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Nutella: good or bad?

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Alkaline Nonsense

DNAIt is so seductively simple.  If you want to avoid cancer, just make sure your body is “alkaline!”  Here is the rationale.  When a cell becomes cancerous it reduces its use of oxygen and cranks up its production of acids.  These conditions then allow such cells to multiply quickly.  To counter this, you have to ensure that cells get an adequate supply of oxygen and that the acids produced are neutralized.  How?  By introducing sources of oxygen such as hydrogen peroxide or ozone into the body and consuming “alkaline” foods.  If cancer has already taken a foothold, then it may be necessary to dose up on cesium, the “most alkaline nutritional mineral.”  So simple, and so wrong!

As so often happens, promoters of nonsensical therapies seize a few filaments of scientific fact and weave these into a tangled web that ensnares the desperate and the scientifically confused.  In this case, it all starts with the work of German physician Otto Warburg who received the 1931 Nobel Prize in medicine for his work on cellular metabolism.  Warburg showed that that the growth of malignant cells requires markedly smaller amounts of oxygen than that of normal cells and that their metabolism follows an “anaerobic” pathway leading to the production of lactic acid.  This notion lay dormant until the 1980’s when Dr. Keith Brewer, a physicist with no medical training, used it to support his perplexing theory of how potassium and calcium control the transport of glucose and oxygen into cells, and how irritation of the cell’s membrane interferes with this transport system.  The result, Brewer maintained, is the “Warburg effect,” which lowers the cell’s pH, reduces its oxygen supply, and causes changes in DNA characteristic of cancer.  He then went on to claim that cesium’s chemically similarity to potassium allows it to be readily taken up by cells, but that unlike potassium, it does not transport glucose into cells while allowing oxygen to enter.  As a result, cancer cells are enriched in oxygen, deprived of glucose, form less lactic acid, become more alkaline, and as a consequence, die.  Sounds good, but Brewer got the “Warburg effect” all wrong.  Cancer cells do shift to a mode of metabolism that doesn’t use oxygen, but this happens even in the presence of oxygen!

Brewer went on to buttress his argument by claiming that cancer is almost unknown among the Hopi Indians of Arizona, the highland Indians of Peru and the Hunza of North Pakistan.  Why?  Because due to the cesium in the soil, they have a “high pH” diet.  Whether these people actually do have a lower cancer rate is questionable, and even if this were the case, it could not be ascribed to cesium in the diet without further investigation.  But then to take the cake (undoubtedly cesium enriched) Brewer in 1984 published a paper with the following claim: “Tests have been carried out on over 30 humans and in each case the tumour masses disappeared.  Also, all pains and effects associated with cancer disappeared within 12 to 36 hours; the more chemotherapy and morphine the patient had taken, the longer the withdrawal period.”  Not only had he discovered the cancer cure that had eluded the thousands of PhDs and MDs working in cancer research around the world, but he also showed that chemotherapy was actually harmful.  Quite a claim!

And just where were these miraculously cured patients, and who had treated them?  Brewer refers to Dr. Hellfried Sartori (aka Prof. Abdul-Haqq Sartori) who had accomplished this incredible feat in the Washington D.C. area.  This is the same Dr. Sartori who in July of 2006 was arrested in Thailand for fraud and practicing medicine without a license.  He was charging desperate patients were up $50,000 for “cancer cures” which included cesium chloride injections.  The good doctor, who routinely promised that he could cure his patients of any disease, has a rather illustrious history.  Known as the notorious “Dr. Ozone” in the U.S. , he served five years in prison in Virginia and nine months in New York for defrauding patients with unapproved therapies such as cesium chloride injections, coffee enemas and ozone flushes.  Needless to say, there are no records of the patients whom, according to Brewer, Sartori cured of cancer.  Australian police are now looking into the deaths of six people who died after intravenous injections of cesium chloride at clinics following Sartori’s protocol.

