0:09

Hey everyone, welcome to a

0:11

sneak peek, Ask Me Anything, or

0:13

AMA episode of the Drive podcast.

0:16

I'm your host, Peter At the

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more now by going to peteratiamd.com,/subscribe.

0:32

So without further delay, here's today's

0:35

sneak peek of the Ask Me Anything

0:37

episode. Welcome to Ask Me Anything,

0:39

AMA episode 67. For today's AMA,

0:41

we're going to focus on something

0:43

that's gotten a lot of attention

0:45

lately in the news, online, social media,

0:48

and as a result, we've received

0:50

an endless stream of questions, not

0:52

only from our audience, but also

0:54

from our patients. And that

0:57

topic is microplastics and all

0:59

other accompanying chemicals, such as

1:01

BPAs, Pefas and Thalates. Given

1:03

the interest, we decided to dedicate

1:05

an AMA to this topic. In this

1:08

conversation, we dive deeply into what we

1:10

know and what we don't know about

1:12

these chemicals. Why they seem to

1:15

appear all of a sudden, everywhere, how

1:17

we're exposed to them, how much exposure

1:19

we have, and how dangerous they may

1:21

or may not be to our health.

1:23

Ultimately, and perhaps most importantly,

1:25

I think, we propose a

1:28

framework for how someone can

1:30

think about avoiding and mitigating

1:32

exposure to these chemicals. If you

1:34

are a subscriber and you want

1:36

to watch the full video of

1:39

this podcast, you can find it

1:41

on the Show Notes page. If

1:43

you're not a subscriber, you can

1:45

watch a sneak peek of the video

1:48

on our YouTube page. So without

1:50

further delay, I hope you enjoy

1:52

AMA 67. Peter, thanks for coming

1:54

back for another AMA. How are

1:57

you doing? Good, thank you for

1:59

having me. get started today, quick

2:01

question. Do you have a beverage

2:03

in front of you? I do.

2:05

What type of glass is that

2:07

in? Is it plastic? Is it

2:10

glass? It is plastic. Huh. Okay.

2:12

Interesting then. That will be interesting

2:14

for this AMA, which is going

2:16

to cover one topic, which is

2:18

something that seems to be grown

2:20

in interest. We've been getting a

2:22

ton of questions on, ton of

2:25

conversation online. That's microplastics and other

2:27

chemicals such as BP. PFS and

2:29

Thalates. So what we did gathered

2:31

all these questions that have come

2:33

through, pulled them together, and are

2:35

ultimately going to try and help

2:37

people understand, should they be worried?

2:40

What should they be worried about?

2:42

What's dangerous? Based on all that,

2:44

what can they do about it?

2:46

Before we get started, anything you

2:48

want to add. I think there's

2:50

actually a lot I need to

2:53

say before we dive into this

2:55

for context. So I'll preface maybe

2:57

by saying the following. Obviously, people

2:59

who are regular listeners of the

3:01

AMA can appreciate that these are

3:03

not off-the-cuff remarks that we make

3:05

here, and we put a lot

3:08

of work into doing this. When

3:10

I sit up here and do

3:12

these AMAs, I'm doing them based

3:14

on the work that me and

3:16

a team of analysts have done

3:18

for usually about a month in

3:20

preparation for them. I think it

3:23

would be safe to say that

3:25

in the six years we've been

3:27

doing this, or is it seven

3:29

or eight now I've lost track?

3:31

To date, at least, this will

3:33

go down as the AMA that

3:35

has required the most work, that

3:38

has probably generated the most swear

3:40

words, and probably resulted in the

3:42

secretion of the most adrenergic compounds

3:44

from the adrenal glands. In other

3:46

words, this has been a royal

3:48

pain in the ass to prepare

3:51

for. And as recently as last

3:53

night, At 10 o'clock, I was

3:55

emailing you saying, What the F?

