In 2013, the Food and Drug Administration presented soap manufacturers in the United States with a challenge: show us proof that antibacterial soap is more effective than regular soap and water, or prepare to remove your products from the market.
For the soap manufacturer, this was a startling announcement. On the market at the time, a majority of liquid soap and about one-third of bar soap contained antibacterial ingredients. This meant antibacterial-soap manufacturers would have to pay for lab testing to prove that their soaps worked better if they wanted to keep their goods on the shelf.
For the consumer, it was a win for public health and safety. Capitalism would have to front the bill on consumer education. But the problems for soap makers didn't end there: a few years later the FDA would go on to ban 24 antibacterial ingredients from the market, labeling them as potentially dangerous, except for one: triclosan (1).
If you browse the ingredients in antibacterial soap today, many of them still contain the ingredient triclosan. But what is it, how does it work, and is it safe?
Triclosan is a synthetic ingredient originally used as an insecticide. Its' molecular structure is similar to that of DDT (2). It works to weaken the membranes of bacterial cells. Specifically, cells that have ENR enzymes. Once these membrane walls are weakened, they break and the cells die.
In September 2016, NPR reported that the FDA banned Triclosan and 18 other chemicals typically used in antibacterial soaps. At that time, many companies jumped ship, abandoning the recommended chemicals, and adopting new ones such as benzalkonium chloride, benzethonium chloride, and chloroxylenol (PCMX). But some companies, such as Dial, kept Triclosan in their products despite the FDA ruling (6).
Following that announcement, the FDA issued a "final rule" on anti-septic products. It banned triclosan and 23 additional active ingredients from being used without a premarket review:
"Premarket approval (PMA) is the FDA process of scientific and regulatory review to evaluate the safety and effectiveness of Class III medical devices. ... The applicant must receive FDA approval of its PMA application prior to marketing the device." - www.FDA.gov
So is Triclosan safe? Originally it was argued that Triclosan was not harmful to humans because humans do not have an ENR enzyme. The ENR enzyme being the enzyme responsible for building and strengthening the bacteria cell walls we discussed previously. Since then, research has found other reasons to raise alarm (more on that below).
How do Soap and Water work?
So how does soap work, you ask? Soap molecules are both polar and non-polar. Polar molecules can be mixed, or "dissolved" into the water, whereas non-polar molecules cannot be. What makes soap so special is that it has both! Soap molecules can attach to dirt and bacteria, wiggling them free from our skin (3).
Once the dirt and bacteria are loose, water rinses them down the sink. Keep in mind - washing your hands with soap and water won't kill germs or bacteria - it just removes them from the surface they've been living on (4).
The only difference between antibacterial soap and regular soap is that antibacterial soap has special ingredients (possibly Triclosan) added to it.
Four Incentives to Stop Using Antibacterial Soap
The Food and Drug Administration has announced that antibacterial soap is no more effective than regular soap and water when it comes to preventing illness. The application of over-the-counter antibacterial soap is still in use in some hospital settings as a precaution, but the FDA has warned that the use of antibacterial soap lacks sufficient science to claim superiority, and that the long-term use of these products (and their synthesized chemicals) may indeed be dangerous to our health (1).
"Following simple handwashing practices is one of the most effective ways to prevent the spread of many types of infection and illness at home, at school and elsewhere, We can’t advise this enough. It’s simple, and it works." - Theresa M. Michele, MD, of the FDA’s Division of Nonprescription Drug Products
Antibacterial Soaps Have Little Proof of being Superior
To keep this first incentive plain and simple: there is not enough scientific evidence to show that antibacterial soaps are more effective than conventional soap and water. While the anti-septic ingredients added to soap products do indeed kill bacteria, the FDA determined that adding such chemicals to soap is, for lack of a better term, overkill (1).
There are few exceptions in practice where an OTC antibacterial soap would be more beneficial, such as a contaminated hospital room, or an Ebola-treatment site.
Antibacterial Soaps Create Antibiotic-Resistant Bacteria
This is one of the main arguments against adding anti-septic qualities to soap. While the FDA recognizes that antimicrobial resistance is a growing threat to the world because of antibiotics, the FDA also reported in 2019 that there is not enough information available to determine that adding antibacterial agents to soap is contributing to the growth of antibiotic-resistant microbes (7).
Despite the FDA's stance on this point, the World Health Organization has recognized bacterial resistance due to antibiotics as a "threat to global health security" (9). For example, a study by the Norwegian Scientific Committee for Food Safety in Norway found the potential for both Escherichia coli and Salmonella enterica to develop antibiotic resistance because Triclosan. This is confirmed (10).
