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?
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
- Inflammation
- 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.
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.
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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.
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.
If you’d like to read more about BPA in plastics and other food containers, check out my previous article and podcast on this topic.
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I am wondering if this study used conventional/drugstore-brand hand sanitizers, and if there would be a difference when using a purely alcohol-based hand sanitizer like EO, or essential oil based sanitizer like Clean Well. Do these ‘natural’ hand sanitizers contain the absorption enhancers like the conventional brands? Also, this may sound like a silly question, but what if one uses the sanitizers AFTER handling receipts? I have been doing this SPECIFICALLY to try to clear my hands of BPAs or similar compounds from receipts for a while now!
The study used Purell hand sanitizer. The abstract of this study lists some of the dermal penetration enhancing chemicals that have been studied and used. http://www.ncbi.nlm.nih.gov/pubmed/15019749
Some BPA is passed to even dry hands when handling receipts, so I probably wouldn’t use hand sanitizer afterward because it could potentially increase the absorption of that BPA into the skin.
https://www.facebook.com/BPAFreeReceipts
I’ve known about this dangerous combo of BPA and hand sanitizers for a few months. There are BPA-free receipts. Good Earth, the natural foods store in Fairfax, California uses them. Of all of the comments, the one that struck home for me is the fact that BPA is used in dental materials. I sought out a very aware dentist, but I’m not sure he knows about this and will make sure he does. Great string of comments and important article.
Something I have noticed this year, with heavy use of hand sanitizer, is my hands are cracking and itchy in this cold, Michigan weather. It’s not a problem in summer. My new job has me outdoors more, and I often use the sanitizer to “clean-up” after coming inside (6-12 times a day).
I never use hand sanitizer even though my employer has huge bottles of it scattered around the workplace. And yes, I knew that receipts are dangerous and barely touch them. I toss them into the store bag and don’t touch them again unless I need to return something. I pressure can my own dried beans so that we don’t have to deal with the plastic can lining. But then again I eat store-bought yogurt that comes in plastic cups and store my frozen foods in plastic. *sigh* It’s crazy hard to eliminate ALL sources of BPA.
I agree Laurel. When grocery shopping the other day, I thought I might eliminate using the apple sauce squeeze packs that I put in my daughter’s lunches for school by buying a big jar of it and doling it out in servings for her. Then I realized the big “jar” of apple sauce is made of plastic and what would I put the servings in? Little plastic cups w/plastic lids! Oy! What a dilemma we have here!
There has to be a better way. These plastic manufacturers need to be regulated on what they are allowed to use, chemical wise, in their products, so that maybe then they will be forced to test the chemicals for absolute safety & possibly come up with something that is safe.
I would add that BPA is also in some dental materials like some composite fillings and sealers. Talk about continual exposure into the tissues of the mouth! Find a holistic/biological dentist who has this awareness and who does materials testing to find compatible materials for your particular biochemistry.
Beth, BPA exposure is not the only reason to go to a holistic dentist. I don’t have time to go into all the details, but just let me say don’t EVER have a root canal performed & if you have them already, get them removed ASAP, especially if you are having health issues!!!
Just Google Dr. Weston Price and root canal dangers for more info.
I will NEVER go to a “regular” dentist again!
How do you have a root canal removed? Once it’s done, it’s done! You can’t have the nerve put back in!
Good information to have but (as Chris acknowledges) there really isn’t any solid evidence that BPA is so harmful. Not that I won’t be trying to avoid it. But sometimes it seems like jeez, we do have to live on this planet.
The evidence is accumulating and I’m becoming more convinced that it is an issue. As I said in the article, this is a situation where the precautionary principle applies. We don’t need to go crazy and pull gloves out of our pockets or purse before the cashier hands us a receipt (assuming dry hands), but we should certainly avoid using skin products with dermal penetration enhancers before handling receipts, and people who work in retail need to be aware of this issue.
Thanks for the news on this study! I’ve been avoiding hand sanitizer for years now because I doubt most bacteria I encounter on a daily basis can be more dangerous for me than the chemicals in the sanitizer. I knew about the antibiotic in it, but hadn’t thought about something like dermal penetrators! This study raises the issue that these dermal penetrators could be exposing us to so much more than just BPA! Imagine someone who wears a daily moisturizer that contains these, then walks around a city with smoggy air full of carcinogens. They’ve just increased their risk of skin cancer… And once again, the marketing story on so many of these industrial skin & hair products is that they’re ‘healthy’ and ‘natural’ because they contain plant extracts. Tea tree essence doesn’t cancel out sulfates! But so many people feel that they desperately need hand sanitizer, lotion, shampoo, and all this stuff… What happened to plain old soap, water, and vinegar?
re: … ‘healthy’ and ‘natural’ because they contain plant extracts.
When they really do contain botanicals, I suspect this actually increases the need to load the product up with antibiotics, to prevent undesired organisms from growing in it on the shelf.
