Enfermos, gordos y pobres

by Leonardo Trasande, Ana Pedrero Verge (Translator)

Hay algo siniestro que acecha en nuestros hogares, se esconde en nuestros lugares de trabajo y contamina el aire que respiramos. Algo que hemos decidido ignorar durante demasiado tiempo. El Dr. Leonardo Trasande nos cuenta cómo nuestros entornos cotidianos están haciendo que estemos más enfermos, más gordos y seamos más pobres.

Con una mezcla de estilo narrativo, labor científica detectivesca y datos concretos acerca de las conexiones entre estas sustancias y las enfermedades, esta obra nos enseña qué podemos hacer para protegernos a nosotros y a nuestras familias a corto plazo, y cómo podemos contribuir a hacer efectivo el cambio que merecemos.

Genres: Health, Nonfiction, Science, Medical, Economics, Self Help

256 pages, Paperback

Published April 7, 2020

Reviews

[Andy · Rating 2 out of 5]

Good title. A few pages of probably reasonable precautionary tips, e.g. don't microwave in plastic. Unfortunately, not much more. The author is a pediatrician and expert on endocrine disruptors, but he doesn't seem to have a book's worth of solid material. He keeps telling dramatic patient anecdotes followed by jargon-laden descriptions of studies, but then the conclusions are variations on "Nobody really knows" for whether the patients' diseases were caused by chemicals. This is much better than lying, but I didn't find it to be good reading.

Oversimplifying, he has a bunch of red flags from animal studies, and some suggestive but weak human studies. And he makes some logic leaps based on physiology. The stuff he recommends seems harmless (albeit expensive) so why not do it if you can afford it, and why not change policy to make it cheaper? OK, but then why not just say it like that?

Nerd addendum...
Overall, there was an opportunity here to explain how we determine causality well enough to justify action even if we can't have perfect certainty. He mentions Austin Bradford Hill, but I was confused by the reference. Trasande seems to be saying that you can't use studies that measure exposure at the time of disease because one of the Hill criteria is that the cause must precede the effect. It's true that the cause must precede the effect, but that doesn't preclude using studies that take place after the effect has manifested (case-control, retrospective cohort, etc.) as long as there's some good reason to assume that the measured risk factor reflects exposure in the past. If you're looking at a chronic disease and the measured exposure only reflects what happened today, then yeah that's not useful, but then why even mention it?

[Lindsey · Rating 2 out of 5]

I think this book gets into the details too much. Lots of different names and studies. Made it laborious to read. I skipped entire sections to get to parts that resonated with me.

[Mike · Rating 5 out of 5]

Here is a book that the country needs to read and understand. I place the author up there with Dr. Lustig as someone trying to point out the health dangers of the everyday things around us. As can be shown, government regulation lags what companies use in food products. With BPA, the companies replaced the material with something just as toxic, but not regulated.

The facts and conclusions in the book are scary. I had to stop half way through and read something else, as I kept looking around the house & thinking of my kids. People can believe they are making the right choices for their health, but without education will be harming their families. I knew some of this, but not the extent to what the studies illustrate.

Essentially it all boils down to a few easy to remember revelations. All plastic is suspect & probably bad. Many are estrogen analogs & will mess up your biology. This includes anything in cans. In the book _Rust_ that author pointed out that BPA was used to line most cans. If "BPA free", it just means BPS is the replacement & just as bad. So nothing in any type of metal can. Really. No plastics around heat. Organic food to keep away from as many pesticides as possible. Businesses want as cheap a container as possible, which is why none of this is good for you & won't be fixed anytime soon.

The author also goes into the statistics & projections of how this costs us as a country. Which is where the title comes from. It really is true that a little effort up front to prevent exposure will have huge benefits later on. The really scary part is that constant exposure to the small group of chemicals listed in the book will cut down the IQ of everyone. Which will make it harder for society to find solutions to a whole heap of problems. The enriching of a few makes us all more stupid.

Things will only change when a segment of the population says enough. BPA in kids bottles is one such example. But the industries will keep such change at bay through lobbying politicians & whispering that all is fine, when it isn't. The only way to protect yourself is reading and learning, then acting. You can't be lazy with your kids future or your own health. I learned a long time ago very few people actually care about your health. No one will sit down and teach you. No white knight is going to make it so you can't harm your family's health through lazy choices. It is up to each of us to cut through the noise & act. I am.

[David · Rating 4 out of 5]

Structure is to review one problem at a time [obesity, testicular cancer, extremely early puberty for girls, low sperm counts and resultant infertility.........], show that it's on the increase, and paint a picture of converging strands of evidence suggesting that at least a contributory cause of the problem could be exposure to environmental endocrine-disrupting compounds.

