Part II of my summary of this book. See part I here.  

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Brunson+Sterling Gentleman’s Cream was set up by James Hamblin to demonstrate the unregulated nature of skin care business. All rights are reserved by James Hamblin.

DETOXIFY:

James Hamblin set out to create a skin care comapmny (against the advice of his girlfriend) after he learned about the process firsthand through skin care entrepreneurs who had little or no prior knowledge or experience. He decided on the tag line “Brunson+Sterling: Menscare for Fucking Perfect Skin.” He contacted his friend, a designer to create a logo for the company, and to help with a budget for website and Instagram advertising.

Dr. Hamblin used his address to register the Food and Drug Adminstration (FDA) as a new vendor, without having to specify “what’s in the product, or provide any evidence that it was safe, or that it had any effects at all.” When he finally decided on a recipe, he went to Whole Foods, and bought an assortment of trendy ingredients: jojoba oil, vitamin C, collagen, acacia fiber (a prebiotic), turmeric, shea butter, honey, coconut oil. He made the mixture and packed them into two-ounce Amazon brown glass jars, and posted the product on Squarespace website. Voila! Brunson+Sterling Gentleman’s Cream was born.

While pricing the cream at $200, Hamblin decided to make no claims about what it does, and not to try it on himself or anybody he knew. He listed all of the ingredients because they are “generally recognized as safe” by the FDA. He explained that if the cream was tested and had zero effect, he would have to ethically abandon the project. On the contrary, if it did work and had “antiaging” effects, out of guilty conscience, he would need to put it through safety testing as a drug that possibly effects human genes.

Unlike Hamblin’s careful considerations for his product labels, many skin care companies are increasingly blurring the lines between cosmetics and drugs, with claims promising to “change the structure and function of the skin to make it look better.” Notable cases of harmful cosmetics include the “cleansing conditioner” WEN (advertised as extra gentle) causing a young child to lose her hair in 2014, or Claire’s makeup products (targeted for adolescent girls) containing asbestos, sharp fibers that can cause fatal cancers via inhalation in 2017. Yet, in both cases, FDA does not require the manufacturer to pass on serious complaints or force a company to recall a product.

FDA commissioner Scott Gottlieb reminds the public that “the cosmetics industry is undergoing rapid expansion and innovation” — citing $88.2 billion in sales in 2018, up from $73.3 billion five years earlier — and yet “at the same time, the provisions in the Federal Food, Drug, and Cosmetic Act … have not been updated since it was first enacted in 1938… Right now, when it comes to cosmetics, companies and individuals who market these products in the U.S. hold the responsibility for the safety and labeling of their products. This mean that ultimately a cosmetic manufacturer can decide if they’d like to test their product for safety and register it with the FDA. To be clear, there are currently no legal requirements for any cosmetic manufacturer marketing products to American consumers to test their products for safety.”

Alarmed by the laxed regulation of cosmetics by FDA, Hamblin is convinced his brand Brunson+Sterling will not get into trouble with regulators. He set out to make deodorant with Rachel Winard, the owner of Soapwalla. A classically trained violinist turned a volunteer at Ground Zero, Winard, was diagnosed with lupus shortly after. Under the standard immune-suppressing drugs to treat lupus, her skin became redder and itchier, burning and painful.

She started experimenting with formulation for deodorant. She took a gap year from law school to “reset” in India, where she practiced yoga and became more mindful of what she ate. Winard’s skin cleared up and her immune response went back to normal state.

Returning to New York with a new healthy lifestyle, Winard decided to start selling her deodorant to help others who might have similar sufferings. Through word of mouth and organic blog advertising of the early 2010s, she was able to leave her law firm to run her company full time.

Soapwalla deodorant is a cream that has to be applied by finger. It falls in the domain of “natural” deodorants…Natural deodorants tend not to include the traditional antibiotic compounds long used in stick deodorants, and instead employ essential oils that can mitigate odor… But what really sets the product apart to me is the way it’s sold. The package is inconspicous, and the marketing almost nonexistent… In fact it (Soapwalla) does not feature any humans, ever, out of concern that this would create some idealized conception of who the products are for and what bodies should look like.

Like Soapwalla, the minimalist movement is another alternative in skin care that allow people to pull the plug on the unobtainable standard of beauty. Adina Grigore, founder of S.W Basics, gave up showering after two years of severe acne problem and religious steroid cream treatment. She started her skin care company to encourage people to do almost nothing to their skin. Their best selling products are a rosewate spray (called “rosewater”) and a cream for dry skin (called “cream”).

Once she stripped down her routine, Grigore became especially attuned to the other thing sin life that affected her skin — food and sleep and stress… As she describes the experience, cutting back on products put her in touch with this less talked-about side of skin care: caring for everything inside of one’s skin. What might be called self-care, or simply health.

  MINIMIZE:

Among the people with the lowest rates of asthma and allergies is the Amish community of Pennsylvania and Indiana. Mark Holbreich, an allergist, immunologist and researcher of Indiana University, studied over 100 Amish children in his Indiana clinic. He found that the Amish rates of asthma and allergies was 5%, lower not just by U.S standard but also by Amish heritage — Switzerland’s rates of 7% for farm children, and 11% for nonfarm children.