Introducing ozone or hydrogen peroxide to raise cellular oxygen levels is a scientifically bankrupt idea, as is raising a cell’s pH with cesium chloride.  Of course, it is not the absurdity of the theory that rules out its effectiveness, it is the lack of evidence!  There are no controlled trials showing cancer being cured with ozone or cesium.  But there is evidence that cesium chloride can cause cardiac arrhythmia and death.  Granted, it is unlikely that this can happen from the oral doses being promoted by numerous alternative practitioners aimed at raising the body’s pH, but the idea that cesium chloride can neutralize acids in cells is sheer nonsense.

Yes, cesium is an “alkali” metal.  Dropping a piece of cesium metal into water does indeed produce an alkaline solution (and an explosion).  But cesium chloride is not the same as cesium metal, it is a neutral salt.  In any case, the blood’s pH cannot be altered by cesium chloride ingestion, or indeed with the ingestion of any food.  It is a marvelously buffered system, meaning that it resists any change in acidity.  It doesn’t matter what we eat or drink, our blood contains substances that can act as acids or bases to maintain our blood pH at 7.4.  The only body fluid that responds to diet in terms of pH is the urine.  Breads, cereals, eggs, fish, meat and poultry can make the urine more acidic while most, but not all, fruits and vegetables make the urine more alkaline.  A diet high in fruits and vegetables and low in meat can indeed reduce the risk of cancer, but this has absolutely nothing to do with changing the pH of cancer cells.  The idea of an “alkaline” diet to prevent or treat cancer may sound seductively simple, but in reality it is just simple minded.

Joe Schwarcz PhD

Serious Nonsense

cancer wellness program“We’ve had more people reverse cancer than any institute in the history of health care, so when McGill fails, or Toronto hospitals fail, they come to us. It can be stage 4 cancer and we reverse it.” You can imagine why that quote caught my eye. Both McGill and University of Toronto have world-class cancer treatment centers, but unfortunately, when it comes to stage 4 cancers, which are the most deadly, the chance of successful treatment is low. So, who is it that claims success where the latest evidence-based treatments fail? “Dr.” Brian Clement, who runs the Hippocrates Health Institute in Florida, apparently has the answers that have evaded mainstream researchers. What sort of doctor is this fellow? One who has some sort of accreditation as a “nutritionist” from a diploma mill where they apparently teach some, let us say, “interesting” science. I’m judging by the following rather fascinating outpouring of nonsense-bedecked drivel from the Hippocrates Health Institute.

“Based on modern biophysics and ancient Chinese medicine, color frequencies are applied to acupuncture points using a light pen and crystal rods. This promotes hormonal balance, detoxification, lymph flow and immune support while reducing headaches and sleeplessness. Working on cellular memory where the cause of disease resides, color puncture promotes healing from within.” And all you have to do is shell out $120 for a 50 minute treatment. All this of course is laughable, but when it comes to claims about curing cancer, the humour quickly vanishes with the realization that it is real people with real cancer who are being duped. And going by the following asinine promo, that is just what is happening.

“One of the major treatment goals of The Cancer Wellness Program at Hippocrates Health Institute is to strengthen the basic vitality, flow, and coherency of a person’s BioEnergy Field upstream to affect and change their downstream physical mass. The changes in a person’s vibrational frequency or bioenergy field, once stabilized, changes the electrical/chemical milieu in their body so that it is more difficult for their cancer or tumor mass with its own specific vibrational frequency to be sustained.”.

This is inane claptrap is far from the only type of cancer treatment Hippocrates offers. Intravenous vitamins and wheat grass implants are standard fare. Implanted where? Well, let’s just say in areas where the sun doesn’t shine. Clement maintains that “every disease known to man, plus premature aging, can be successfully dealt with on a diet of organic plant based foods.” Apparently not mental disease, given that Clement surely follows this diet. Patients are also told to give up meat and dairy, and are asked to swallow some rather bizarre ideas. Genetics don’t matter much, Clement says, and what doctors say about the BRCA gene predisposing to breast cancer is false. On his regimen, this mental wizard claims, tens of thousands of people have reversed the final stages of cancer. I would love to see the evidence for that. This charlatan is in Canada right now, giving talks, mostly to entice First Nations people to visit his Institute in Florida for treatment. Just like that given to the unfortunate 11-year-old Ontario girl who suffered from leukemia. That had a very sad outcome. Let’s just say she was not one of the tens of thousands of patients that Clement claims to have successfully treated.

