Did you know the air quality in your car may be worse than outside?

Research in London conducted by Enviro Technology Services using the Air Quality Monitoring vehicle –also known as the ‘smogmobile’, has shown that NO2 was on average 21% higher inside vehicles than outside. Dr. Ben Barratt, air quality researcher at Kings College in London, mentioned that these research findings add to the already existing evidence that vehicles do not protect against air pollution. In fact, he called on the need to better understand the health effects of this high pollution exposure for those who spend vast amounts of time in a car, such as taxi and bus drivers. Another recent research by El-Fadel M and Abi-Esber L also showed that exposure in-vehicle to VOC and PM2.5 is high, that the ventilation mode greatly contributes to the exposure,  that 3 out of 6 cars have instrusion of own engine fumes and that air pollution was higher inside new cars than outside. In fact, taxi and bus drivers have 5 times more exposure to bad air quality than people who work elsewhere.

The new car smell

A number of studies have been conducted in the past 10+ years on Volatile Organic Compounds (VOC) inside new cars. In fact, that attractive ‘new car’ smell, is off-gas derived from a mix of materials used in the treatment of leather, dashboards and seats, in addition to the glues.

There can be 50-100 VOC individual compounds in any given car, including bromine, chloride, phtalates, lead and heavy metals. All of which, according to Jeff Gearhart -research director at the Ecology Center, have been linked to cancer, birth defects, allergies, liver toxicity and impaired learning.New cars have VOC concentrations above the indoor permissible levels, but luckily they fade away in the first 6 months of a car’s life.Heat can increase these concentrations considerably.

PM2.5, mould spores, microorganisms and others

In addition to VOCs, studies which have been conducted to look into the air quality inside the cars, have found that there is also high concentration of PM2.5 and higher concentrations of carbon monoxide, benzene, toluene and fine particulate matter than in road-side monitoring stations. Moreover, studies have also found high concentrations of mould spores and bacterial endotoxins, which may induce major respiratory symptoms, allergies and are of concern to asthmatics.

How can we protect ourselves?

Ensure car ventilation to decrease the inside VOC at a faster rate, specially in the first 6 months of a car. Either have the windows down or use air conditioning regularly.

– Use air re-circulating options when stuck in traffic to avoid excessive amounts of engjne exhaust fumes coming into the car.

– Use air conditioning to control humidity and reduce mould spores and bacterial microorganisms.

– Avoid accumulation of dust, moisture/mould or residual cigarette smoke.


Science Direct – Indoor to outdoor air quality associations with self-pollution implications inside passenger car cabins

Explorations of everyday chemical compounds – The Chemicals Behind the ‘new car smell’.

Ecology Center – New Ecology Center guide to toxic chemicals in cars helps consumers avoid a major source of indoor air pollution

NIH – Car Indoor Air Pollution

…And now breast cancer?

There has been an intense debate over the possible link between breast cancer and air pollution. FIGO- the International Federation of Gynecology and Obstetrics highlighted the discovery of a link between air pollution and breast cancer following an article published in the Breast Cancer Journal on the results of research conducted by the University of Florida. This was reported by mainstream media as an alarming call to women living in areas with high air pollution.

Do not panic!

But there is no need to panic, it’s very important to be cautious with scientific results. In fact, many organizations like Cancer Research-UK, BreastCancer and others jumped to clarify that finding a link does not mean that air pollution causes breast cancer. Two things can be highly correlated without implying causation.

We know and we’ve talked about how pervasive air pollution is in our bodies, affecting our lungs, circulation, diabetes, skin and many more. The link between air pollution and lung cancer is very well researched, many research teams have worked on this subject for decades and have found how it happens and why. All the other links of air pollution to diseases are still in the very beginning of compiling research results and while it is one thing to link air pollution with skin problems, it is another step entirely to link it with a life-threatening disease like breast cancer.

Be cautious and understand the risks

We should not panic, but we should know the extent of current research on this matter. The latest research was conducted by the University of Florida, US, and looked at the link between breast density and air pollution. They found that women living in areas with high pollution had denser breast tissue. Women with dense breast tissue are up to six times more likely to develop some form of breast cancer.