3:57

Why are we doing this? It's

3:59

a never-ending morass of information, most

4:01

of which is incomplete. There's so

4:03

much I could say on this.

4:06

And then the most wonderful thing

4:08

happened, which always happens, anyone has

4:10

experienced this if they think back

4:12

to being in college. Even the

4:14

night before the exam, you're like,

4:16

I don't know what the hell

4:18

is going on. And the best

4:21

advice is usually, just go to

4:23

bed, get a good night's sleep,

4:25

get up, nice and early, fresh

4:27

cup of coffee. And I think

4:29

that sort of happened this morning.

4:31

Me and a couple of the

4:34

other analysts went to bed, got

4:36

up this morning, and all of

4:38

a sudden I just had more

4:40

clarity about, in my words, how

4:42

to land the plane. And I

4:44

took to writing a couple of

4:46

pages out, and I think I've

4:49

got kind of a sensible way

4:51

to make sense of something that

4:53

is incredibly noisy. So what I'm

4:55

going to say at the outset

4:57

is... If you are listening to

4:59

this thinking that there is a

5:01

punchline and a one-word answer, I'm

5:04

going to spare you the disappointment.

5:06

This is a very nuanced topic.

5:08

If I could answer this in

5:10

a word, I promise you I

5:12

would, and I would never try

5:14

to go through the 75 pages

5:17

of notes that our team has

5:19

assembled to help me think about

5:21

this topic. I swear to you.

5:23

There are a hundred things I'd

5:25

rather be doing right now. than

5:27

going through this. However, it is

5:29

important in an area where there

5:32

is so much uncertainty, so much

5:34

asymmetry, and such complete and incomplete

5:36

information that we have to understand

5:38

the boundary conditions so that we

5:40

can each make a reasonably informed

5:42

decision. So with that is my

5:44

preamble. Let's do our best to

5:47

guide people on a journey that

5:49

we've been on and acknowledge our

5:51

shortcomings, acknowledge where we wish we

5:53

knew more, where maybe others do

5:55

know more, but leave people with

5:57

a framework such that at the

6:00

end of this... AMA, which will

6:02

hopefully be sometime today and not

6:04

tomorrow, everyone can sort of make

6:06

a risk-based decision for themselves, for

6:08

their families. Definitely. And it kind

6:10

of reminds me of what Bob

6:12

Kaplan always used to say, right,

6:15

which is further from the shore,

6:17

the deeper the water. So as

6:19

we've kind of like gone deeper

6:21

and deeper on this, it seems

6:23

more complicated, more complicated. The last

6:25

question last before we get started,

6:27

that coffee you drank this morning...

6:30

Was that in a glass mug

6:32

or like a Starbucks paper mug

6:34

with the plastic lid on top?

6:36

It was actually in a metal

6:38

yeti camping coffee cup. That's sort

6:40

of my favorite way to drink

6:43

coffee. All right, so you redeemed

6:45

yourself a little bit there, which

6:47

is good. Starting off, I think

6:49

it'd be helpful as we kind

6:51

of typically do definitions. What are

6:53

microplastics? What's BPA? What are these

6:55

chemicals we're talking about? Let's just

6:58

define them now. So as we

7:00

say them going forward, people understand

7:02

what we're talking about. Part of

7:04

this is you just have to

7:06

suck it up through the semantics,

7:08

and part of the challenge is

7:10

that some of the definitions are

7:13

not very helpful. So starting with

7:15

microplastics, they're typically defined as any

7:17

particles of plastic that are smaller

7:19

than five millimeters. Now again, I

7:21

realize that not everybody is facile

7:23

with the metric system, but anybody

7:26

who is will realize five millimeters

7:28

is huge. You can see five

7:30

millimeters. That's half a half a

7:32

centimeter a centimeter. So we're not

7:34

really talking about that. I think

7:36

most current studies would really classify

7:38

microplastics as those smaller than one

7:41

millimeter, one tenth of a centimeter,

7:43

about one twenty-fifth of an inch.

