According to the CDC, between 1980 and 2014, the number of people diagnosed with diabetes increased fourfold, from 5.5 million to 22 million. A recent analysis found that nearly 35% of adults and 50% of people over the age of 60 had metabolic syndrome.1

Metabolic Syndrome is a clustering of at least three of the five following medical conditions: abdominal obesity, elevated blood pressure, elevated fasting plasma glucose, high serum triglycerides, and low high-density lipoprotein levels. Clearly, poor eating and sedentary lifestyles play a role in this shocking rise, but environmental aspects are also implicated.

Recent evidence indicates that environmental exposure to toxins may be contributing to the rise in metabolic dysregulation. One newly identified culprit may be phthalates, the ubiquitous chemicals found in food packaging, toys, perfumes, vinyl floors, and personal care products. These endocrine disruptors have a number of physiological effects, even though their half-life is relatively short. Most people come into contact with phthalates daily and thus have high levels of cumulative exposure over time.In one study using the National Health and Nutrition Examination Survey (NHANES) data, 80% of participants had detectable levels of phthalate metabolites in their urine.2 For adults in the study, increased levels of phthalate metabolites were correlated with increased obesity, waist circumference, and BMI.2 Now, a new study has found that increased levels of phthalate metabolites correlated with increased odds of metabolic syndrome, even after controlling for several lifestyle and demographic factors (age, sex, race/ethnicity, total caloric intake, education, physical activity, smoking, and poverty level).3 Sex differences were observed, where different phthalate metabolites were associated with increased risk for men (DEHP) and for pre-menopausal women (MBzP).3Research into the effects of low-dose, long-term, cumulative exposure to toxicants is still an emerging field, hampered by practical limitations.4 In one analysis of 85 common chemicals, 59% were found to have low-dose effects that could cumulatively lead to metabolic dysregulation and/or cancer.5Environmental factors like sunlight, radiation, temperature, and infectious disease can also alter the toxicity of various compounds.6 Genetic variations enhance or inhibit an individual’s ability to process and eliminate toxins, and nutrition and lifestyle can improve or detract from natural detoxification capability. A range of endocrine-disrupting chemicals have been linked to type 2 diabetes, and the cumulative ‘cocktail’ effect of daily exposure to many endocrine disruptors may be raising risks of cardiometabolic issues higher than currently estimated.7Methods for assessing cumulative toxic burden may offer insights into how to reverse and prevent toxicant-mediated illness.8 Assessing environmental factors like toxicants and helping patients to reduce their exposure has enormous potential in preventing and reversing metabolic syndrome and diabetes..9


  1. Aguilar M, Bhuket T, Torres S, Liu B, Wong RJ. Prevalence of the metabolic syndrome in the United States, 2003-2012. JAMA. 2015;313(19):1973-74. doi:10.1001/jama.2015.4260.
  2. Hatch EE, Nelson JW, Qureshi MM, et al. Association of urinary phthalate metabolite concentrations with body mass index and waist circumference: a cross-sectional study of NHANES data, 1999–2002. Environ Health. 2008;7:27. doi:10.1186/1476-069X-7-27.
  3. James-Todd TM, Huang T, Seely EW, Saxena AR. The association between phthalates and metabolic syndrome: the National Health and Nutrition Examination Survey 2001–2010. Environ Health. 2016;15:52. doi:10.1186/s12940-016-0136-x.
  4. Robey RB, Weisz J, Kuemmerle NB, et al. Metabolic reprogramming and dysregulated metabolism: cause, consequence and/or enabler of environmental carcinogenesis? Carcinogenesis. 2015;36(Suppl 1):S203-31. doi:10.1093/carcin/bgv037.
  5. Goodson WH, Lowe L, Carpenter DO, et al. Assessing the carcinogenic potential of low-dose exposures to chemical mixtures in the environment: the challenge ahead. Carcinogenesis. 2015;36(Suppl 1):S254-96. doi:10.1093/carcin/bgv039.
  6. Rider CV, Boekelheide K, Catlin N, et al. Cumulative risk: toxicity and interactions of physical and chemical stressors. Toxicol Sci. 2014;137(1):3-11. doi:10.1093/toxsci/kft228.
  7. Song Y, Chou EL, Baecker A, et al. Endocrine-disrupting chemicals, risk of type 2 diabetes, and diabetes-related metabolic traits: a systematic review and meta-analysis. J Diabetes. 2016;8(4):516-32. doi:10.1111/1753-0407.12325.
  8. Sarigiannis DA, Hansen U. Considering the cumulative risk of mixtures of chemicals – a challenge for policy makers. Environ Health. 2012;11(Suppl 1):S18. doi:10.1186/1476-069X-11-S1-S18.
  9. Bijlsma N, Cohen MM. Environmental chemical assessment in clinical practice: unveiling the elephant in the room. Tchounwou PB, ed. Int J Environ Res Public Health. 2016;13(2):181. doi:10.3390/ijerph13020181.