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MSG and Weight Gain

No MSGThe Body Mass Index (BMI) is a measure of the relative percentages of fat and muscle mass in the human body, based on a person’s weight and height, used to assess obesity. This barometer was used by researchers to determine the effect of the food additive, monosodium glutamate (MSG), on weight over a period of time. It was learned that those persons who consume MSG regularly experience changes in the part of the brain that controls appetite, thus having an influence on energy balance and consequent weight gain.

When researcher, Ka He, and his colleagues at the University of North Carolina began to look for a relationship between monosodium glutamate and weight gain, they hypothesized that it would be a positive one.  As a design element of the study, “…overweight was defined as a body mass index ≥ 25…based on World Health Organization recommendations for Asian populations.”  With an average MSG intake of 2.2 grams a day, and a five-year follow-up, the study population demonstrated that “MSG consumption was positively, longitudinally associated with overweight development…”

The better it tastes, the more we’ll eat.  That seems logical.  Most Americans eat so fast that their brains don’t have enough time to process the information that says they’re full.  Since that lag time is about twenty minutes, we should take at least that much time to eat.  But the school cafeteria, the incessant phone calls, the pressures of the job, and other lifestyle components disallow that.  Combine any of these facets of life with food additives that enhance flavor, and start looking for a longer belt.

Leptin is a hormone that plays an important role in energy intake and expenditure, and it tells us when to stop eating…if it works the right way.  It’s made by fat cells, oddly enough, but can also come from other parts of the body, such as the bones, stomach, and liver.  It acts on parts of the brain’s hypothalamus, where it inhibits appetite. If leptin is not appropriately received and taken up by the hypothalamus, appetite fails to shut off and food intake is uncontrolled.  Where does MSG fit into this picture?  It seems to be able to induce hypothalamic lesions and ensuing leptin resistance (He, et al. 2008).  The stage is now set for weight gain.

Glutamate is the major excitatory transmitter in the brain, meaning that it makes things happen, especially in cognition, memory and learning.  It also affects brain development, cellular survival and the manufacture of synapses.  Too much glutamate, though, can raise serious concerns because its excitatory nature becomes intensified by virtue of its accumulation, allowing excess calcium to enter a nerve cell and damage it beyond repair.  This is what happens in the hypothalamus.

Glutamate, sometimes as glutamic acid, is responsible for the tantalizing flavors of poultry, some fishes, and eggs, among other foods.  Its salt, MSG, was introduced to the United States after WW II as “Accent” flavor enhancer.  It can be made by the fermentation of beets, sugar cane, or molasses.  People began to experience adverse reactions to MSG after eating Chinese food prepared with it, thereby coining the expression “Chinese Restaurant Syndrome.”  Sensitivity to monosodium glutamate may present with headaches, asthmatic symptoms, hyperactivity (especially in children), and obesity.  Frequency of such responses is low, but if it happens in your family, it’s high enough to merit attention.

We all know that the world revolves around the dollar bill and the ball point pen, the latter often employed to guarantee the former.  As long as clandestine groups can get away with something, they’ll persist.  And so it is with MSG.  It has more disguises than Artemus Gordon and Sherlock Holmes combined.  Here are a couple handfuls of MSG aliases:  glutamic acid, monopotassium glutamate, magnesium, glutamate, monoammonium glutamate, yeast extract, hydrolyzed anything, calcium or sodium caseinate, yeast nutrient, gelatin, textured protein, soy protein isolate, soyprotein concentrate, whey protein, ajinomoto.

These ingredients often contain glutamic acid:  carrageenan, bouillon, stock, maltodextrin, barley malt, protease, malt extract, soy sauce, and any protein that is fortified or fermented.  Additionally, these work with MSG to further enhance flavor:  Disodium 5’-guanylate; Disodium 5’-inositate; and Disodium 5’-ribonucleotides.  Wherever these three abide, it’s almost guaranteed that MSG is a companion.

