers have shown that they have higher levels of BPA in their urine than the general public. (6, 7)
This is the first study, however, to highlight the dramatic impact that hand sanitizer and skin products with dermal penetration enhancers can have on BPA absorption from receipts. And it may help to explain the high levels of bioactive BPA observed in the serum and urine of humans—especially those suffering from “diseases of civilization” like obesity, diabetes, and cardiovascular disease.
Unfortunately, the solution to this problem is unlikely to come from industry or government anytime soon. A recent EPA report examined 19 alternative chemicals that could potentially replace BPA as a developer in thermal paper, and concluded that “No clearly safer alternatives to BPA were identified in this report; most alternatives have Moderate or High hazard designations for human health or aquatic toxicity endpoints.” (8) The report mentioned that “decision makers may wish to consider alternative printing systems.” Hmmm. Forgive me for not holding my breath until that happens.
Conclusions and recommendations
Perhaps someday we will live in a society that requires industry to thoroughly test a new chemical before introducing it into our environment. At the moment, that is not required. So what we’re left with is doing our best to determine the toxicity of chemicals after they are already present—and, in the case of BPA, ubiquitous—in our food supply and commercial products.
In other words, all of us (as well as our children, grandchildren, etc.) are unwitting participants in a gigantic, uncontrolled, society-wide experiment. And so far, the results of this experiment are not encouraging.
Yes, there is still disagreement in the scientific community about just how much BPA exposure is safe, and just how harmful BPA is to human health. But why should we gamble our own health and that of future generations on the hope that a chemical already known to be toxic may turn out to be a little less toxic than we feared? Given that more than 90% of us have detectable BPA levels in our urine, and that BPA is associated with chronic diseases increasing at alarming rates, shouldn’t we be doing everything in our power to better understand BPA’s effects—and protect ourselves from them if necessary?
If your answer to that question is “yes”, here are a few things you can do to reduce your exposure to BPA in receipts, and elsewhere:
- Avoid using hand sanitizer and other skin products like sunscreen or lotion prior to handling receipts.
- Avoid handling receipts even with dry hands for long periods of time. If you are a cashier, make sure to wear gloves.
- Use glass and stainless steel containers at home for food storage. Be aware that the lids of Mason and Kerr brand canning jars contain BPA. There are BPA-free lids, but they still may contain chemicals with estrogenic activity, and I’ve been told they’re made with formaldehyde. Weck makes 100% glass jars that are a good alternative. Crate and Barrel sells them here. My favorite stainless steel containers are from Lunch Bots.
- Use glass, stainless steel, or silicone instead of plastic for freezer storage. See this article for recommendations.
- Use a stainless steel water bottle (like the Klean Kanteen) instead of plastic bottles.
- Don’t drink bottled water from plastic bottles, especially when they’ve been exposed to sunlight.
- Parents: use glass baby bottles instead of plastic. Evenflo is a commonly available brand you can buy at Target, Wal-Mart, Walgreens, Rite-Aid, etc. and online at Amazon and other retailers.
Now I’d like to hear from you. Were you aware of this connection between hand sanitizer and BPA from thermal receipts? Is this something that would affect you in your daily life? What steps are you planning to take to reduce your exposure?