Joe Schwarcz PhD

Chemistry Lesson for The Food Babe…and everyone else #20

vani hariOrganic farmers are allowed to use a number of pesticides as long as they come from a natural source. Pyrethrum, an extract of chrysanthemum flowers, has long been used to control insects. The Environmental Protection Agency in the U.S. classifies it as a likely human carcinogen. There you go then, a “carcinogen” used on organic produce! Does it matter? Of course not. Just because huge doses of a chemical, be it natural or synthetic, cause cancer in test animals, does not mean that trace amounts in humans do the same. Furthermore, pyrethrum biodegrades quickly and residues are trivial. But that is the case for most modern synthetic pesticides as well! And how about rotenone? This compound was discovered in the 1800s in the extracts of the root of the derris plant. Primitive tribes had learned that the ground root spread over water would paralyze fish which then floated to the surface. Rotenone is highly toxic to humans and causes Parkinson’s disease in rats. It has been used by organic farmers to control aphids, thrips, and other insects on fruit although it is being phased out. Residues probably pose little risk to humans, but synthetic pesticides with the same sort of toxicological profile have been vilified.

Organic farmers are also free to spray their crops with spores of the Bacillus thuringiensis (Bt) bacterium which release an insecticidal protein. Yet, organic agriculture opposes the use of crops that are genetically modified to produce the same protein. Isn’t it curious that exposing the crop to the whole genome of the bacterium is perceived to be safe, whereas the production of one specific protein is looked at warily? The truth is that the protein is innocuous to humans, whether it comes from spores sprayed on an organic crop or from genetically modified crops. True, organic produce will have lower levels of pesticide residues but the significance of this is highly debatable.

A far bigger concern than pesticide residues is bacterial contamination, especially by potentially lethal E. coli 0157:H7.  The source is manure used as a fertilizer. Composted manure reduces the risk, but anytime manure is used, as of course is common for organic produce, there is concern. That’s why produce should be thoroughly washed, whether conventional or organic. Insect damage to crops not protected by pesticides often leads to an invasion by fungi. Some fungi, like fusarium, produce compounds which are highly toxic. Two varieties of organic corn meal once had to be withdrawn in Britain because of unacceptable levels of fumonisin, a natural toxin.

Are organic foods more nutritious? Maybe, marginally. When they are not protected by pesticides, crops produce their own chemical weapons. Some of these, various flavonoids, are antioxidants which may contribute to human health. Organic pears and peaches are richer in these compounds and organic tomatoes have more vitamin C and lycopene. But again, this has little practical relevance. When subjects consumed organic tomato puree every day for three weeks, their plasma levels of lycopene and vitamin C were no different from that seen in subjects consuming conventional puree. In any case, we simply are not going to feed 7 billion people organically.

Joe Schwarcz

Hazard and risk

DNAIf you watched the news, read newspapers or surfed the web recently you will have been inundated with pictures of bacon and headlines describing it as carcinogenic. That’s because the International Agency for Research on Cancer (IARC) classified processed meats as being carcinogenic, placing them in the same category as tobacco smoke, asbestos, oral contraceptives, alcohol, sunshine, X-rays, polluted air, and inhaled sand. However, it is critical to understand that the classification is based on hazard as opposed to risk. Hazard can be defined as a potential source of harm or adverse health effect. Risk is the likelihood that exposure to a hazard causes harm or some adverse effect. If a substance is placed in IARC’s Group 1, it means that there is strong evidence that the substance can cause cancer, but it says nothing about how likely it is to do so. That likelihood depends on several factors including innate carcinogenicity, extent of exposure and personal liability. Ultraviolet light, a component of sunlight, is a good example to illustrate the difference between hazard and risk