Individual amino acids are not generally listed on the ingredients labels of food or health care products.  Binders and fillers may or may not contain MSG.  Believe it or not, MSG may also appear in cosmetics, including shampoos, soaps and hair conditioners.  If the words “hydrolyzed,” “amino acids,” or “protein” appear on the label, MSG could be in it.  Live virus vaccines may also have it.  Even though reactions to MSG are dose-dependent, you could react to a very small amount all of a sudden, when you never did so before.  Yes, MSG is natural, but so is arsenic.  To most of us, MSG does not cause problems.  MSG might make you want to eat more.  It might affect the state of your hypothalamus.  On the other hand, it’s not likely to make you wash your hair more often.  Is it?

Referneces

Am J Clin Nutr. 2011 Jun;93(6):1328-36. Epub 2011 Apr 6.
Consumption of monosodium glutamate in relation to incidence of overweight in Chinese adults: China Health and Nutrition Survey (CHNS).
He K, Du S, Xun P, Sharma S, Wang H, Zhai F, Popkin B
Departments of Nutrition and Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Acta Physiol Hung. 2011 Jun;98(2):177-88.
Monosodium glutamate versus diet induced obesity in pregnant rats and their offspring.
Afifi MM, Abbas AM.
Department of Biochemistry, Zagazig University, Zagazig, Egypt.
Abstract

Am J Clin Nutr. 2011 Jun;93(6):1328-36. Epub 2011 Apr 6.
Consumption of monosodium glutamate in relation to incidence of overweight in Chinese adults: China Health and Nutrition Survey (CHNS).
He K, Du S, Xun P, Sharma S, Wang H, Zhai F, Popkin B.

Nutrition. 2005 Jun;21(6):749-55.
Monosodium glutamate in standard and high-fiber diets: metabolic syndrome and oxidative stress in rats.
Diniz YS, Faine LA, Galhardi CM, Rodrigues HG, Ebaid GX, Burneiko RC, Cicogna AC, Novelli EL.
Department of Clinical Cardiology, Faculty of Medicine, University of São Paulo State, Botucatu, Brazil.

Mol Pharmacol. 1989 Jul;36(1):106-12.
Delayed increase of Ca2+ influx elicited by glutamate: role in neuronal death.
Manev H, Favaron M, Guidotti A, Costa E.
Fidia-Georgetown Institute for the Neurosciences, Georgetown 4niversity, Washington, DC 20007.

Cell Calcium. 2003 Feb;33(2):69-81.
Calcium influx constitutes the ionic basis for the maintenance of glutamate-induced extended neuronal depolarization associated with hippocampal neuronal death.
Limbrick DD Jr, Sombati S, DeLorenzo RJ.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Wellness In The New Year (or any year for that matter)

wellness-roadThere are some things in life we just can’t control. The weather is a good example, but other people’s behavior runs a close second. In fact, sometimes we have a hard time controlling our own behaviors. Take a look at the last éclair in the box. Isn’t it calling your name? Although we can’t direct weather patterns, we can prepare for their uncertainties. Humans do have the wherewithal to live through a hurricane unscathed, but it takes conscious effort and self-direction. We can’t rely on other people to take care of us while they’re trying to tend to their own needs. When it comes to our personal health behaviors, only we are responsible. This we can control. Making a resolution to do it is fruitless, almost inane. Doing it is noble.

Wellness is not the same thing as health. It’s possible to suffer a chronic condition and still be well. A person who lives with a limitation may be more well than a person whose faculties are fully operational. While health may be defined as being physically, mentally and spiritually sound—maybe even financially, occupationally and socially— wellness describes a desire to enhance successful existence, one’s quality of life. Yet the definition of wellness is elusive and subjective. New models of wellness emerge regularly, existing on a continuum and being peculiar to each of us.

A sage cleric once said that ideas determine consequences, a concept based on absolute truth. Simply put, if you do this, that will happen. You can deny that black is black, and even call it dark white, but that changes nothing. The decisions you make today determine the outcome down the road. Because wellness is a process, it can always be improved, even by borrowing ideas and habits from others. Take a gander at some of these wellness ideas.  A few might make sense to you.

