Plastic or Metal: Which Water Bottle is Best?

 

In ancient times, the philosophers would gather and walk around the marketplace, the agora, and contemplate the weighty matters of the world such as the nature of justice, the ideal city, distinguishing the good from opinion, and seeking truth and knowledge.  All of that walking, talking and thinking in the hot sun can make a scholar dehydrated. So, naturally, the first question these great minds would tackle is: plastic or metal? Which water bottle is best for walking and thinking?

 

Plastics are everywhere. The worldwide production of plastic has exploded from less than 2 million tons in 1950 to about 400 million tons in 2020. Once a plastic item has been used, it tends to stick around for a while. Plastic takes a long time to break down. For example, a plastic water bottle may take 450 years to decompose! Due to this phenomenon, plastic waste is everywhere. Only 10-15% of plastic is recycled. The rest ends up in a landfill or the ocean or is burned off. As the plastic in landfills or in the ocean breaks down, smaller particles called microplastics are produced. When plastic is burned, microplastics are released into the air. Microplastics have been found everywhere including on remote islands, in Antarctica, deep in the ocean and, increasingly, in human tissue and organs. Microplastics enter the body by two routes. Microplastics in the air are inhaled. They also enter by ingestion, for example by eating microplastic laden sea fish or drinking from plastic water bottles (even reusable water bottles). Microplastics have been found throughout the human body. They are present in high concentrations in the liver and kidneys and to lesser degrees in the hair, saliva, blood, colon and lung. Aside from just being present, do microplastics cause human disease? An important study found microplastics in atherosclerotic plaque. In the study, 58% of patients undergoing surgery for blockage in their carotid (neck) arteries had microplastics in their arteries. These patients were 4 times more likely to die, have a heart attack or stroke over the next three years compared to patients without microplastics. Another study found that coastline counties in the United States (where there is a higher exposure to ocean microplastics) had higher risks for diabetes, heart artery disease and stroke. We now know that the brain is full of microplastics as well. It was found that the level of microplastics in the brain increased by 50% from 2016 to 2024. In addition, people with higher levels of brain microplastics had more dementia and Alzheimer’s disease. 

 

Like plastics, metals are everywhere. However, unlike plastics, our bodies require small amounts of certain metals, called essential metals, for normal metabolism. Essential metals include copper, manganese, cobalt and zinc. Small amounts of these metals are needed, but larger quantities can be toxic as are nonessential metals, such as cadmium, arsenic, lead, tungsten, uranium and mercury. Cadmium is present in tobacco smoke, meats, shellfish, and vegetables. Cadmium, tungsten, uranium, cobalt, copper and zinc come from industrial emissions, electric batteries, oil production, welding, and mining. Arsenic is found in the water and some foods. What are the health effects of metals? It has been shown that with high urinary concentrations of cadmium, tungsten, uranium and the essential metal zinc, there is an increased risk for dementia. There is no association of high urinary lead levels and dementia. In addition, there is an association between high urinary levels of cadmium, tungsten, uranium, and the essential metal cobalt and coronary calcification, a measure of plaque in the heart arteries. It is felt that these metals promote atherosclerosis through inflammation. A recent study proved the concept by showing that lead and cadmium exposure leads to increased blood levels of troponin (a measure of heart damage), proBNP (a measure of heart strain) and C reactive protein (a measure of inflammation). Lastly, a study from China showed that long-term exposure to high levels of copper, manganese, aluminum, zinc and cadmium in the drinking water increased the risk for major cardiac events (heart attacks, cardiac deaths). 

 

What should our philosophers choose, a plastic or metal water bottle?  Which one is the healthier choice? Reusable plastic water bottles add to the microplastic load. Wear and tear, repeated washing and exposure to heat damages the inner surface of the bottle, releasing microplastics into the water that is drunk. The concentration of microplastics in reusable bottles is higher than single use water bottles. Most bottles are made of polyethelene terephthalate (PET). Bisphenol A (BPA) is another chemical used to make plastic bottles. BPA has multiple adverse health effects including endocrine problems, diabetes, high blood pressure.  It is best avoided. Most metal water bottles are made of stainless-steel. Stainless-steel does not wear down and release metal into the water. In addition, there are no known adverse health effects of stainless steel. When choosing a stainless-steel water bottle, make sure there is no aluminum and no lead-based solder used to seal the bottle. Lastly, make sure the plastic cap does not contain BPA.