Light can be thought of as being composed of packets of energy called photons. When a photon impacts a molecule of DNA it can damage it, triggering an irregular multiplication of cells, in other words, cancer. X-rays are also made up of photons, but these are more energetic than the photons of ultraviolet light so they are more likely to damage DNA. Although both sunlight and X-rays are in Group 1, X-rays are clearly more capable of triggering cancer than sunlight. But exposure matters. A single chest X-ray is not a problem but repeated baking in the sun is. More photons of lower energy can have a greater effect than fewer photons of greater energy. Then there is individual liability. A person with dark skin is less at risk for developing cancer than someone with pale skin even at the same ultraviolet light exposure.
Inhaled sand is also listed in Group 1. That’s because studies have shown that workers engaged in occupations that can result in inhaling sand show a significantly increased risk of cancer. But this doesn’t mean that going to the beach and frolicking in the sand is a risky business. Tobacco smoke is also in Group 1because there is no doubt that it causes lung cancer. In fact about ninety percent of all lung cancer cases can be attributed to smoking. Alcohol is also in this category because it is known to increase the risk of oral cancers as well as breast cancer, yet nobody worries about drinking a glass of wine. Listing processed meat in IARC’s Group 1 just says that like alcohol, like tobacco, like sunshine, and some 180 other chemicals, mixtures and exposure circumstances, it is capable of causing cancer. It does not mean that if you have a bacon lettuce and tomato sandwich you are putting yourself at risk.
Let’s clarify what is meant by processed meat. Grinding meat into hamburger does not result in processed meat. But smoking, fermenting or adding chemicals such as salt or nitrites to either extend the product’s shelf life or change its taste does. We’re talking about bacon, sausages, hot dogs, salami, corned beef, beef jerky and ham as well as canned meat and often meat-based sauces.
The evidence that these tasty morsels are linked to cancer comes from observational studies, which of course do not prove cause and effect. But they are quite consistent in demonstrating that populations that consume lots of processed meats have higher cancer rates, particularly colorectal cancer, even when corrections are made for smoking, other foods eaten and activity levels. Furthermore, there are theoretical and experimental foundations for declaring some components found in processed meat, like polycyclic aromatics, heterocyclic amines, nitrites, insulin-like growth factor and heme-iron, carcinogenic.
The evidence is certainly not ironclad, but science rarely is. It comes down to making educated guesses and evaluating the downside of such guesses. There is no significant downside to limiting processed meat, especially if it is replaced by plant products.But the significant question to ask is how much can we reduce our risk of colorectal cancer by robbing our taste buds of the taste of bacon and such? The risk of this cancer in the general population is roughly six in a hundred. After poring through some 800 peer-reviewed publications, IARC estimates that eating 50 grams of processed meat every day over a lifetime increases risk by about 18%. In other words, if a hundred people follow such a regimen over a lifetime, there will be seven cases of colorectal cancer instead of six. So for an individual, the chance of getting colon cancer because of eating processed meats is about 1 in 100. That is a very small risk, but because there may well be millions of people following such a diet, the impact on the population can be significant, in IARC’s estimate, about 34,000 cases a year.

What do we do with this information? A one in a hundred chance is not insignificant and it makes sense to try to reduce it. That means consuming less than 50 grams of processed meat a day on average. To do that we need to keep some numbers in mind. Two to three strips of bacon add up to 50 grams, as do two slices of ham, 4 slices of salami or one hot dog. Remember though that we are talking averages here. Certainly a couple of hot dogs, a salami sandwich and a couple of bacon and egg breakfasts a week is not a great risk. But if you have a smoked meat sandwich, well, you have used up your weekly allotment. But remember that all these numbers are estimates, basically educated guesses, and are not based on hard evidence.