Indoor plants purify the air, albeit some are better at it than others. One of the best ways to improve indoor air is to quit smoking, and, if you have children, you’ll save money on doctor visits, too. Clean air also will help you in your newly-designed exercise program, even though it starts at only five minutes a day. We won’t beleaguer you with admonitions. We promise. This you can begin upon arising, while still in bed. What does the dog do when he first wakes up?  He stretches. Your blood vessels have been scrunched up all night. Stretch and open ’em up. Try to do a few sit-ups while you’re at it. Believe it or not, it’ll make a difference. Yes, it’ll take time, but some things are worth the wait. After your feet hit the floor, drink a full glass of water. A drop of lemon juice won’t hurt. You’ve been dehydrated all night—no fluids for eight hours. Your cells probably resemble dried peas or a half-inflated basketball. It’ll take about 20 minutes for the water to hit home, but when it does you’ll feel refreshed and improve the viscosity of your blood to keep it flowing the way it should.

Replacing that soda with plain or acidulated water or tea will swap hazard for benefit. The sugar in soda provides empty calories that get stored as fat if you don’t burn ‘em off. Even artificial sweeteners fool the body into thinking you ate something sweet. When the body learns it’s been fooled, it makes you hungry so you can use up all the insulin that’s now floating around, looking for something to do. Weight may increase. http://www.medicinenet.com/artificial_sweeteners/page11.htm

Have you looked into supplements?  Despite some negative press by opposing industries and their minions, they work. Fish oil does provide cardiac and anti-inflammatory profit, and high quality multi-vitamins do what they declare (Fletcher, 2002) (Gaziano, 2012). Besides, the nutrients once promised by fruits and vegetables now are in short supply because of modern farming practices, careless shipping and storage, and poor kitchen habits.

The cost of sleep deprivation—both financial and salubrious—is enormous. During this suspension of will power and consciousness the body and mind put things that have been disassembled by the day’s toils back together. Some of the factors that interfere with sleep can be controlled. Though not the simplest thing to do, interfering stress can be modified or even eliminated. Getting eight hours of sleep at least three or four times a week is a boon to health (Romeijn, 2012) (Ribeiro, 2012) (Chamorro, 2011) (Donga, 2010).

Taking care of yourself is necessary before you can be expected to take care of others. Some proactive measures, albeit controversial in particular circles, ask for more than moderate energy expenditure.

Reading labels is one. Learn what toxins are added to the kids’ vaccines and do something to avoid them, like asking the doctor to take the liquid from the middle of the vial—if vaccinations are a must. What’s the rub with vaccines?  Formaldehyde, mercury and MSG as preservatives. Getting more than one shot at a time places a heavy burden on a little body, so request dosing at intervals. Learn what additives are in your toothpaste. Got canker sores?  Look for sodium lauryl sulfate on the label (Chahine, 1997). Other personal and house care items might contribute to personal woes because of unneeded synthetic additives like perfumes, foaming agents, softeners and petroleum distillates.

Among the many steps to wellness, one of the most effective is realizing that food is nourishment, not entertainment. Eat what your body needs, not what your senses of smell and taste otherwise dictate. Unburned carbs get stored as fat. Sugars—think cookies and cakes—create acids that support disease, including cancer (Liu, 2000) (Burley, 1998) (Tuyns, 1988). The wrong fats encourage vascular problems—get the essential fats instead, like omega-3 and omega-6 fatty acids. Under hydration frustrates cell activity and will cause mental fog. The more you talk about health, the more likely you are to cater to it. Who better to direct person-centered health care than the person inside?

References

Mauro Alivia, Paola Guadagni, and Paolo Roberti di Sarsina
Towards salutogenesis in the development of personalised and preventive healthcare
EPMA J. 2011 December; 2(4): 381–384.

Burley VJ.
Sugar consumption and human cancer in sites other than the digestive tract.
Eur J Cancer Prev. 1998 Aug;7(4):253-77.

Chahine L, Sempson N, Wagoner C.
The effect of sodium lauryl sulfate on recurrent aphthous ulcers: a clinical study.
Compend Contin Educ Dent. 1997 Dec;18(12):1238-40.

Chamorro RA, Durán SA, Reyes SC, Ponce R, Algarín CR, Peirano PD.
[Sleep deprivation as a risk factor for obesity].
Rev Med Chil. 2011 Jul;139(7):932-40. Epub 2011 Sep 16.

Donga E, van Dijk M, van Dijk JG, Biermasz NR, Lammers GJ, van Kralingen KW, Corssmit EP, Romijn JA.
A single night of partial sleep deprivation induces insulin resistance in multiple metabolic pathways in healthy subjects.
J Clin Endocrinol Metab. 2010 Jun;95(6):2963-8. Epub 2010 Apr 6.

