As a cause of human illness?
“Doctor, what do you know about the risks of using antiperspirant?” asked my 26-week pregnant patient, “Should I be worried?”
Feeling pretty uninformed, I told her, “if it makes you feel better, switch to a natural deodorant instead”.
I also told her she just gave me my next homework assignment.
Aluminum basics. ~
Aluminum is the most common element in the earth’s crust and third most common element in nature. Because it is so reactive, aluminum is primarily bound to other elements. (Verstraeten et al, 2008).
What are the health risks of aluminum? ~
In humans, there is no known physiologic need for aluminum but it can be absorbed from the GI tract, the mucosa, and across the skin (the concern with antiperspirants). In individuals who have normal kidney function, the aluminum absorbed is removed. When the kidneys don’t function well the aluminum can accumulate. It then competes with other essential elements we do need, such as magnesium, calcium, and iron (Bernardo, 2010). Therefore, its negative effects have to do with displacing these important elements, resulting in effects seen in the central nervous system, bone, and skeletal muscle.
How much aluminum do we actually absorb from antiperspirants? ~
If you look at the back of any antiperspirant, an aluminum-based compound is the main/active ingredient. The maximum aluminum compound permitted is 25% of the product, with an average range of 10-25% (FDA, 2009). This ingredient functions to clog the sweat glands to reduce the amount of sweating that occurs.
Based on a small radioactive isotope tagging study, we absorb very little through the skin. In this study, 84 mg of labeled Aluminum chlorohydrate (ACH), the active ingredient in many antiperspirants, was applied to a single underarm of two adult subjects with blood and urine samples being collected over 7 weeks. They also did skin cell collection for the first 6 days. They found only 0.012% of the applied aluminum was absorbed through the skin. At this rate, about 4 micrograms of aluminum is absorbed from a single use on both underarms. This is about 2.5% of the aluminum absorbed on average by the gut in food over the same time period. Therefore, they concluded that a single use of ACH applied to the skin does not appear a significant contribution to the body burden of aluminum (Flarend et al, 2001). However, there study only included two individuals and each person may absorb and eliminate differing amounts of aluminum as demonstrated by another case report.
In this case report a 43-year-old woman applied around 1-gram of an aluminum chlorohydrate-containing cream on each underarm daily for four years providing circumstantial evidence of potential harm. After experiencing bone pain and fatigue without another found cause, she discontinued her antiperspirant. A couple months later the aluminum levels in her blood plasma and urine had decreased and at eight months her symptoms resolved. The authors of this study suggest that, “although individual variations in aluminum absorption are likely, one should apply aluminum containing antiperspirants with caution” (Guillard et al, 2004).
Aluminums effect in humans. ~
As mentioned before, the main risks of elevated aluminum levels are that they displace similarly sized elements that have physiologic purpose in our bodies, but can it cause some of our familiar diseases?
There are a number of discussions going on about the potential influence of aluminum on Parkinson and Alzheimer’s, as it has been shown to cross the blood-brain barrier, and in Breast cancer, due to absorption near the breast tissue.
An example often cited to refute aluminum as a cause of these disease, is that individuals on dialysis have higher levels of aluminum [when compared to those with normal functioning kidneys] and they don’t have any higher risk of developing these diseases (Brown et al, 2008). There is concern, however, that when the digestive tract is bypassed there may be a higher risk of accumulation.
Does aluminum cause Parkinson’s? ~
The link between these diseases and aluminum come from many different conflicting studies.
For instance, people who live in areas with high aluminum concentration in the water have been found to have higher rates of Parkinson’s (Muhlenberg, 1998). High aluminum concentrations have also been found in post-mortem brain specimens of patients with Parkinson’s and there is suggestion from animal models where aluminum administration caused a decrease in dopamine content, that via this mechanism it may influence development of the disease. (Bolt & Hengstler, 2008) However, simply because there is a presence and at supra-physiologic doses causes harm, does not indicate it is the cause.
Does aluminum cause Alzheimer’s? ~
Aluminums suspect involvement in the development of Alzheimer’s disease was introduced in the 1960’s (Terry & Pena, 1965 and Klatzo et al, 1965). Since that time, no causal relationship has been established and a link seems more unlikely.
Again, some studies have found higher levels of aluminum in the brains of people with Alzheimer’s (Crapper et al, 1976), but other researchers have found no difference (Trapp et al, 1978). Again, even if present this does not indicate cause and is more likely a secondary effect. No positive association of antiperspirant use with Alzheimer’s disease has been shown (Flaten & Odegard, 1988).
Does aluminum cause Breast Cancer? ~
Some research suggests that aluminum-based compounds have estrogenic properties and can alter DNA replication by increasing the rate of errors during replication (Darbre, 2005). Therefore, it was concluded that aluminum in antiperspirants may influence the development of breast cancer given its proximity to breast tissue (Fakri et al, 2006).
Two studies, one in 2002 and another in 2006 interviewed women with or without breast cancer and evaluated their use of antiperspirants and shaving practices. These studies found no difference between the groups (Fakri et al 2006, Mirick et al 2002). While these two studies found no apparent link, a study in 2003 seemed to suggest earlier diagnosis of breast cancer in women who shaved and used antiperspirants. This effect was especially noted in women who started younger than 16 years of age (McGrath, 2003).