Joe Schwarcz

 

Unexpected consequences are part and parcel of science

 Screen Shot 2014-11-07 at 10.31.47 PMScience is as a quest for knowledge. Sometimes it ends with a clear-cut result, often not. The Earth goes around the sun. Water is composed of hydrogen and oxygen. The speed of light is 299,792,458 meters per second. These are facts and will never change. But knowledge is often fluid, conforming to new information as it comes to light. We no longer think maggots spontaneously arise from decaying flesh or that heart attack patients have to be kept on six weeks bed rest. These beliefs, though, were reasonable based on the knowledge available at the time.

Scientists are sometimes accused of being slipshod, too profit-motivated, or even incompetent for having made a decision that eventually turned sour. The prescribing of thalidomide, the introduction of DDT and the routine use of hormone replacement therapy at menopause are commonly cited as scientific errors, yet these were all backed by appropriate peer-reviewed studies. It often takes years for problems to emerge, and not having foreseen them does not mean that researchers erred or were motivated by interests other than the honest pursuit of science. Of course, when unexpected consequences do occur, it is important to recognize them. Making a change is not an admission of failure, indeed it is one of the hallmarks of science.

When back in the middle of the last century research revealed that cholesterol levels in the blood were associated with a risk for heart disease, it made sense to suggest that eggs, because of their significant cholesterol content, should be consumed in a limited fashion. That, though, was just an educated guess. Science dictates that such a guess be followed up and be properly evaluated. But it can take years of studies to determine if a hypothesis is correct, and such studies, particularly in the are of nutrition, are not easy to carry out. Food frequency questionnaires are notoriously unreliable, and there are all sorts of confounding factors such as genetics, age, weight and other dietary components that have to be taken into account.

Furthermore, no decision can be made based on any single study; a preponderance of evidence is required to arrive at a conclusion. With eggs, sufficient data has now been collected to indicate that their consumption does not have a significant effect on blood cholesterol levels. Indeed, the expert panel in the US that every five years makes dietary guideline recommendations has concluded that “cholesterol is not a nutrient of concern because cholesterol from foods doesn’t cause higher blood cholesterol levels.”

As far as scientific questions go, the effect of eggs on blood cholesterol was a relatively easy one to answer. But this is not always the case. Consider the question of chemicals that are suspected of causing cancer. Obviously people cannot be given suspected carcinogens and in any case, such trials would take decades to reveal an effect. Therefore, “knowledge” emerges from human epidemiological evidence along with studies in animals and cell cultures.

Various organizations classify carcinogens into different categories, with the most widely referenced one being the International Agency for Research on Cancer (IARC). Its Group 1 substances are definitely known to cause cancer based on human evidence and include tobacco, the combustion product benzopyrene, asbestos, benzene, formaldehyde, dioxin and ultraviolet light. Aflatoxins from molds, infection by helicobacter pylori bacteria, herbal remedies containing Aristolochia species, x-rays, occupation as a painter and alcoholic beverages are also on this list.

Group 2A is a compilation of “probable” carcinogens as determined by strong evidence from animal studies but limited human evidence. Lead compounds, acrylamide in baked goods, emissions from frying foods, hairdressing as an occupation, shift work, the herbicide glyphosate and insecticides such as diazinon and malathion are in this category. “Possible” carcinogens for which there is insufficient animal evidence and limited evidence in humans fall into Group 2B and include coffee, pickled vegetables, radiofrequency fields, titanium dioxide and DDT.

Combining all three groups, there are more than 450 substances or processes that are classified as known, probable or possible carcinogens. What do we do with this information? We can limit alcohol consumption, take care with sun exposure, treat helicobacter infection, avoid charred foods and of course shun smoking. As far as the other agents are concerned, sometimes we have to be satisfied with knowing that not everything can be known. Outside of occupational exposure, there just isn’t enough known to make sweeping recommendations. But if you are offered a job as a chimney sweep, don’t take it.