Fletcher RH, Fairfield KM.
Vitamins for chronic disease prevention in adults: clinical applications.
JAMA. 2002 Jun 19;287(23):3127-9.

Gaziano JM, Sesso HD, Christen WG, Bubes V, Smith JP, MacFadyen J, Schvartz M, Manson JE, Glynn RJ, Buring JE.
Multivitamins in the prevention of cancer in men: the Physicians’ Health Study II randomized controlled trial.
JAMA. 2012 Nov 14;308(18):1871-80.

Albert Lee, Andrew Kiyu, Helia Molina Milman, and Jorge Jimenez
Improving Health and Building Human Capital Through an Effective Primary Care System
J Urban Health. 2007 May; 84(Suppl 1): 75–85.

Simin Liu, Walter C Willett, Meir J Stampfer, Frank B Hu, Mary Franz, Laura Sampson, Charles H Hennekens, and JoAnn E Manson
A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women1,2,3
Am J Clin Nutr June 2000 vol. 71 no. 6 1455-1461

Ronald W. Manderscheid, PhD, Director, Carol D. Ryff, PhD, Elsie J. Freeman, MD, MPH, Lela R. McKnight-Eily, PhD, Satvinder Dhingra, MPH, and Tara W. Strine, MPH
Evolving Definitions of Mental Illness and Wellness
Prev Chronic Dis. 2010 January; 7(1): A19.

McMahon S, Fleury J.
Wellness in older adults: a concept analysis.
Nurs Forum. 2012 Jan-Mar;47(1):39-51. doi: 10.1111/j.1744-6198.2011.00254.x.

Mullen KD.
Wellness: the missing concept in health promotion programming for adults
Health Values. 1986 May-Jun;10(3):34-7.

Ribeiro S.
Sleep and plasticity.
Pflugers Arch. 2012 Jan;463(1):111-20. Epub 2011 Sep 27.

Romeijn N, Verweij IM, Koeleman A, Mooij A, Steimke R, Virkkala J, van der Werf Y, Van Someren EJ.
Cold hands, warm feet: sleep deprivation disrupts thermoregulation and its association with vigilance.
Sleep. 2012 Dec 1;35(12):1673-83. doi: 10.5665/sleep.2242.

Tuyns AJ, Kaaks R, Haelterman M.
Colorectal cancer and the consumption of foods: a case-control study in Belgium.

Nutr Cancer. 1988;11(3):189-204.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Toxins In Baby Wipes

baby-wipes-boxThe populace has become so self-assured that it trusts people and products to be what they want them to be, which could genuinely be opposite of their expectations. In the case of personal hygiene products, we are satisfied if they remove the smudge, erase the stain and kill the germ. Few consider the trade-off. Well, folks, it’s about time we did…consider the trade-offs, that is. As is the case with our food, if you can’t pronounce the name of the ingredient, it doesn’t belong in or on your body. We’re told that we consume too little of this or that chemical to be concerned about cancer but have you wondered if a little bit here and there adds up to a lot? Such it is with baby wipes.

Methylisothiazolinone (MIT) is one of those barely pronounceable words that may or may not find its way to the label of your baby wipes. It’s sort of like MSG, which has so many aliases you can’t tell if it’s in a food or not. Autolyzed this or that and hydrolyzed that or this are but two examples of MSG stage names. However, cosmetics and baby products do NOT fall under FDA regulations. A few things, such as soaps, require no label at all, but some makers include one to protect themselves legally. At the same time, proprietary ingredients can be secret and need not be listed at all. You see, if a product does not claim to have medicinal properties, its label can be vacant. MIT is a powerful biocide used in personal care products because it works well in solutions that contain water, which is a medium in which bacteria like to grow. Human occupational exposure to this chemical has resulted in contact dermatitis, chemical burns and allergic sensitization (Goncalo, 2013) (Urwin, 2013). Inhalation is also a common route of exposure (Aerts, 2013).  That means your baby gets a double whammy during a diaper change. The danger?  Neurotoxicity. Even brief exposure damages nerve cells (Du, 2002). One drop in a 55-gallon drum of water is all it takes. And that’s considered a safe level. Isn’t contact dermatitis enough insult (Lundov, 2011) (Monroe, 2010)?