In 2010, another study by the Research Institute of the MUHC, McGill University and Université de Montreal also showed a link. This study mapped air pollution against breast cancer patients and found that women living near areas with higher levels of pollution were twice as likely to develop breast cancer than the rest. However, Dr Goldberg, a researcher at The RI MUHC said:

“For example, we don’t know how much the women in the study were exposed to pollution while at home or at work, because that would depend on their daily patterns of activity, how much time they spend outdoors and so on”

In the case of this study, what is interesting is that the motivation to study the link between air pollution and breast cancer was to try to understand why cancer rates were going up in general / in these particular high pollution areas. The results showed that it could be air pollution but it may well be some other factor that the study could not control. In fact, the researchers called for more research on this subject and more research on the biological explanation behind this possible link.

Before more scientific evidence is gathered, we should make it a habit to know the quality of the air we breathe and take actions to improve the quality of the air we are exposed to, both indoors and outdoors!

Smells clean…but it may be harmful!

Our quest for cleaner and cleaner living environments with no traces of bacteria leads us to use cleaning products advertised as effectively eliminating 99% of bacteria especially in our kitchens and bathrooms. Cleaning products have been progressively improved with fragrances that we associate with cleanliness but are we being fooled!?

Many of these aromas are created through the use of enzymes that are known to be allergens. The smell that we associate with cleanliness is often the evidence that there are volatile organic compounds (VOC) in the product which give off different types of gasses. Fragrances and many other product features are created through the use of chemicals that are often harmful to our health and environment. Moth repellents, air freshners, aerosol sprays, degreasers, dry cleaning fluids and cleaning products / detergents are all toxic if ingested, but can also enter our body through touch and smell.

How our cleaning products may affect us will depend on many factors including how long we are exposed to it, the level of exposure and the nature of the VOC or chemical in use. In addition, we must not forget that many of these products are not eliminated by the body and just keep accumulating until a problem arises. Many of their ingredients fall into three harmful categories: carcinogens which may cause or promote cancer’s growth; endocrine disruptors which mimic hormones and affect reproduction, development, growth and behaviour; and neurotoxins which affect brain activity.

TYPE of chemicals that are harmful:
  • Pesticides: cleaning products are not seen as pesticides but they are. They are carcinogens and endocrine disruptors that are difficult to eliminate from the body once ingested.
  • APEs: help cleaning solutions easily spread in a surface and known to be endocrine disruptors.
  • Organoclorides: endocrine disruptors.
  • Phtalates: endocrine disruptors, possible carcinogens and are currently not required to be disclosed as ingredients.
Common chemicals in cleaning products:
  • Perchloroethylene, a known carcinogen, is used in dry cleaning agents and degreasers.
  • Styrene is an endochrine disruptor, used in floor waxing products.
  • Formaldehyde is a known carcinogen, used in household antiseptics, medicines, dishwashing liquids, fabric softeners and carpet cleaners.
  • Benzene also carcinogenic is used in detergent and furniture wax.

Without a doubt, those most at risk are children, followed by elderly, asthmatics and those persons with compromised immune systems. We tend to believe that if we ensure these products are out of children’s reach they are safe. However, we seldom think that children are exposed to the ill effects of these products through touch and smell. They crawl on the ground, lick their fingers and as a result have greater contact with surfaces cleaned with these products than Adults. Moreover, any exposure they have has a larger effect in their body because of the ratio between exposure and body size, as well as the fact that their immune system is in a developmental phase.

Surprisingly in many countries, household cleaners are not required to list all their ingredients. This makes it more difficult for consumers to know more about the potential risk.








EPA – Volatile Organic Compounds’ Impact on Indoor Air Quality

The Guardian – Enzymes used in cleaning products and food ‘are potent allergens’, warns study

Healthy TIPS: With a little help from Vitamin B

In a previous blog-post we talked about protecting our health from within and stressed the need to consume vitamin C, E, Beta-carotene and Omega3 which boosts our body’s anti-inflammatory and antioxidant capacity. Research published in the Pharmaceutical Journal is now including Vitamin B in the realm of our must-have nutrients to fight health consequences from air pollution.