Dr. Joe Schwarcz 

Miracle Mineral Solution is a Nightmare

MMSMalaria, AIDS, hepatitis, herpes, cancer.  Terrible diseases.  That’s why thousands and thousands of scientists around the world, armed with advanced degrees, are engaged in research projects aimed at finding a cure.

Now, ask yourself this question: what is the chance of a gold prospector, with no training in the health sciences, tackling a problem and finding an answer that has eluded the world’s most renowned researchers?  Furthermore, it’s simple to administer, readily available, and to boot, also destroys the H1N1 virus, clears up acne, eliminates heavy metals and cures the common cold.  I can tell you what probability I would attach to this miracle solution performing as claimed.  Let me see now, how does “zero” sound?

There’s nothing subtle about the name of this purported wonder: “Miracle Mineral Solution (MMS)!”  Well, there are no miracles to be had.  Or minerals.  Admittedly, however, there is a solution.  Not a solution to any problem, but a solution in the sense of a substance being dissolved in water.  And that substance is sodium chlorite, a common disinfectant and bleaching agent.  Its chief promoter, Jim Humble, is either a brilliant inventor, a self-delusional scientifically-bewildered simpleton, or a cunning scoundrel.  Take your pick.  I know which box I would tick off.

In a decidedly non-humble fashion, Humble claims that “this breakthrough can save your life, or the life of a loved one.”  He then brags that his discovery is the answer to AIDS, hepatitis A,B and C, malaria, herpes, TB, most cancers and many more of mankind’s worse diseases.”  Of course you may not have heard of this revolutionary treatment because it is being hidden from the public by those devilish pharmaceutical companies whose profits would be destroyed if the word got out about all diseases being cured in such a simple fashion.

Let’s just trace how this visionary, this wonder-worker, this mental colossus, discovered the gift “that would shift the course of human health history forever.”  Incidentally, MMS wasn’t this amazing philanthropist’s first gift to humanity.  That was the automatic garage door opener, which humble Humble supposedly invented although I can’t find any documented evidence for this claim.

In any case, the MMS saga begins in the South American jungle where our hero was prospecting for gold when two of his men fell ill with malaria.  With no prospects for immediate medical help, Humble had to resort to his razor-sharp wits.  Actually, I don’t think there was much chance of any cuts being inflicted.  The sodium chlorite solution he had brought along to disinfect water obviously killed bacteria, our champion thought, maybe it would also destroy whatever was causing the malaria.  So, he gave the men some of the solution and was stunned to see their symptoms vanish in just four hours.  I bet he was!

Now Humble had a new calling, rid the world of malaria.  He started to treat sick South Americans but found that the sodium chlorite solution was only effective 70% of the time.  Not good enough for this dazzling mind!  He began to experiment with his concoction and discovered that when mixed with citric acid, the chlorite would be converted to chlorine dioxide, which turned out to be a superior treatment.  Wow!  Before long, Humble claimed to have registered 75,000 successful treatments of malaria with his miracle product.

Strange, but I can’t find any of these spectacular results documented in the scientific literature.  Wouldn’t you think that the discovery of such a simple cure for malaria would merit publication?  Surely a Nobel Prize would be in the offing!  Ah, I know.  It must be those dastardly jealous scientists, or the evil pharmaceutical companies that are preventing publication.  Yup.  Must be.  As a supporter explains, “Humble had become so famous that two drug companies contacted the Minister of Health (in an unnamed country) and threatened to quit shipping drugs to the local hospitals if she didn’t do something about the person claiming to be able to cure malaria.”  Those fiendish companies!  It’s a wonder they have allowed Humble to live.  Actually.  Maybe they haven’t.   Attempts to contact him repeatedly fail.  I’m told he is “travelling” the world, busily helping people.  Helping them lighten their wallets, I suspect.  If you want to know the details of his discovery, that is “how to manufacture it in your own kitchen, how to use it intravenously, how to cure colds in an hour, how to cure the worst of flu in 12 hours, how to treat cancer, AIDS and hundreds of other problems,” you have to buy his book.