A preservative originally meant for the paint industry has found its way into personal care products, including baby wipes. Iodopropynyl butylcarbamate (IPBC) is a biocide whose use is restricted in some countries, but not in the U.S.  Initially deemed safe, IPBC has been reported to be a potent contact allergen (Badreshia, 2002) (Bryld, 1997). Some things are put on the market without ever being checked out for safety. And that means long-term safety, not just for this week. Carbamate biocides inhibit acetylcholine at nerve synapses and neuromuscular junctions. Fortunately, this is reversible, but it might take a few weeks. Not all babies will react to all things in like manner, but there are signs to watch for. Hypersalivation, hypermotility of the GI system (stuff moves faster through the gut than normal), constriction of the pupil of the eye, vomiting, diarrhea, sweating, cyanosis, respiratory distress, muscle twitching and weakness, and convulsions are major reactions to carbamates (Merck Manual, 2013). This chemical has such potential for harm that the healthcare profession is prepared to handle its deployment as a terrorist weapon of mass casualties (Rosman, 2009). Sounds safe, eh?  If you don’t see it on the label, you have to call and ask…unless you have a guaranteed baby-safe product in your hand. This is serious business.

We’re not done yet. There’s one more. Actually, there are a few more, but time and space prevent their inclusion right now. If a disposable wipe is made from paper, it probably contains dioxins, which are not intentionally produced, but which are the by-products of several industrial processes, including bleaching of paper pulp, chemical and pesticide manufacture, and combustion activity. If there is waste incineration or a forest fire, there is combustion (Shibamoto, 2007) (Environment Australia, 1999). Anything termed “polychlorinated” is in the dioxin family. Notice that chlorine, a bleaching agent, is in the term. The toxicity of the various dioxin compounds varies, but it’s still there. Endocrine disruption is one action; altered gene expression is another. Reproduction problems, developmental delay, hormone dysfunction and immune damage add to the array. A more pressing matter with dioxins is their use in disposable diapers, where baby’ skin is exposed for a large part of the day.

Dioxins are persistent organic pollutants (POP’s) that exist ubiquitously—they’re everywhere, including the food supply, though because of strict emission controls are now on the wane. Because they accumulate in body fat, effects may not be realized for a long time, making it hard to pinpoint the blame for changes in liver function, heme metabolism, thyroid function and even diabetes and immunological disorders (Sweeney, 2000). Disturbances in tooth and sexual development have been observed (Alaluusua, 2004) (Mocarelli, 2000, 2008), as well as in bone resorption and formation (Koskela, 2012), where interference with the differentiation of osteoblasts and osteoclasts is a targeted effect (Korkalainen, 2009).

It’s important to purchase baby products that are safe. Adult products are no less contaminated with unpronounceable materials. Wipes made with organic fruit and vegetable extracts are much preferred, though paper may still be the substrate, in which case you night opt for cotton or flannel, which may be flushable, as hemorrhoid pads are. Considering the size of a baby’s gluteus, how big does a wipe need to be?  By the way, breast milk will contain dioxins that the mother has ingested from meats, poultry and fish that absorbed them from aerial transport of the chemical and consequent deposition on vegetables, pastures and roughages. Trimming fat from meat is the best first step to avoidance.

References

Aerts O, Cattaert N, Lambert J, Goossens A.
Airborne and systemic dermatitis, mimicking atopic dermatitis, caused by methylisothiazolinone in a young child.
Contact Dermatitis. 2013 Apr;68(4):250-1.

Alaluusua S, Calderara P, Gerthoux PM, Lukinmaa PL, Kovero O, Needham L, Patterson DG Jr, et al
Developmental dental aberrations after the dioxin accident in Seveso.
Environ Health Perspect. 2004 Sep;112(13):1313-8.

Badreshia S, Marks JG Jr.
Iodopropynyl butylcarbamate.
Am J Contact Dermat. 2002 Jun;13(2):77-9.

Bryld LE, Agner T, Rastogi SC, Menné T.
Iodopropynyl butylcarbamate: a new contact allergen.
Contact Dermatitis. 1997 Mar;36(3):156-8.