7:45

And then of course we talk

7:47

about what are called nano plastics,

7:49

which are particles that are smaller

7:51

than one micrometer or micrometer, so

7:53

one one thousandth of a meter.

7:56

So we abbreviate these as M&Ps

7:58

or micro nano particles and we

8:00

should just. acknowledge that these things

8:02

are completely ubiquitous. They're found anywhere

8:04

that we have looked for them,

8:06

which is to say we find

8:09

them in water, we find them

8:11

in food, we find them in

8:13

fruit, on fruit, in vegetables, on

8:15

vegetables, in meat, in the air,

8:17

and therefore micro nanoplasticles or mnps

8:19

are completely ubiquitous. Okay, you asked

8:21

about BPA. Now there are lots

8:24

of these... bisphenol chemicals, but bisphenol

8:26

A or BPA is the one

8:28

that most people are familiar with.

8:30

Ironically, the presence of BPA at

8:32

least being used actively has been

8:34

reduced quite a bit over the

8:36

past 15 years, but just understand

8:39

that there's a whole family of

8:41

these bisphenols, and typically we substitute

8:43

one for the other. But what

8:45

are they? They're chemicals that are

8:47

used to make polycarbonate plastic. Polycarbonate

8:49

plastic is the hard plastics we

8:52

have in our world. So if

8:54

you think about all the places

8:56

use plastic and it's hard. I

8:58

think of the now gene type

9:00

water bottles, epoxies, resins, things like

9:02

that. That's where you're going to

9:04

have historically found a lot of

9:07

BPA. Of course, today this is

9:09

less the case, but the truth

9:11

of the matter is they're now

9:13

replaced by other bifinels, so BPS

9:15

and BPF. And the truth of

9:17

the matter is not clear that

9:19

we know if those are any

9:22

better than BPA. When I say

9:24

BPA, I think it's just easiest

9:26

to sort of think of the

9:28

broad category of these families. Another

9:30

thing that we're going to talk

9:32

a bit about, and I've talked

9:35

quite a bit about this in

9:37

the past, is actually particulate matters

9:39

of the 2.5 or smaller variant.

9:41

These are abbreviated PM2. And again,

9:43

it refers to particulate matters in

9:45

the air that are smaller than

9:47

2.5 micrometers. So why is that

9:50

important? About a particle that's that

9:52

small which is that if inhaled

9:54

it has the potential at least

9:56

to become systemic and the reason

9:58

for that has to do with

10:00

the anatomy of the lung and

10:02

the size of both the alveolar

10:05

air sacs and the epithelial linings

10:07

of them, which again it's not

10:09

necessarily that intuitive that you could

10:11

breathe something, but that it is

10:13

small enough that it could actually

10:15

get across a cell barrier at

10:17

the innermost part of the lungs

10:20

and enter the systemic circulation just

10:22

as though it had been injected

10:24

into you. A PM 2.5 refers to

10:26

any particulate matter that is inhaled in

10:28

the air that is of that size

10:31

or smaller. Now, are there some

10:33

microplastics or micronanoplastics that fit

10:35

that description? Yes, but most are

10:37

not. So most PM 2.5s are

10:39

not microplastics. I forget the exact

10:42

number. I know it's somewhere we

10:44

did look it up. It's on

10:46

the order of a few percent.

10:48

I would say that the greatest

10:50

contribution to PM2.5 is probably come

10:52

from air pollution. So anything that

10:54

has to do with when there's

10:56

a fire, burning wood, obviously burning

10:58

fossil fuels, but coal being hands

11:00

down the leader of this, I

11:02

mean, natural gas combustion produces much less

11:04

of this. And then we'll talk about

11:07

thallates, which are another class of chemicals

11:09

that are kind of like, I think

11:11

of them as sort of the opposite

11:13

of the BPAs. So these are the

11:15

things that are used in plastics to

11:18

make plastic more flexible, flexible, flexible, flexible,

11:20

to have more bend in it. They're

11:22

also found in products that we use,

11:24

like shampoos, lotions, laundry detergents.