Further studies were done by Holbreich and colleagues of two genetically similar farming communities, the Amish and the Hutterites. The results were consistent with previous findings, with Amish rates of asthma four times lower compared to the Hutterites.

Amish kids grow up extensively interacting with the farm environment: the animals, the soil, and the airborne sediment and microbes that a farmer inhales... The researchers found that levels of endotoxin in the dust of Amish houses were seven times higher than in the Hutterites homes…The scientists use vacuums to collect house dust from both populations and puffed it into the noses of mice. The mice exposed to Amish dust, compared to those exposed to placebo dust, developed less reactive airways and lower levels of allergy-related cells.

To understand this “complicated relationship between our bodies and microbes,” Dr. Hamblin explains inflammation, the process in which lymphocytes (white blood cells) are accumulated to the site of infection and attack the antigens (“foreign” material). While inflammation can save lives, it can kill us when our lymphocytes starts attacking our own cells, resulting in autoimmune diseases.

Exposure early in life is the key. By three or four years of age, a child’s microbiome is established and the immune system has completed much of its training. Even if a person does not develop an autoimmune condition until later, it seems that the foundation of inflammatory processes is paid in the first few years of life… The indoor air is lacking in the wealth of bacterial particles that used to temper our immune systems. Our diet is hyperprocessed and cleaned and low in fresh fruits and vegetables — which are naturally loaded with bacteria.

David Strachan, an epidemiologist at the London School of Hygiene and Tropical Medicine, proposed that infections in early childhood protect people against allergic disease. He noted that British firstborn children are four times more likely to have allergies compared to fifthborns. As a result, Strachan’s “hygiene hypothesis” suggests that hygiene practices might lead to the observed recent increase of allergic disease in the developed world. As our immune systems are exposed to fewer benign antigens from the modern world, they are more likely to attack our own cells.

To explore this hypothesis further, Dr. Hamblin visited Jack Gilbert, a scientist at Argonne National Laboratory. Gilbert, one of Holbreich’s collaborators on the Amish allergy study, studies microbiome of the skin and bowels. He pointed out that removing microbes from our skins (by showering or excessively cleaning) will open up space for more microbes to inhabit — pathogen included. Gilbert futher explained that pollution such as Beijing smog contains airborne particles in which disease-caring bacteria and fungi grow on. Breathing in these new microbes can cause autoimmune flares.

While antibiotics change human longevity forever, its ubiquituous presence in cleaning products has had an adverse effect on human health. In 1963, Proctor and Gamble introduced Safeguard New Deodorant and Antibacterial Soap, which contained an antibiotic called triclocarban. By the 1970s, studies showed that hexachlorophene (e.g: triclocarban) can be absorbed through the skin and affect the nervous system.

After hexachlorophen products were recalled by the FDA in 1972, soap companies started marketing triclosan, another microbe-killing compound, as “anti-bacterial”. Following decades of washing our hands allows for accumulation of triclosan in water and soil. By 2014, Animal studies showed that triclosan alters hormone signaling, and potentially promote the growth of live tumors. However, by then, “it (triclosan)’s really everywhere in the environment”, said Robert Tukey, a professor of University of California, San Diego. It was not until 2017 that triclosan was removed from the market after the FDA ruled triclosan, hexacholorophene and 17 other ingredients unsafe.

Another problematic ingredient in hygiene products is antimicrobial preservatives, most notably parabens. Since the 1950s, parabens have been used in deodorant, makeup, toothpaste, shampoos and many packaged foods to make them more shelf-stable, and thus more affordable. Decades of exposure from millions of products raises concern of the effects of paraben to our immune systems and microbiomes.

Studies have found links to an increased risk of breast cancer and reproductive toxicity by way of endocrine disruption, since parabens mimic the effects of estrogen… Researchers at the National Institue of Allergy and Infectious Diseases have found that products containing parabens can block the growth of Roseomonas mucosa from healthy skin. This bacteria seems to help improve the skin’s barrier function, and can directly kill the Staph. aureus that proliferates during eczema flares… Parabens could leave people more susceptible to eczema flares.

Other prominent immunologists, such as Graham Rook of University College London, have suggested “biodiversity” hypothesis, in replacement of hygiene hypothesis. The hypothesis emphasizes that many microbes live and evolve with us, and are beneficial to our immune systems. Not only do modern world children live in a sanitized world, the low-fiber diets and antibiotic use have altered our skin and gut microbiota and contributed to the rise of asthma and allergies.

Jenni Lehtimaki and her group at University of Helsinki in Finland have been advocates of skin microbes through their research on environmental effects on allergic symptoms. She is currently working on increasing microbial exposure in our homes and offices. Her study of dogs in Finland found that when a dog was allergic to something in the environment, its owner was more likely to be allergic as well.

Increased exposure to natural environments also seems to have a broader effect on health… A 2018 meta-analysis found statistically significant associations between exposure to green spaces and reduced blood pressure, heart rate, cortisol levels, incidence of type 2 diabetes, and death from cardiovascular disease… Various theories have been offered to explain these findings, including the emotional boost you might get from spending time outside.