So, while there have been a number of studies examining this question, overall the research seems to suggest a potential for earlier development of breast cancer, potentially in women who are susceptible to breast cancer, but not necessarily the cause of the breast cancer.
What will I tell my patient? ~
The risks are not fully supported. In fact, it is likely there are multiple factors contributing to the development of these human illnesses. There is definitely a risk of aluminum toxicity due to displacement of other elements; however, the amount absorbed via the skin is so miniscule it would require excessive application of aluminum antiperspirants and a poor functioning renal system for toxicity to occur.
For both Parkinson’s and Alzheimer’s, it seems that aluminum is most likely a secondary findings and not the cause of the disease.
In women who are susceptible to the development of estrogen-positive breast cancer, anything that has an estrogen-stimulating effect may lead to earlier development of the disease. As mentioned in an earlier post about parabens, the cumulative effect of estrogenic like substances in our environment may lead to earlier development, but are in all probability not the only cause. Other risk factors such as genetics, hormone replacement therapy, and long-standing obesity are greater contributors to risk.
So, what will I tell my patient who is pregnant about risks to the fetus? Since aluminum has been shown to cross the blood-brain barrier by hijacking the iron transport system, it is also the case that aluminum could use the same mechanism to travel across the placenta to the developing fetus and displace essential elements during growth. If the cumulative amount is significant enough, this could make a difference during critical periods of time. From antiperspirants alone though, the amount one would have to absorb is so great that this is highly unlikely to have any influence on development.
As with all things, there is a risk/benefit analysis that has to take place. Based on available research, the risk from the aluminum in antiperspirants appears so low in general that even during pregnancy, if you perspire heavily and need an antiperspirant, don’t hesitate to use it. However, if a natural deodorant will suffice and it makes one feel better about limiting their aluminum exposure, then switch to that on lower activity days.
The amount of aluminum through other sources such as drinking water and aluminum pots and pans through the gastrointestinal tract is significantly greater and generally one can rid this if they have well-functioning kidneys. However, that is for another blog post.
As for this patient, I have a feeling the next question coming from her will be…do you think aluminum antiperspirant is safe to use during breastfeeding?
Hmmmm, while I now know potential risks and absorption amount have to review amount in breast milk and newborn’s ability to eliminate aluminum. I’ll be getting back to this question, off to review the research!
Bernardo J (2010). Aluminum toxicity. Medscape Website. Accessed: November 15, 2011 http://emedicine.medscape.com/article/165315-overview
Bolt HM, Hengstler JG (2008). Aluminum and lead toxicity revisited: mechanisms explaining the particular sensitivity of the brain to oxidative damage. Archives of Toxicology; 82(11): 787-8.
Brown RO, Morgan LM, Bhattacharya SK, Johnson PL, Minard G, Dickerson RN (2008). Potential aluminum exposure from parenteral nutrition in patients with acute kidney injury. Annals of Pharmacotherapy; 42(10): 1410-5.
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Exley C (2001). Aluminum in antiperspirants: more than just skin deep. Food Chemical Toxicology; 39(2): 163-8.
Fakri S, Al-Azzawi A, Al-Tawil N. (2006). Antiperspirant use as a risk factor for breast cancer in Iraq. Eastern Mediterranean Health Journal; 12(3–4): 478–482.
FDA Website (Last updated 2009). Accessed: December 21, 2011 http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/Over-the-CounterOTCDrugs/StatusofOTCRulemakings/ucm070826.htm#Original
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Flaten, T., and Odegard, M. (1988). Tea, aluminum and Alzheimer’s disease. Chemical Toxicology; 26: 959-960.
Guillard O, Fauconneau B, Olichon D, Dedieu G, Deloncle R (2004). Hyperaluminemia in a woman using an aluminum-containing antiperspirant for 4 years. American Journal of Medicine; 117(12): 969-70.
Klatzo I, Wisniewski H and Streicher E (1965). Experimental production of neurofibrillary pathology: 1. Light microscopic observations. Journal of Neuropathology and Experimental Neurology; 24: 187-99.
McGrath KG. An earlier age of breast cancer diagnosis related to more frequent use of antiperspirants/deodorants and underarm shaving (2003). European Journal of Cancer; 12(6): 479–485.
Mirick DK, Davis S, Thomas DB (2002). Antiperspirant use and the risk of breast cancer. Journal of the National Cancer Institute; 94(20): 1578–1580.
Muhlenberg, W (1990). High aluminum concentrations in well water of southern Lower Saxony sandy soil areas caused by acid precipitation: evaluation from the public health and ecologic viewpoint. Offentliche Gesundheitswesen; 52, 1-8.
Terry R D and Pena C (1965). Experimental production of neurofibrillary pathology: electron microscopy, phosphate histochemistry and electron probe analysis’. Journal of Neuropathology and Experimental Neurology; 24: 200-10.
Trapp G A, Miner G D, Zimmerman R L, Mastri A R, Heston L L (1978). Aluminum levels in brain in Alzheimer’s disease. Biological Psychiatry; 13 (6): 709-18.
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National Parkinson Foundation – http://www.parkinson.org/
Alzheimer’s Society – http://alzheimers.org.uk/site/scripts/documents_info.php?documentID=99
National Cancer Institute (fact sheet) – http://www.cancer.gov/cancertopics/factsheet/Risk/AP-Deo