11:27

It makes fragrances last longer.

11:29

Now, there's been a constant regulatory

11:31

shuffling around all of these things, and

11:33

I'm not going to get into it

11:35

because I could just put everybody to

11:38

sleep right now. We're going to leave

11:40

a ton of this in the show

11:42

note section where we're going to kind

11:44

of go through the regulatory machinations on

11:46

this, and... which of these products

11:48

were banned and when and what

11:51

got substituted in. But the bottom

11:53

line is that the use of

11:55

fallites are still currently allowed in

11:57

food content application, but many companies

11:59

have undergone voluntary reductions in this.

12:02

There doesn't appear to be any

12:04

restriction in the use of fallates

12:06

for personal care products. I think

12:08

this is probably where people are

12:10

going to see their greatest exposure

12:12

to them. So I guess I'll

12:14

stop there, Nick, but that's the

12:16

whirlwind tour of what all these

12:18

different compounds are. Do we have

12:20

any idea why it seems like

12:22

we're... Now hearing about microplastics being

12:24

everywhere, it doesn't seem like that

12:26

was always the case. So do

12:28

we know why there's been this

12:30

huge uptick in this? Yeah, I

12:32

think there's two things going on.

12:34

So the first is that obviously

12:36

plastics are relatively new, didn't really

12:38

exist much prior to the 1950s.

12:40

And if you think about it,

12:42

I mean, they were pretty remarkable.

12:44

So incredibly lightweight. remarkable strength to

12:46

weight ratio, resistant to rotting and

12:48

corrosion and shattering. I mean there

12:50

are lots of reasons we use

12:52

plastic. So when you combine the

12:54

fact that they've been increasing in

12:56

their proliferation over the past 70

12:58

years, that would certainly explain why

13:00

we might be seeing more of

13:02

them. But there's also a little

13:04

bit of what it's the expression

13:06

that drunk under the street light

13:08

problem. People are also looking at

13:10

this more and more and more.

13:12

In fact, if you don't mind

13:14

if you could pull up, there's

13:16

a figure we've got that shows

13:18

the number of scientific publications focusing

13:20

on microplastics in the last 20

13:22

years. So if you go back,

13:24

it's showing basically 2000 to 2020.

13:26

It's a linear scale, but it's

13:28

still pretty remarkable. It still looks

13:30

like you're basically watching Bitcoin from

13:32

2010 to 2020. That's effectively. what's

13:35

been going on. So I don't

13:37

doubt that there are more and

13:39

more microplastics accumulating in the environment.

13:41

That's likely, but we can't lose

13:43

sight of the fact that we're

13:45

also looking for it nonstop. So

13:47

one of the questions that I

13:49

didn't come up with a satisfactory...

13:51

answer to was, if you just

13:53

look at the last five years,

13:55

are we seeing a true increase?

13:57

I wouldn't doubt that there's more

13:59

2020 versus 1980. That strikes me

14:01

as, hey, over that 40-year period,

14:03

I could really see it going

14:05

up. But 2020 to 2025, is

14:07

that a real increase? Or is

14:09

that an artifact of observation? You

14:11

touched on a teeny bit when

14:13

you were kind of going over

14:15

the definitions, but I think it'd

14:17

be helpful to just dive into

14:19

it a little deeper, which is...

14:21

How are humans being exposed to

14:23

microplastics currently? We should always be

14:25

thinking about this through the lens

14:27

of relevant versus not so relevant

14:29

exposure. But again, we're going to

14:31

always try to focus on a

14:33

relevant exposure, which is an exposure

14:35

that has the potential to accumulate.

14:37

So the most common route of

14:39

human exposure is from inhaling plastic

14:41

dust and fibers and from consuming

14:43

food and beverages that contain... these

14:45

micro nano plastics. And again, that's

14:47

why I prefer to talk about

14:49

NMPs rather than just micro plastics.