Vitamin B essentials

Our bodies need Vitamin B for producing energy through food, growth and cell division, as well as for the proper functioning of the nervous system, arteries, heart and brain. These vitamins can be found in foods such as meats, whole grains, vegetables and nuts – and especially in chickpeas, beef liver, yellowfin tuna, salmon, chicken breast, potatoes and bananas. We need to maintain a good intake of these foods at the same time as facilitating its absorption by decreasing alcohol, coffee and tea consumption. The vitamin B group includes a range of vitamins but the most essential are B12, B6 and Folic acid

Vitamin B and air pollution

Studies had first found that persons with low vitamin B6 and B12 were particularly susceptible to the adverse health effects of air pollution. Now, scientists from the Mailman School of Public Health from Columbia University looked at the possible effect of vitamin B in minimising DNA damage. The study sample size is very small but it is being conducted on people and compares DNA changes in people exposed to PM2.5 against those who were not exposed. And then compares the protective effect of Vitamin B6, B12 and Folic acid (B9).

Dr Jia Zhong from Harvard School of Public Health led the study and found that although the results from such a small sample cannot be conclusive, they do show DNA damage from exposure to PM2.5 and a protective effect from Vitamin B even when the individual is exposed to PM2.5. The sample was small and the vitamin dose used was very high, but the relevance of this finding is that more research can be done to further to understand the correct dosage and if this effect is also experienced among people who are under chronic exposure to air pollution.

As a preventive measure we can make sure we have good vitamin B intake to help our bodies protect us from air pollution

Mayo Clinic – Vitamin B6
Live Sciences – Sources and Benefits
PNAS – B vitamins attenuate the epigenetic effects of ambient fine particles in a pilot human intervention trial
The Pharmaceutical Journal – Vitamin B may help reduce impact of air pollution on health

Is Air Pollution Changing our Gut Microbiota?

It may seem a far cry, but scientists have been studying the effects of particulate matter (PM) in our intestines, gut microbiota (previously referred to as gut flora) and its relation to the sharp increase of Inflammatory Bowel Diseases (IBD). There is not an overwhelming amount of research, but certainly for more than a decade institutes in several countries have researched the possible link between exposure to air pollutants and various parts of our digestive system.

These studies show why being careful about what we eat and drink can take us a long way in protecting our gut microbiota from air pollution. In fact, hereditary genes may explain only a fraction of the IBD and scientists have in the past two decades seen that environmental factors are important contributors to these diseases.

But how does PM reach our bowel/intestines?

Well, researchers have observed that there are two primary ways: first the lungs clear part of air pollutants through a process called ‘mucocialiary clearance’ towards the intestines; and second we ingest it through our water and food.

And what is the effect of PM in our bowel?

Scientists in this field suggest that air pollutants cause systemic inflammation and change of the intestinal microbiota. Research has shown correlation between air pollution and IBD but scientists call for caution in the interpretation of these results due to methodological weaknesses and suggest more research should be done. However,

“If this connection is found to be true, this could have important implications for public health since intestinal diseases are relatively common and cause significant morbidity and mortality in addition to their economic impacts. Understanding how pollution contributes to intestinal disease will identify potential interventions or help advocate for patients by reducing exposures to dangerous materials.” say Leigh A. Beamish, Alvaro R. Osornio-Vargas and Eytan Wine in their 2011 publication in the Journal of Crohns and Colitis.

More recently (2015), scientists from Canada published an article on how microbiota can be modified by air pollution and last moth a group of researchers also published an article on PM and its effect on gut microbiota and the link to cholesterol. Overall, there is increasing knowledge of the importance of maintaining a healthy gut microbiota as a protection against diabetes, obesity, metabolic disorders and IBD. Scientists have shown that air pollution affects both the composition and the function of microbiota. They concluded:

“Together, our study in IL-10−/− mice, in conjunction with previous experimental and epidemiological observations, strongly suggests that ingested particulate matter could trigger and accelerate the development of gastrointestinal inflammatory diseases” Salim, Kaplan and Madsen from the University of Alberta and Calgary.

As individuals, let’s start now to protect ourselves. We can eat organic, we can have a specific vegetable and fruit cleansing routine, we can filter our water. Let’s start minimizing our ingested air pollution to take care of our gut microbiota!