Antibacterial Agents are Bad for the Environment
There is significant evidence to prove that the anti-septic agents we use end up in our water supply. Whether that be by soap and drain, or falling from our clothes in the wash and the rain. Triclosan, for example, is added to a plethora of consumer products for bacterial contamination prevention. Some items that contain Triclosan include toothpaste, body wash, cosmetics, clothing, furniture, toys, and kitchenware (7).
Triclosan and other chemicals have been found to persist after wastewater treatment. Traces of these chemicals end up in lakes and rivers which have the potential, science has discovered, to inhibit algae's ability to photosynthesize (11).
But water flow doesn't end with rivers and lakes: it ends in the ocean. Scientists In 2009 found traces of Triclosan in blood plasma samples collected from bottlenose dolphins off the coast of South Carolina, U.S. Triclosan had bioaccumulated in the dolphins (12). Which leads us to our last point.
The Ingredients In Your Soap Could Cause Health Problems
Bioamplification of chemicals in the environment is a substantial threat to not only wildlife but also humans. Bioaccumulation of chemicals end up in the environment, in the animals living there, and then move up the food chain into the food we eat. With Triclosan, the chemical is fat-soluble, meaning it can build up in the fatty tissues of animals - humans included. Triclosan can also be absorbed through the skin, as was discovered in a study that additionally found Triclosan in the urine of 75% of the people whom were tested (13).
In the North American bullfrog, Triclosan was found to "modulate thyroid hormone-associated gene expression." Meaning that, at low concentration levels, the chemical was able to interfere with the thyroid hormone of the tadpoles and frogs. The tadpoles, for example, experienced transient weight loss, but an increase in hindlimb development and a change in the expression of the tadpole tail fin (14).
The effect present in the frogs classifies Triclosan as an endocrine disruptor:
"Endocrine disruptors are chemicals that may interfere with the body’s endocrine system and produce adverse developmental, reproductive, neurological, and immune effects in both humans and wildlife." - www.niehs.nih.gov
While there is not sufficient evidence to prove Triclosan affects human's the same way it does the bullfrogs, it still raises alarm for concern. Further research is needed to understand its' bioaccumulation in the environment and the impact it could have on life. Until we know firmly it is 100% safe, it is probably wise to stay away from this synthetic, anti-septic ingredient.
#HonOrableMention: Bacteria Killing TechnologY
That's right. Humans have invented technology to kill bacteria - like lasers and ray-beams. It's freaking awesome and kicking serious bacteria-butt in places like hospitals. Read more here.
Life After Antibacterial Soap
Fortunately, we create environmentally conscious soap here at Soul Salve. Browse our soap selection here:
1) Antibacterial Soap? You Can Skip It, Use Plain Soap and Water. https://www.fda.gov/consumers/consumer-updates/antibacterial-soap-you-can-skip-it-use-plain-soap-and-water
2) Triclosan. http://www.chm.bris.ac.uk/motm/triclosan/triclosanh.htm
3) Say Goodbye to Antibacterial Soap. http://sitn.hms.harvard.edu/flash/2017/say-goodbye-antibacterial-soaps-fda-banning-household-item/
4) The handiwork of good health. https://www.health.harvard.edu/newsletter_article/The_handiwork_of_good_health
5) Hand hygiene: Back to the basics of infection control. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249958/
6) FDA Bans 19 Chemicals Used In Antibacterial Soaps. https://www.npr.org/sections/health-shots/2016/09/02/492394717/fda-bans-19-chemicals-used-in-antibacterial-soaps
7) 5 Things to Know About Triclosan. https://www.fda.gov/consumers/consumer-updates/5-things-know-about-triclosan
8) Premarket Approval (PMA). https://www.fda.gov/medical-devices/premarket-submissions/premarket-approval-pma
9) Antibiotic resistance - a threat to global health security. https://www.who.int/drugresistance/activities/wha66_side_event/en/
10) Triclosan and antimicrobial resistance in bacteria: an overview. https://www.ncbi.nlm.nih.gov (pubmed/16922622
11) Triclosan persistence through wastewater treatment plants and its potential toxic effects on river biofilms. https://www.sciencedirect.com/science/article/abs/pii/S0166445X10003292
12) Occurrence of triclosan in plasma of wild Atlantic bottlenose dolphins (Tursiops truncatus) and in their environment. https://www.ncbi.nlm.nih.gov/pubmed/19410343
13) National Biomonitoring Program - Triclosan. https://www.cdc.gov/biomonitoring/Triclosan_FactSheet.html
14) The bactericidal agent triclosan modulates thyroid hormone-associated gene expression and disrupts postembryonic anuran development. https://www.sciencedirect.com/science/article/abs/pii/S0166445X06003407
15) Endocrine Disruptors. https://www.niehs.nih.gov/health/topics/agents/endocrine/index.cfm