14:51

Why? Because my concern about consuming

14:53

a five millimeter piece of plastic

14:55

is nil, because it can't be

14:57

absorbed. It's going to come right

14:59

out my body the next day.

15:01

This is not the thing that

15:03

we need to be afraid of.

15:05

So what are the foods and

15:07

beverages we need to be concerned

15:09

with? The highest places we tend

15:12

to see these are in seafood,

15:14

salts. water, both tap water and

15:16

bottled water, but also in fruits,

15:18

vegetables, meats, even beverages like milk,

15:20

beer and wine, which obviously contain

15:22

water as well. Nanoplastics in soil

15:24

can accumulate within plants, and obviously

15:26

the exposure gets magnified as you

15:28

go up the food chain. This

15:30

again explains why we would see

15:32

it in seafood, given that we

15:34

understand the role of plastics in

15:36

the oceans. And that's why obviously

15:38

you can see seafood and land

15:40

animals accumulating these as well. The

15:42

epithelial barrier is the first line

15:44

of defense. Remember there's an epithelial

15:46

layer on the outside of your

15:48

body. that we can see, but

15:50

there's also an epithelial layer on

15:52

the inside of your body. Everything

15:54

between your mouth and your anis

15:56

is also an epithelial layer, and

15:58

that's why generally micronanaparticles don't enter

16:00

the body through the skin or

16:02

through the gut, unless they are

16:04

small enough. We've already talked about

16:06

it. The pulmonary epithelium requires them

16:08

to be smaller than 2.5 microns,

16:10

and in the lining of the

16:12

gut, it could probably be as

16:14

big as... 150 microns to be

16:16

absorbed. Do we know how much

16:18

plastic humans actually consume? And is

16:20

it even knowable? You often hear

16:22

numbers thrown around a lot. Curious

16:24

what we know on that. It's

16:26

difficult to know, but I think

16:28

we can probably put some brackets

16:30

around it. So first, there's a

16:32

huge amount of variability based on

16:34

a lot of factors. So where

16:36

you live, what type of food

16:38

you eat. and what your source

16:40

of drinking water is would probably

16:42

be the three biggest determinants of

16:44

your exposure to MFPs. That's worth

16:46

noting again, and I think it's

16:48

worth stating. Your geography, your source

16:51

of food, your source of water,

16:53

plays the biggest role. If you

16:55

aggregate the data from all of

16:57

the studies, it would suggest that

16:59

humans are consuming, and this is

17:01

a broad range, so that's just

17:03

unfortunately the nature of this stuff.

17:05

somewhere between 10 and 300 micrograms

17:07

a week. This is 10 to

17:09

300 thousandths of a gram per

17:11

week. Now, a study that was

17:13

published in 2021 estimated that on

17:15

average we consume about four micrograms

17:17

per week from fish and other

17:19

sea things like crustaceans, mollusks, tap

17:21

water, bottled water, bottled water, The

17:23

study simulated the expected exposure to

17:25

amounts that agreed with measured quantities

17:27

in microplastics and stool. So I

17:29

think this is... probably

17:31

an underestimate given

17:33

that it didn't

17:35

look at some

17:37

of the other

17:39

areas that have

17:41

already been found

17:43

to contain some

17:45

MMPs such as

17:47

fruits, meat, vegetables,

17:49

potentially plastic off -cutting

17:51

boards, utensils, plastics

17:53

that may come

17:55

from things we'll

17:57

talk about like

17:59

reheating food and

18:01

things like that.

18:03

The point is

18:05

that the mass

18:07

of these things

18:09

is pretty small

18:11

and that might

18:13

not be the

18:15

right way to

18:17

think about it

18:19

and we can

18:21

talk about some

18:23

of the misinterpretations

18:25

of that stuff.