NIH – Air pollution effects on the gut microbiota: a link between exposure and inflammatory disease

Nature – Ambient Ultrafine Particle Ingestion Alters Gut Microbiota in Association with Increased Atherogenic Lipid Metabolites

Crazy for a cruise holiday? Let’s talk air quality

A cruise is one of the most sought-after holiday destinations. The Caribbean, Mediterranean, Alaska, northern Europe and some areas in Asia have the largest array of Cruises with lavish restaurants and what seems like a relaxing holiday in the middle of nature but with all the conveniences of a touristy city on board. Worldwide a total of 24.2 million passengers enjoy cruises every year.

Unfortunately for cruise holiday goers, reports conducted by journalists in France and in the UK have shown that fine particulate matter (known as PM2.5 and PM 10) is particularly high on these cruise destinations.

Cruise ships are important sources of air pollution impacting the routes they cover and the cities in which they dock. One cruise ship emits the same amount of carbon dioxide as one million cars per day. We might think that this is only the trail left by the cruise, but in fact it affects also the people on the cruise. Journalists measured the air quality on the main deck and found that the concentration of fine particles was twice as high as the concentration in London’s Picadilly Circus and similar to the measurements in New Delhi, all coming from the same ship’s funnels.


Cruises use residual fuel of very low quality, it’s the fuel left after the refined fuel for cars has been extracted.  But it’s cheap and maritime global regulation is limited and difficult to enforce. Nonetheless, the International Maritime Organization has fixed  the 1st January 2020 as the date for all passenger ships to use fuel with maximum 0.5% lead content, it is now 3 times that level at 1.5%.

All cruise goers and communities living in the ports where these cruise ships dock have the right to know what they breathe. More regulation is essential, but constant monitoring on-board and off-board is essential to reassure users and communities of the air quality they are exposed to.

Meo’s air quality monitor- measures PM2.5 and PM10.

Let’s measure and take control of the air we breathe!

Independent – Air quality on cruise ship deck ‘worse than world’s most polluted cities’, investigation finds
LaProvence – Le souffle pollué des géants des mers en Méditerranée

Strokes and What We Breathe

When we think about the health effects of air pollution, our immediate thought goes to our lungs. But the silent threat of poor air quality reaches many unexpected areas of our body. In the past two decades, research has shown that strokes, heart attacks and irregular heart rhythms can result from exposure to air pollution especially among people at risk. Currently, nearly 15 million people suffer a stroke worldwide, out of which 6 million die and 5 million are left with disabilities, possibly severe. The latest study suggests that approximately 29.2% of global strokes are linked to air pollution and the strongest link (33.7%) was seen in developing countries were solid fuels are burned indoors for energy. In developed countries, the link is much weaker at 10.2%.

“A striking finding of our study is the unexpectedly high proportion of stroke burden attributable to environmental air pollution, especially in developing countries. Air pollution is not just a problem in big cities, but is also a global problem. With the ceaseless air streams across oceans and continents, what happens in Beijing matters in Berlin. Air pollution is one aspect of the fossil fuel and global warming problem, which is itself partly a result of westernisation and urbanisation, especially in India and China.” Professor Vladimir Hachinski, University of Western Ontario, London, Canada and Dr Mahmoud Reza Azarpazhooh, Mashhad University of Medical Sciences, Mashhad, Iran.

Asia is responsible for two-thirds of the global stroke mortality. The local situation is characterised by two distinct yet opposite trends 1. mortality following a stroke has been declining in North Asia (Korea, Japan, Taiwan and urban China) perhaps due to improved stroke care, albeit the occurrence (incidence) of stroke is apparently not declining, thus leaving a greater number of people with long-term care needs, and 2. southern Asia (India, Pakistan, Bangladesh, Indonesia) where life expectancy is increasing but risk factors such as hypertension, diabetes, obesity, cigarette smoking are not yet adequately addressed. Given that cardio-vascular diseases are particularly affected by small particles found in haze, smoke and dust and the high link found between strokes and pollution, air pollution may be playing a major role in stroke statistics in Asia.

Effects of air pollution in cardiovascular diseases and strokes may be immediate or long-term. Immediate effects happen in older persons and sensitive persons with the build-up of fatty deposits in the arteries, where accumulation of small particles may worsen the situation.[7] Long-term exposure to poor air quality may, according to research, facilitate and worsen atherosclerosis (hardening and narrowing of the arteries) a disease commonly associated with high blood pressure and heart attacks / strokes.

