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Is too much cleanliness dangerous? - (11/10/2020)

By Dr. Ron Gasbarro

The pharmacist was telling his friend Pete about his brother and his wife when the pandemic first hit. “They – like most other people – were confused and on the verge of panic. The first thing they did was buy as much toilet paper, Lysol®, and paper towels as they could grab. Then, they turned their garage into a cleaning station. The Ping-Pong ball table was set up with disinfectant and gloves, and they proceeded to wipe everything down – each box of macaroni, jar of mayo, and carton of OJ.” The pharmacist continued, “Once the virus was found to be spread by respiratory droplets flung through the air, the gloves came off, and the facemasks were slapped on.” “It’s funny what is considered clean and not clean,” said Pete. “I wonder if cleanliness can be taken to an extreme, whereby it is unsafe. Some germs are good, right?” 

As the COVID-19 enveloped Planet Earth in 2020, the demand for and hoarding of sanitizers, bleach, and, weirdly, toilet paper reached a fevered pitch. But there has been some speculation that this ultra-cleanliness is somehow weakening our immune systems. Let’s look back at history when good hygiene was virtually absent. In the 1,000 years before the 21st century, bacterial diseases such as cholera and typhoid were spread by contaminated water and food and killed millions of people worldwide. As sanitation improved in the early 1900s, these diseases were virtually shut down in the industrialized world. So much so that in 1999, the Centers for Disease Control and Prevention (CDC) declared that water chlorination was one of the 10 most outstanding public health achievements of the 20th century [CDC, 1999]. The CDC attributes this victory to the disinfecting of drinking water, the pioneering of toilets and sewer systems, the cleaning of urban streets, and overall food safety. Most of us are alive today because of these developments. 
  
Conversely, allergies and autoimmune disorders, such as asthma, type 1 diabetes, and lupus, are largely afflictions of the last few centuries. Some researchers believe that the "hygiene revolution" of the last 200 years was a possible cause, in that the cleaner we are, the more our immune systems can go awry. “A child’s immune system needs education, just like any other growing organ in the human body,” says Erika von Mutius, a prominent pediatric allergist at the University of Munich, Germany. "The hygiene hypothesis suggests that early-life exposure to microbes helps in the education of an infant's developing immune system." Without this initial “priming” of one’s immune system, our immunological defenses can go haywire and attack itself to open the door to a life-long autoimmune disorder. 

Thus, as humans who have evolved through the millennia in the dirt and rot, we need certain germs to survive. A healthy body is a reflection of that. The microbiome is a gathering of microorganisms that live together in one environment. The human microbiome refers to all bacteria, yeasts, viruses, and other microorganisms that have lived in and on the human body from antiquity. We need this natural ecological community of bugs to keep our immune systems lean and mean. 

Grubbing about outside can build a robust immune system. But cleanliness counts when preparing food, before eating, and after using the toilet. Amid rising antibiotic resistance cases, it is more important than ever to stop infections, mainly when they are new to our collective microbiomes as COVID-19 is. “Until we have a vaccine or a drug for this coronavirus,” the pharmacist said to Pete, “Handwashing and a face mask are our only defenses."

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.

 


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