Of course, terms like natural, organic, healthy, botanical and even hypoallergenic are apparently completely legally meaningless, and no assurance of safety whatever.
http://www.ewg.org/skindeep/
might be a place to start on dealing with that.
I am gradually transitioning to using cash more, so the need for a store receipt diminishes considerably. The other thing that helps reduce exposure is to encourage vendors to use something like Square, so that your receipt comes through a text or email (little more secure). I use Square for face-to-face contact in my business.
Good info to know. Why not take it a step further and mention the triclosan aspect of hand sanitizers?
Also, don’t forget the coffee connection. Pod coffee makers and their coffee pods are plastic-based. And conventional takeout coffee cups have a thin plastic interior coating into which scalding hot liquid is poured.
re: … conventional takeout coffee cups have a thin plastic interior coating into which scalding hot liquid is poured.
Bring your own tumbler. Starbucks, for example, not only serves in this manner, they provide a 10¢ discount. If not available, at least immediately decant into your own tumbler – vacuum-insulated stainless steel is worth a look.
Well, I guess I am much more “dirty” than I thought.
I just dont wash my hands that many times a day…
Is it like that everywhere or just in the US, that washing your hands so many times a day is so common?!
I use Silver Shield from Nature’s Sunshine or ASAP Silver Gel from American Biotech. Stays on the skin for 4 hours and only kills bad bacteria and not the good.
That’s not really how antiseptics work, unfortunately. Unless the markers are highly highly specific (like a targeted antibiotic, and even then we’re pushing it), they are going to kill anything susceptible, which, I’m sorry to say, is definitely going to include “good” bacteria. “Good” bacteria come in both gram+ and gram-, coccal, rod, and different surface markers. You can’t differentiate as easily as you think, and the companies are lying to you if they say they can.
I have just moved from Texas back to Europe, Norway. I never understood the need in the US to have hand sanitizer absolutely everywhere you go. Here in Norway it’s nowhere to be seen & everyone is just fine! Kids are healthy & happy, this artical is another really solid reason to remove HS from society, hospitals yes a very good idea no real need anywhere else.
Never forget, plain old soap and water are the best and least expensive way to wash hands. In acupuncture we are constantly washing out hands and I do not want to use a chemical product to do so. Also, I have the clerk toss the receipt into my bag of purchases. Then I only use Shaklee skin products for my complexion to avoid chemicals and at 77 I don’t look my age, my skin is clear and I constantly get compliments. Other than work, no need to wash hands often nor take showers/baths every day! Give the body a chance to produce its natural oils!
Please confirm, phrase not clear …
“The primary route of exposure wasn’t the thin skin in the mouth, not the GI tract.) ” – was absorption through the oral mucosa or lower down in the GI tract (ie after you’ve swallowed the BPA).
That was a typo, thanks for bringing it to my attention. It should say “was the thin skin of the mouth”. I’ve updated it.
What are your thoughts on plastic Britta water filters (to filter or not to filter through plastic before decanting into a stainless steel container) and coffee filter machines with plastic components?
I make my own hand sanitizer with ever clear and any essential oil. Just shake & pour into a very small glass spray bottle. (Whole foods carries strong, small cobalt colored bottles) Why use hand san at all? I have seen too many people leave public bathrooms without washing their hands. Yuk.
A reverse osmosis under sink water purifying still seems to be the best solution for water filtration. They remove toxins like fluoride, chlorine & more. Systems like Britta don’t remove fluoride, which nobody should ingest systemically just to benefit teeth. (Some commenters were wondering). If only someone would create an affordable reverse osmosis system w/ all stainless steel & no plastics!
I fully agree. Start reading labels and instructions with what an appliance really does.
Chris,
Great info here. Good reminder about the dangers of BPA’s. I feel that these concerns have been brushed under the rug in the last couple of years.
One comment – LunchBots don’t recommend putting their stainless steel lunch boxes in the freezer. Any other good alternatives?
I just updated that bullet point. Thanks for the heads-up on Lunch Bots. We use glass containers for freezer storage ourselves.
Do the Weck jars you mentioned freeze ok. The product info doesn’t mention freezing.
Thanks
I have never been able to freeze liquids in glass. Two days later I remove shards of glass from my freezer and throw out the glass-coated cylinder of ice. I ALWAYS leave plenty of head space, at least an inch, and screw the cap very loosely. I’ve tried refrigerating overnight before trying to freeze, I’ve tried freezing warm. Every single time, the jar shatters. The ice expands horizontally faster than it can rise vertically in the jar. How are you able to freeze liquids in glass?
Lifefactory makes very nice glass food storage containers that are not only freezer safe, but freezer -to -oven safe (without the lid.)
Thank you for pointing out that the AHB and other topical preparations have absorbtion enhancing ingredients.
As someone who uses alcohol-based handrub around 150 times a day as part of my job as a phlebotomist, I’m curious why people need to use AHB’s instead of just washing their hands if they’re concerned about what’s on them.