Usually a data-dense discussion of pesticides, phthalates, etc. seems as if it would be improved by incorporating compelling clinical case studies, but for this book I think he could have actually dropped them. Here's why we have reason to believe pesticides are bad; here's what should be done at macro level IMO; in the meantime, you might want to eat organic produce; here are some initiatives to make doing so more affordable...........is maybe not a scintillating and relatable story, but tossing in "here's a few paragraphs on someone who has the disorder I'm talking about; it may or may not have been causes for them by this exposure" doesn't add much either.

He does cover some success stories [getting lead out of the gasoline, notably], but for the most part it's a scary book in light of the low level of interest in current USA presidential administration for regulation of any kind.

[Angel · Rating 5 out of 5]

This was an excellent read, very short and to the point. I will start using his suggestions today!

[Robin Tobin (On the back porch reading) · Rating 4 out of 5]

Nothing that surprised me. But this was well written.

[blake · Rating 2 out of 5]

He's not wrong, probably. So let me explain my rating.

I came to this book by way of Dr. Rhonda Patrick, who expressed some reservations about the overall tone but in favor of the last section on prevention. (It's about the last 40 of 160 pages, the rest is all footnotes, index, etc.)

I have read many similar "panic" books in the past. Some that I think were right that never got much attention (Women and the Crisis In Sex Hormones springs to mind), and then there are some that had an outsized effect, like Silent Spring, frequently cited by Trasande. But then he'll name drop Rudolf Steiner in the same breath and well...huh. I mean, I'm not against out-of-the-box thinking: I presume we're drastically wrong in what we collectively believe or, you know, things would be a lot better than they are (if that makes sense). But when you pull in a bunch of names with little explanation, I get the sense I'm supposed to know who they are and agree with their ideas. I don't (know them), and if I did, I wouldn't necessarily agree.

The effect here is kind of desultory. I'm not sure how the people you're referencing bear upon the topic at hand—and the topic at hand is overwhelming enough. I docked a star for this.

The topic, as near as I can tell, is the danger of endocrine disrupting chemicals (EDCs) in our environment. We get a scattershot look at the science, with one really significant (and perhaps hard to grasp) point: The effects of some of these chemicals may not scale linearly. A little may hurt more than a lot. Also, a tiny exposure may doom your great-grandchildren.

These early ambiguities—everything is "may", "might" or "could", which is to be expected of an honest book—are punctuated by examples from Trasande's practice which almost certainly aren't. They're used because they're similar to what may, might or could be caused by what he's talking about. I docked a star for this, too. It's a formulaic trope of these kinds of books meant to humanize the issues, as if issues of cancer and fertility and pediatric illness needed any extra humanizing.

Trasande's big on regulation early on in the book. And he frequently cites industry-backed studies with a tone of "these are suspicious". Suspicion is good. Then he goes on to cite, admiringly, how they're using tactics the IPCC is using to bolster the climate change case. But of course the IPCC knows how all its tests are supposed to come out in advance. He cites The Lancet, which published the link between MMR and autism. It really doesn't matter whether you believe there's a link between MMR and autisim or not: Either way, they published, then retracted—they were (or are) wrong. And that's just one of many non-reproducible studies.

What I'm getting at is that the imprimatur of industry no more (and no less) taints results than the imprimatur of any establishment organization, even if it styles itself "non-profit". And regulation is a severe danger here: Consider that, per Trasande, a lot of us may have had our first major exposure to EDCs from fire-retardant chemicals in pajamas mandated by the state of California.

I had to dock a star for this kind of "We've got to regulate!" You get the absurdity of BPA being banned for some uses, only to be replaced by chemical dopplegangers BPF, BPS and so on. There's a potentially harmless, mildly more expensive chemical used for the same purpose (to minimize bacterial growth on the inside of cans, I believe is the purpose), but maybe it's not harmless and maybe corporations will fight to save 2 cents on a can of soda, rather than just jacking up the price a nickel.

By the end, he expresses the (IMO) correct idea that education is the best weapon here. But it's hard to educate when you don't know yourself what's going on. And yes, you'll have to fight a lot of disinformation, though I don't think it's as bad as it is in areas like vaccines and climate change because there isn't nearly as much money involved, and even the evil corporations would prefer to have a product they can sell without killing their customers or being sued by them.

The monetary breakdown to me was odd and seemed to be aimed at...I dunno, policymakers? I don't care if it saves (or costs!) $100 billion, if it means I don't get cancer and my kids can have healthy kids. But I guess that's a thing for...someone.