In conclusion, if you are a person at risk of cardiovascular diseases or not “The central theme here is to be careful,” said Dr Luepker from the American Heart Association and “Avoid situations where you are exposed to a high level of air pollution.”


Circulation – Air pollution, Climate and Heart Disease
Science Daily – For the first time, air pollution emerges as a leading risk factor for stroke worldwide
BMJ – Stroke in Asia: geographical variations and temporal trends
NIH – Stroke in Asia: a global disaster

ASTHMATIC? Air pollution might be making it worse

Today, 235 million people across the world suffer from asthma. Indoor and outdoor pollution can trigger asthma attacks and make symptoms worse.

It is well documented that air pollution can trigger asthmatic reactions in people who are already diagnosed with asthma. The role of air pollution in people developing asthma is less understood. Nonetheless, research funded by the US Air Resources Board has shown that children living in communities with higher ozone levels and/or living closer to busy roads are more likely to develop asthma.

 Asthma: a chronic disease of the lungs. The airways narrow, swell and produce more mucus. Which makes breathing difficult and trigger coughing, wheezing and shortness of breath.

Asthma is rarely fatal but causes sleepless nights, fatigue, reduced physical capacity as well as school and work absenteeism. The use of medication is important, but management of asthma triggers is essential to deal with this chronic disease and to enjoy a good quality of life and overcome the economic burden.

Indoor and outdoor air pollution can trigger asthma attacks and make symptoms worse because air pollution irritates the lungs and airways. Exposure to long-term air pollution in high concentrations can trigger asthma in both children and adults. A research study showed that people with moderate to severe asthma were 40% more likely to have an acute asthma episode on high pollution days. Moreover, research suggests that if your exposure happens during pregnancy your baby could be more likely to develop asthma because particulates can cross through the placenta to the developing baby. According to the US Center for Disease Control (CDC) asthma is primarily affected by ozone (smog) and particle pollution (haze, dust or smoke).

Ozone is a gas and contributes to ‘smog’, mostly present in urban areas where there are more cars and in the summer when sunlight increases. Ozone triggers asthma, it irritates the lungs and airways and reduces their function making it more difficult for a person to breathe deeply. It has been directly related to increased asthma attacks, increased asthma related emergencies and increased need for asthma treatment. Small particles are emitted into the air from industrial activity and energy production and can reduce lung function and increase asthma attacks. Moreover, 60% of people with asthma have allergic asthma, which means that allergens such as dust, pollen and pets can  trigger inflammation of the airways and create an asthma attack. As a result of increased exposure to pollution, your airways can be more sensitive to allergens.

In Asia, it is estimated that less than 5% of adults suffer from asthma; and data about elderly asthma is not homogenous across the region, it ranges between 1.3 and 15.3% (5). A recent literature review on this subject showed that asthma was increasing with age in Asia, particularly in Korea, Japan, China, Hong Kong, Mongolia, Iran, India and Bangladesh.

Controlling asthma as well as the triggers that cause it to arise or get worse is important to lead a good quality life and also to reduce its economic burden. Asthma has direct costs in inhalers and medications and has indirect costs from the negative impact of productivity which can be as large as the direct costs. In addition, research showed asthma affects not only work absenteeism but also “presenteeism” (individual loss of function when at work). A study in the US in 2007 estimated that the total cost of asthma to society was USD 56 billion (USD3,259 per person). A separate research in Asia-Pacific estimated that indirect and direct costs ranged from USD184 in Vietnam to USD1,189 in Hong Kong.


Simple tips to know if air pollution is triggering your asthma attacks:

  • Keep a symptom diary and note daily activities and pollution levels. This will help you see patterns of symptoms linked to pollution levels.
  • When pollution is high and even 24h after you might notice:
    1. Increased sensitivity to other asthma triggers,  
    2. Symptoms are worse and harder to control,
    3. You are using your inhaler more.