I wash my hands before handling or eating food, after using the toilet (but not after I’ve touched the doorknob, ha ha) at home and after I’ve sneezed at work. I don’t see the need to use AHB in these situations as they are just a few times a day.
The reason I use AHB when drawing blood is that time is limited. We are obliged to do this 4 times for each patient. I see the patients using this stuff after I’ve drawn their blood when their hands have not come into contact with anything. Seems to be some OCD ritual or they’ve been brainwashed by TV ads.
When I go hiking, I don’t wash my hands at all the whole time so if it’s a 10 day hike, I haven’t washed my hands for 10 days. I think they enjoy the break.
For years now, I’ve been asking the cashier to keep the receipt due to the BPA/BPS and sometimes I explain why if I feel they’re receptive or interested. So that’s been on about 2 occasions. Now I’ll add this extra information and let my colleagues know as well. Recently our hospital was audited for hand hygiene and we phlebotomists performed the highest rate of compliance (>80%) of all the health professionals.
The other times I need to make sure my hands are clean is before I touch my eyes or inner nose (if you know what I mean…). And we need to wash our hands if we’ve touched these places or our skin surfaces e.g. mouth at work. But I wouldn’t use AHB before I touch my eyes etc.
I’ve asked cashiers on numerous occasions if they know if their receipt paper contains BPA since it disrupts hormones. I also mention that about 40% of stores have this, so it’s optional and can be easily fixed. The cashiers are invariably very interested to find out, and motivated to get it sorted out because they touch them all day long.
There is an alternative to BPA receipt paper, but even those contain endocrine disrupters. Just like the BPA-free plastic bottles and such, those products still contain BPS and other questionable health risky compounds. Cashiers should just use gloves.
re: Cashiers should just use gloves.
I wonder how many are prohibited from doing so by management because it might upset the [clueless] customers.
cust: Why are you wearing gloves? No food is served here.
cash: Because the receipt I’m handing you is seriously toxic.
I’m sensing looming class actions here, on multiple fronts.
Some cashiers at our local Super Walmart wear gloves. Smart people!
Is there a risk to being exposed to these chemicals using gloves, from the gloves themselves?
Another reason to make your own hand sanitizer! I make mine from witch hazel or plain ol’ water with naturally antimicrobial essential oils. Does a great job of cleaning up!
re: Another reason to make your own hand sanitizer!
I take it as another reason avoid using HS except when absolutely necessary (and gloves aren’t an alternative). Routinely nuking the skin biome is likely to turn out to not be such a great idea.
re: I make mine from witch hazel or plain ol’ water with naturally antimicrobial essential oils.
That’s certainly infinitely better than commercial preps loaded with triclosan, parabens, and sold in bpa/s-contaminated containers, but it does have some considerations. The witch hazel will cause some of the AB to penetrate the skin and perhaps become systemic. Does it adversely affect gut biome? (I dunno) Also, with some natural AB oils, like tea tree, chronic use can eventually result in an allergic reaction (it did for me).
Chris,
What about water that comes in PETE bottles, such as Evian?
And regardless of the type of plastic, does pouring the water into a glass make any difference compared to continuously taking a sip directly from the plastic bottle?
Thanks,
David
re: What about water that comes in PETE bottles, …
PETE is resin code /1\. It can be made without bpa or bps, but I would look for a specific claim to that effect.
Resin codes /2\ (HDPE), /4\ (LDPE) and /5\ (PP) are generally considered safer, but aren’t as common in retail single-serving water bottles.
re: … does pouring the water into a glass make any difference compared to continuously taking a sip directly from the plastic bottle?
It won’t change whatever’s already in the water, of course, but eliminates oral contact with the plastic. Value? Beats me.
I’m beginning to think that drinking anything from cans is unwise, both due to bpa/bps in the can liner, and needless oral contact with elemental aluminum on the top. Beverage cans have to have polymer linings, or the usually acidic contents would eat through in the warehouse.
Glass is your best bet, and unfortunately glass that hasn’t been recycled intact, as it would have been washed with really nasty chemicals, residues of which are apt to be present.
In the excellent new book called Nourishing Broth by Sally Fallon and Kaayla Daniel, they mention that glass is preferable for broth storage. They add that for plastic, use containers with a rating of 1, 2, 4, or 5, and that plastic containing BPA is rated 3, 6, or 7, and to cool the broth beforehand. (They also explain a technique for reducing broth if storage space is an issue, and tons of other useful info + recipes.)
re: Avoid using hand sanitizer and other skin products like sunscreen or lotion prior to handling receipts.
Avoid using HS at all, unless you know it doesn’t contain needless antibiotics (like triclosan). Plus, even if it doesn’t contain AB, it came in a plastic bottle or bag, and likely has its very own bpa or bps dose.
Where e-receipts are offered, use them. When return requiring an original receipt is unlikely, have the clerk hold it for a phone foto and don’t take the paper. Let them know why. Have a place to store such receipts as you must retain, and put nothing else there. I’m tempted to suggest wearing food processing gloves, but they are made of plastic and ….