The statistics felt dubious to me, as well. At one point, when he brings in air pollution, he talks about the dangers of coal burning. Well, great, there's a risk that's known and mitigable (by improving the handling of the waste) versus a less measurable "how many people will die from heat/cold because power's too expensive?" which doesn't get a mention. There are always unseen costs—and Trasande does not always factor those in, preferring large-scale "it costs us $X billion" versus "this will increase the cost to you by ¢Y". (More on individual versus group impacts later.)

I'm out of stars to dock, but the prevention stuff was disappointing. Yeah, you can eat organic food, you can eliminate your exposure to certain chemicals, you can change your whole life (and spend a lot more money, regardless of the idea that "it's getting cheaper because Amazon bought Whole Foods") and you still may not actually get it right. One of the examples used made the situation worse because one item used to wean them off their plastic lifestyle was actually highly tainted.

Oy. I think this review is getting longer than the source material.

This book reminds me a bit of Dr. Hulda Clark's Cure For All Diseases/Cancers/etc, in that you can't help but come away feeling under constant assault by the environment. (Dr. Clark was convinced that it wasn't just chemicals but also microorganisms, and the unholy mixture of the two, that were source of our woes.) But she had designed a testing device you could build yourself on the cheap, so at least you knew if you were doing the right thing (by her theory).

Dr. Clark, of course, was considered a quack but it's interesting how many of her ideas a resurfacing 30 years later under more "establishment" umbrellas.

Point is, the book leaves you with a bunch of rituals that may or may not work. You might find they produce a dramatic change in you, in which case God bless. I used Dr. Clark's "zapper" to cure my allergies. (Might've been a complete placebo effect but you know what? I don't have any allergies so I don't care.) Maybe you cut down your exposure to all the bad plastics and you don't need your BP medicine any more, or maybe nothing changes, and you don't know if it's because nothing was wrong in the first place or you didn't actually do what you thought you did.

If the book had focused more tightly on what an individual could do, and how to know whether or not he'd done it, and what the positive impacts should be, it would've been a lot more useful—and I think it would have been more powerful, because a group of people who had personally experienced health improvements would be a lot more effective in mobilizing against these things.

[Samsara · Rating 3 out of 5]

This is about endocrine disruptors. Leafed through it. Too much fuming. I understand the frustration facing bureaucrats and big bad corp, but I want more science less politics.

Actionable Items:
1. Eat organic to avoid pesticides.
2. No canned food to because can's lining contains phthalates and BPA
3. Try to avoid your food contacting any plastic, from shop, food prep, eat and storage
4. Cosmetics, nail polish, hair sprays, deodorants frequently contains phthalate.
5. Open windows to reduce concentration of flame-retardant chemicals
6. Wet mop the floor to remove conotaminated dust
7. Take enough iodine

[Bill Ward · Rating 5 out of 5]

A frightening book to read. Packed with details and research support. Dr. Trasande is a true champion of wellness and he needs our support and greater visibility. His research into the detrimental impact of chemical additives in our food is among the most important and urgent stories of our time. And government and industry cannot be counted on to take appropriate action to guard our health. Please read this and spread the word and take the recommended actions to minimize your own exposure to these dangerous chemicals.

[Joyce Johansen · Rating 5 out of 5]

Eye opener!

An honest presentation of facts; does not lecture and points out opposing opinions as well as the author’s and lets the reader draw their own conclusions. Technical data but presented in a reader friendly and understandable format. Reminds us we must look at this topic from both sides. Well done!

[Nan Williams · Rating 3 out of 5]

A lot of good information about the effects plastics are having on our lives.
IMHO I think he severely limited the information he was exposing and did not follow through adequately in his section on what we can do to curb the problem.

[Joe · Rating 4 out of 5]

Lots of science and data heavy but good Ingo

[Tim Hand · Rating 4 out of 5]

I found this to be a concise and well written introduction into some of the health consequences of Endocrinol disruptors, and how the science should be guiding public policy discourse.

The cost-benefit analyses illustrate staggering public economic costs for relatively small private productivity gains. That's without considering the welfare costs - hard to quantify but equally vast. I would have liked to have seen a discussion on how collective action problems influence policy decisions. Without that it's hard to understand how policymakers could have gotten things so wrong, and thence easy to default to the view they have gotten things right.

I would have also liked there to be some discussion on how EDC-derived inflammation can drive an immune system response, in turn causing cause behavioural changes, depression and other forms of 'mental' illness. The rapidly developing field of immuno-psychiatry sheds light on the biochemical processes in play. Hard to have a serious discussion about the true economic costs without considering this.

Too controversial? Maybe for the sequel.