Some tips on how to reduce asthma attacks triggered by pollution:

  • Know when and where pollution is bad and plan outdoor activities when or where pollution levels are lower.
  • Limit outside activities and outdoor physical exercise on high pollution days or in high pollution areas.
  • If you do go out, do it earlier in the day before pollution kicks in and stick to back streets, with less traffic.
  • Ensure your indoor air is clean and is not contaminated by outdoor air pollution. Avoid rush hours so that the quality of the air in your car can easily be controlled.
  • Avoid the smoke from barbecues and bonfires.
  • Note that the use of face masks may not make a difference to your asthma symptoms and can actually make breathing feel more difficult.


AsthmaUK – Air Pollution and Asthma

Asthma and Allergy Foundation of America – Air Pollution

NIH – Epidemiology of Adult Asthma in Asi

Air Pollution and Diabetes

The International Diabetes Federation says diabetes mellitus (common diabetes) affects around 400 million people across the world. Research in the past 10 years has shown that environmental irritants in the air and water play a role in these figures. A number of studies have now shown that air pollution has a synergy with other dominant factors and accelerates the propensity for type 2 diabetes, also known as adult-onset diabetes.

At The Duke University rats were exposed to air with highly polluted air (similar to Beijing readings) or filtered air for 19 days. The group of rats exposed to the Beijing air had 50% higher cholesterol level, 46% higher triglycerides and 97% higher total cholesterol.

What is happening in Asia?

Yes! Many studies have been conducted analysing this relation in humans. A study by the German Center for Diabetes Research (DZD) and the Helmholtz Zentrum München showed how air pollution at the place of residence increases the risk of developing pre-diabetic insulin resistance.

“Whether the disease becomes manifest and when this occurs is not only due to lifestyle or genetic factors, but also due to traffic-related air pollution,” said Professor Annette Peters, director of the Institute of Epidemiology II at Helmholtz Zentrum München and head of the research area of epidemiology of the DZD.

“The results revealed that people who already have an impaired glucose metabolism, so-called pre-diabetic individuals, are particularly vulnerable to the effects of air pollution,” said Dr. Kathrin Wolf, lead author of the study. “Thus, over the long term — especially for people with impaired glucose metabolism — air pollution is a risk factor for type 2 diabetes.”

Researchers from King Saudi University, Saudi Arabia, further acknowledged that traffic associated pollutants, NO2 (nitrogen dioxide), tobacco smoke and particulate matter have the strongest link with diabetes. And researchers from Naples University in Italy quantified the risk of future diabetes between 10 and 27% associated with exposure to just a 10 μg/m3 increase of PM2.5. In the most recent research, a US study looked at 1000 Mexican-Americans and found that PM2.5 exposure was significantly associated with diabetes risk factors, with an effect equivalent to that of obesity, the authors noted.

What is happening in Asia?

Asia is affected by the double burden of high levels of air pollution and a high percentage of the population with diabetes. In fact, Asian countries have 60% of the world’s diabetic population. China alone is leading this statistic with 10% of its population (98 million) affected by diabetes. This is the result of a combination of factors: socio-economic growth and industrialization; urbanization spreading widely and notable lifestyle changes. Moreover, Asians have genetically a higher predisposition for diabetes, they develop diabetes earlier and with lower body mass index and waist circumference when compared with the Western population. Prof Juliana Chan of the Chinese University of Hong Kong says there is a complex interplay between genetic, lifestyle and environmental factors, which have been compounded by China’s rapid modernisation. Worryingly, if we combine the higher predisposition to diabetes, the nearly 50% smoking rate among adult men, the change of diet due to globalization and the very high air pollution levels, we can understand the extent of the risk in Asia.

What can we do about it?

Reduce the effect of air pollutants on your diabetes risk:

  • Avoid smoking or passive smoking;
  • Know your indoor air quality and control it;
  • Protect yourself when exposed to outdoor air, especially when its highly polluted;
  • Adopt a healthy diet; and
  • Increase your level of physical activity.


Diabetes Journal – Air Pollution and Type 2 Diabetes

Science Daily – Air pollution, a risk factor for diabetes

NIH -Effect of environmental air pollution on type 2 diabetes mellitus

NIH – Particulate matter pollutants and risk of type 2 diabetes: a time for concern?

REUTERS – Air pollution not just bad for your lungs

TIME – Study: Air Pollution Heightens Risk of Obesity and Diabetes