I’m not sure how to describe that epic work, but “comedic” comes to mind.  Discussions about how chlorine dioxide “elongates the electron shell” of pathogens, and how its safety is confirmed by the fact that its “oxidation strength” of 0.95 volts is less than oxygen’s 1.30 volts amount to no more than mindless chemical chatter.  I don’t buy it.  More importantly, Health Canada and the U.S. Food and Drug Administration don’t buy it.  And both urge consumers not to buy any version of Miracle Mineral Supplement.  Not only is there no evidence of efficacy for any condition, there is evidence of possible harm.  Nausea, vomiting, and a life-threatening drop in blood pressure have been reported.  Humble actually maintains that nausea is a good thing because it means the body is eliminating toxins, but if bothered, he suggests it can be controlled “by eating cold apple slices that will absorb stomach toxins that have been dumped there.” Like I said, comedic.  But what is decidedly not comedic is the advice on some MMS websites that AIDS patients give up their drugs and resort to intravenous MMS.

Jim Humble went out looking for gold and it seems that at least figuratively he has found it.  But it is fool’s gold.  MMS is not based on any reasonable science, has not been tested in any sort of randomized trials, and amounts to no more than a scheme to capitalize on the gullibility of the scientifically challenged and the desperate.  Promoting the sale of this product is criminal.

Dr. Joe Schwarcz

Does Hydroquinone Have a Dark Side?

hydroquinoneThey were once mistakenly thought to be caused by a disease of the liver, so they are called “liver spots.” Actually these skin blemishes are caused by a buildup of the skin pigment melanin and are associated with aging and long-term exposure to ultraviolet light. Technically referred to as “Lentigo senilis,” these hyperpigmented spots usually just present a cosmetic problem unless they develop irregular borders and undergo a colour change, in which case they need to be evaluated by a physician. People bothered by such “senile freckles” can look to hydroquinone for help.

When applied as an ingredient in a skin cream, this chemical inhibits the activity of tyrosinase, an enzyme that is necessary for the formation of melanin. This brings up three questions. How well does hydroquinone work, what concentration is needed, and what risks, if any, does its use present? Hydroquinone does work, and its efficacy, as is to be expected, is dose related. Need a minimum of 1% in a cream to see any result, and really significant effects kick in at 4%. In the U.S., hydroquinone is available in over the counter products at concentrations up to 2%, anything more than that requires a prescription. In Europe and in Canada all hydroquinone products require a prescription. Why the difference?

Different regulatory agencies arrive at decisions in different ways. In this case, Europe and Canada look at worst case scenarios while the U.S. evaluates hydroquinone based on its actual use in cosmetics. Rat feeding studies have suggested that hydroquinone may be carcinogenic, although this is contentious. In humans, in rare cases, accidental ingestion of photographic developer fluid containing hydroquinone has resulted in toxic reactions, but in a controlled trial with human volunteers, ingestion of 300-500 mgs daily for months produced no observable effects. As far as topical application goes, no systemic reaction has ever been noted, and no link to skin cancer has ever been found. But there is a chance of skin irritation, especially if sun protection is not used after application, as well as a rarely seen blue discoloration known as “ochronosis.” With higher concentrations there is the possibility of losing too much pigment resulting in white spots. It is mainly for the latter reasons, and some concern that hydroquinone has not been studied with enough rigour, that Canada and Europe are concerned about over-the-counter availability.

But aside from hydroquinone products that have been adulterated with mercury compounds, which has happened in Africa, no significant problems with 2% solutions have cropped up. Hydroquinone also occurs in nature, found in the bearberry, madder and mulberry plants, extracts of which are touted as “natural skin lightening agents.” These do work, but whatever issues arise with hydroquinone apply to these preparations as well. The fact that the hydroquinone comes from a natural source is irrelevant. Basically, 2% hydroquinone preparations, no matter what the source, can reduce age spots effectively and the alarm sounded by some activist organizations about such products is not backed up by evidence.

 

Joe Schwarcz

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