 

So, don your toga, grab your stainless-steel water bottle and head to the agora to think those heavy thoughts.

 

The Inflamed Heart

 

The Chinese New Year was celebrated on February 17 2026, marking the Year of the Fire Horse. This is a rare event as the last Fire Horse year was 1966. In honor of the Fire Horse, this month's column will discuss inflammation. The term inflammation comes from the Latin word "inflammare", meaning "to set on fire". Inflammation is the body’s defense system. The term conveys the idea that a fire is being lit to protect the body. When the body is faced with a stressor, such as an infection, a trauma, or a toxin, the inflammatory response is activated, isolating the insult, removing it and starting the healing process. The five symptoms of inflammation are: redness (rubor) in the area of injury, heat (calor), swelling (tumor), pain (dolor) and loss of function. Acute, short term (few days) inflammation is vital for protection and healing. However, chronic inflammation (lasting months to years) is harmful and attacks healthy tissue. How is the heart affected by inflammation? How can heart inflammation be detected and treated?

 

The heart is not immune to inflammation. Chronic inflammation leads to several types of heart disease. Coronary artery disease is felt to be an inflammatory process. If the wall of a heart artery is damaged (due to high blood pressure, diabetes or smoking) the immune system is activated and the inflammatory process is initiated to heal the arterial wall. Inflammatory cells and cholesterol come to the area to repair the damage. If the process continues over months to years (chronic inflammation) plaque is built up in the artery wall. If allowed to continue, this can lead to blockage in the blood flow to the heart muscle, causing chest pain. Alternatively, inflammation can cause acute rupture of a plaque leading to a heart attack. It is now well established that long-term, low-grade inflammation is the key to heart artery plaque formation, progression and rupture. In addition, congestive heart failure is driven by chronic inflammation. Inflammation promotes damage to the lining of the heart muscle (the endothelium) and scarring of the heart. This leads to destruction and weakening of the heart muscle. Inflammation is promoted by smoking, obesity, high cholesterol, elevated blood pressure, diabetes, and other chronic inflammatory conditions (such as periodontitis, chronic kidney disease, rheumatoid arthritis, COPD).

 

How can inflammation be detected and followed? The blood test C reactive protein (CRP) is a nonspecific marker of inflammation. CRP levels will rise due to multiple conditions such as an infection, a traumatic event, acute arthritis and chronic inflammation. The latter scenario makes it useful for detecting low level, chronic inflammation in heart disease. CRP levels less than 1 mg/L is low risk for chronic inflammation. CRP levels over 3 mg/L denote higher risk for cardiac inflammation. Levels over 10 mg/L usually are present with an active condition, such as an infection. It is felt that CRP is at least as strong a risk marker for heart disease as blood pressure and low-density lipoprotein (LDL). 

 

How can chronic inflammation be treated? First and foremost are lifestyle changes to reduce the risk factors for chronic inflammation. This includes stopping smoking, losing weight and treating blood pressure, cholesterol and diabetes. Physical activity lowers CRP levels. Diet is vitally important as well. There are proinflammatory diets that increase the risk for inflammation and heart disease. On the other hand, the Mediterranean diet with olive oil, nuts and fatty fish intake lowers CRP and the risk for chronic heart disease. Proinflammatory foods include red meat, processed meat, refined carbohydrates and sweetened beverages. Anti-inflammatory items include green leafy vegetables, whole grains, fruits, tea, coffee. Many medications have been trialed to see if they reduce inflammation and cardiac risk. Statins lower both LDL and CRP and are the first line agents used to combat high cholesterol and chronic inflammation. Another cholesterol lowering agent, bempedoic acid, also reduces CRP by 20-30%. Colchicine has been used for many years as an anti-inflammatory agent in gout. Low dose colchicine has also been shown to reduce cardiac events in patients with known heart artery disease by 25%. 

 

What else can be done to lower chronic inflammation? Aside from protecting against a nasty disease, and much like statins, the shingles vaccine has multiple secondary benefits. The shingles vaccine has been shown, in many studies across the world, to reduce the risk for dementia by about 20%. Now a new study showed that those with the vaccine had lower inflammation scores and that the vaccine actually slowed the aging process. 

 

The Fire Horse symbolizes an intense, high-energy year dedicated to rapid change. So, make this the year you tackle your risk for chronic inflammation. Using the tools described here will keep you on track and in the horse race.