18:28

There was a

18:30

recent study published in 2023.

18:32

It was in Korea and it

18:35

estimated that the population was consuming

18:37

somewhere between 140 and 310

18:39

micrograms per week. That's a nice

18:41

narrower band. It also ports

18:43

with largely the upper limit of

18:45

the US -based study as well.

18:48

I think that's probably the ballpark

18:50

of where people are consuming. How

18:53

do those numbers compare to the

18:55

credit card worth of plastic

18:57

that was all over the news?

18:59

I think you couldn't go anywhere without

19:02

seeing that we're eating or consuming a

19:04

credit card worth of plastic a

19:06

week. The numbers that were seen in

19:08

those studies compared to what that

19:10

would be, how do those compare? Not

19:12

even in the same zip code. That

19:15

soundbite that humans consume a credit

19:17

card worth of plastic refers to a

19:19

report that estimated weekly consumption was

19:21

5 grams of MMPs. That has been

19:23

largely debunked, despite what you've said,

19:25

which is the prevalence in popular media.

19:27

I don't remember who famously stated

19:30

that a lie will travel around the

19:32

world or halfway around the world

19:34

before the truth has a chance to

19:36

pull its boots on. I don't

19:38

even need to go into that. We'll

19:40

link in the show notes to

19:43

both the original analysis which came out

19:45

of the University of Newcastle, commissioned

19:47

by the WWF, was

19:50

released I think in 2019,

19:52

and then obviously the rebuttals

19:54

to that. But yeah, the long

19:56

and short of it is, I don't think

19:58

any serious person believes that we're consuming 5. grams

20:00

of plastic a week. Based on

20:02

what we consume what do we

20:04

know about how they're eliminated from

20:06

our body? The main way that

20:09

these things are eliminated is largely

20:11

through coughing and sneezing them out.

20:13

So anything that's coming into our

20:15

lungs we can get it out

20:17

by a cough or a sneeze

20:19

as well as urine and stool.

20:22

So the largest particles, those that

20:24

are greater than 10 microns, will

20:26

generally be removed. with relatively high

20:28

efficiency, regardless of how they enter

20:30

the body. It's really the smaller

20:32

particles that are eventually going to

20:34

make their way to the immune

20:37

system. If you were going to

20:39

do a mass balance on this

20:41

stuff, the majority to the tune

20:43

of 99% of ingested microplastics are

20:45

going to be eliminated through stool.

20:47

And this is a relatively short

20:50

transit time. We're talking about 24

20:52

to 72 hours. Plastics have a

20:54

very difficult time crossing the GI

20:56

epithelium. So when you look at

20:58

animal studies, we would see that

21:00

it's about 0.3% maybe with a

21:02

ceiling of about 1.7% of microplastics

21:05

have the capacity to be absorbed

21:07

across the GI epithelium. And of

21:09

course it's heavily heavily sized dependent.

21:11

So it's the particles that are

21:13

going to be less than 10

21:15

microns, which remember that's four times

21:17

larger than what is required. to

21:20

get into the lungs. So again,

21:22

just thinking the lung we're anchoring

21:24

to 2.5 microns or less in

21:26

the gut, even though in theory

21:28

the gut could absorb something close

21:30

to maybe 100, I think that's

21:33

more theoretical and in practical terms

21:35

we tend to see it as

21:37

10 micron or four times that

21:39

size. So the bottom line is

21:41

this, if you're encountering a microplastic

21:43

that's less than 2.5 microns, you

21:45

could absorb it both in your

21:48

gut or via your lungs. Now,

21:50

when we go through this type

21:52

of analysis in urine, we again

21:54

see that we also excrete microplastics

21:56

through the urine, but this is

21:58

less than what we do through

22:01

the gut. For the things that are

22:03

not eliminated, where do they end up

22:05

and why are there growing concerns about

22:07

that? So this is really the crux

22:10

of what's going on. Thank you for

22:12

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