[Samantha Parkes · Rating 5 out of 5]

Just finished _Sicker, Fatter, Poorer: The Urgent Threat of Hormone-Disrupting Chemicals To Our Health And Future…And What We Can Do About It_ by Leonardo Trasande, M.D., M.P.P. In this short, eye-opening text, Trasande warns of the dangers of endocrine-disrupting chemicals or EDCs. ECDs are found in plastics, flame-retardant and construction materials, pesticides, and even thermal paper receipts. They can contribute to diabetes, cancer, and fertility issues such as low sperm count and PCOS. They can also lower IQs which has proven to lead to lower wage earning over a lifetime—creating less productive and poorer populations. Although I wish I had listened to it for the pronunciation of all the chemical compounds he discusses, I appreciated how digestible the science was, the advice on how to reduce our contact with said chemicals. He notes that public policy has made great strides in protecting the public from ECDs, but has also come up against roadblocks during the Trump administration. I’ll be asking Santa for some glass Tupperware this year, getting my receipts emailed, and buying organic as much as I can.

[Joy_S · Rating 4 out of 5]

Well-written, accessible book about an important issue that more people should learn about. So many of the chemicals we are exposed to, without our even realizing we're being exposed, can cause so much harm not only to our health but to our children's health. All in the name of cheaper production costs and more profit for corporations. Endocrine-disrupting chemicals are everywhere, so it's unlikely you could avoid them entirely, but learning about them and what you CAN do is important, so I highly recommend this book.

[Eleri · Rating 5 out of 5]

Food for thought. Solid medical conclusions not internet pseudoscience. Every parent should have access to the information contained in this book. Look up the Endocrine Society on the web for further information. They have a. Education section with videos. One day this will be widely accepted medical knowledge and we will look back on the intentional choice of profits over our health and environment and we will wonder why. Thank you for writing this important book.

[Ginger Hudock · Rating 3 out of 5]

Rightly supports reducing chemicals but supports vaccine

The author is a pediatrician and. extols the virtues of vaccines in the very first paragraphs. This made me distrust this book. Chemicals in our foods and environment HAVE lead to many health problems, but so have the many multiplied vaccines given to our kids. See the Children’s Health Defense for a better analysis.

[Paul Bard · Rating 4 out of 5]

Use stainless steel and glass
Buy organic especially for the toxic food that absorb toxins - strawberries apples cherries celery spinach grapes pears potatoes nectarines peaches tomatoes peppers
Prepare meals at home and bring to work.
Avoid canned foods
Don’t reuse single use plastic
Never microwave plastic
Throw out scratched plastic.
Wear natural fibres
Vacuum with a hepa filter
Inoculate with seaweed iodine
Avoid fast foods

[Lauren Horan · Rating 3 out of 5]

this book gives a lot of insight on how chemicals in our daily lives affect our hormones and those of generations to come. filled with stories and scientific studies, but also provides a few tips on steps to take in every day life (ex: limit bpa use)

[Jackie Hamre · Rating 1 out of 5]

If you don’t know about the slow poisoning of humanity then this would be a good place to start. However if you’re advanced in your knowledge and looking for more in-depth information and case studies, this is not for you. It fell very flat and seemed outdated. 99% of this information is old news.

[Miranda · Rating 4 out of 5]

A bit nerdy at times, but overall gave a lot of insightful info. Both the animal & human studies included were interesting. While the author did leave quite a few topics with the feeling of “we don’t really know”, he definitely planted seeds that make you think and question.

[Kristi Michael · Rating 3 out of 5]

Read this for a new class prep but I’m still counting it towards my reading goals for 2025 lol!

I was already aware of a lot of the information in this book but it was nice to hear data and research to back it up!

[Mills College Library]

362.1964 T775 2019

[Angie · Rating 3 out of 5]

Very practical. Somewhat alarming. Easy to read. Written for the layperson. Contains many references.

[Donald · Rating 3 out of 5]

Hood ideas but presented as well as they could be.

[Kai Charles(Fiction State Of Mind) · Rating 4 out of 5]

lots of great information, a lot of it really scary but I've made some positive changes since reading it.

[Holly Shippey · Rating 4 out of 5]

It is hard to say I really liked a book that is basically frightening and depressing. Very educational.

[Jocelyn (jocelyn.reads.books) · Rating 4 out of 5]

A must read for the world we live in!

[Joyce · Rating 4 out of 5]

There is something for everyone in this book and very eye opening regarding multi-generational effects of chemicals we take for granted. A little dry but worthwhile.

[Erica · Rating 3 out of 5]

There's good info in here, but it's a tad too overblown in tone (not in the science, as I can evaluate), and a tad too opaque in prose for easy reading.