Castanedo-Tardana MP, Zug KA.
Methylisothiazolinone.
Dermatitis. 2013 Jan-Feb;24(1):2-6.

Coloe J, Zirwas MJ.
Allergens in corticosteroid vehicles.
Dermatitis. 2008 Jan-Feb;19(1):38-42.

Davies RF, Johnston GA.
New and emerging cosmetic allergens.
Clin Dermatol. 2011 May-Jun;29(3):311-5.

Du S, McLaughlin B, Pal S, Aizenman E.
In vitro neurotoxicity of methylisothiazolinone, a commonly used industrial and household biocide, proceeds via a zinc and extracellular signal-regulated kinase mitogen-activated protein kinase-dependent pathway.
J Neurosci. 2002 Sep 1;22(17):7408-16.

Environment Australia (1999),
Incineration and Dioxins: Review of Formation Processes
Department of the Environment and Heritage, Canberra.
http://www.environment.gov.au/settlements/publications/chemicals/dioxins/pubs/incineration-review.pdf

Environmental Protection Agency
Mechanism of Formation of Dioxin-Like Compounds During combustion of Organic Materials
March, 4, 2005
http://www.epa.gov/ncea/pdfs/dioxin/2k-update/pdfs/Dioxin_Chapter_2.pdf

European Commission
Brussels, 20 July 2001
Fact Sheet on dioxin in feed and food
http://ec.europa.eu/dgs/health_consumer/library/press/press170_en.pdf

Fewings J, Menné T.
An update of the risk assessment for methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) with focus on rinse-off products.
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Gonçalo M, Goossens A.
Whilst rome burns: the epidemic of contact allergy to methylisothiazolinone.
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Korkalainen M, Kallio E, Olkku A, Nelo K, Ilvesaro J, Tuukkanen J, Mahonen A, Viluksela M.
Dioxins interfere with differentiation of osteoblasts and osteoclasts.
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Koskela A, Viluksela M, Keinänen M, Tuukkanen J, Korkalainen M.
Synergistic effects of tributyltin and 2,3,7,8-tetrachlorodibenzo-p-dioxin on differentiating osteoblasts and osteoclasts.
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Lundov MD, Krongaard T, Menné TL, Johansen JD.
Methylisothiazolinone contact allergy: a review.
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Lundov MD, Zachariae C, Menné T, Johansen JD.
Airborne exposure to preservative methylisothiazolinone causes severe allergic reactions.
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Merck Manual. Feb 2013
Organophosphate and Carbamate Poisoning
Reviewed by Gerald O’Malley, DO and Rika O’Malley MD
http://www.merckmanuals.com/professional/injuries_poisoning/poisoning/organophosphate_and_carbamate_poisoning.html

Mocarelli P, Gerthoux PM, Ferrari E, Patterson DG Jr, Kieszak SM, Brambilla P, et al
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Monroe HR, Hu JC, Chiu MW.
Methylchloroisothiazolinone / methylisothiazolinone and moist wipe dermatitis.
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National Library of Medicine
TOXNET
Toxicology Data Network
3-Iodo-2-propynylbutylcarbamate
http://toxnet.nlm.nih.gov/cgi-bin/sis/search/d?./temp/~mlhtu6:0:@sa

Natkunarajah J, Osborne V, Holden C.
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Sato S, Shirakawa H, Tomita S, Ohsaki Y, Haketa K, Tooi O, Santo N, Tohkin M, Furukawa Y, Gonzalez FJ, Komai M.
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Schöllnast R, Kränke B, Aberer W.
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Shibamoto T, Yasuhara A, Katami T.
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Siebert J.
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M.H. Sweeney, P. Mocarelli
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U.S. Department of Health and Human Services
Household Products Database
Health and Safety Information on Household Products
3-iodo-2-propynylbutylcarbamate
http://hpd.nlm.nih.gov/cgi-bin/household/search?queryx=55406-53-6&tbl=TblChemicals&prodcat=all

Urwin R, Wilkinson M.
Methylchloroisothiazolinone and methylisothiazolinone contact allergy: a new ‘epidemic’.
Contact Dermatitis. 2013 Apr;68(4):253-5. doi: 10.1111/cod.12064.

Uter W, Gefeller O, Geier J, Schnuch A.
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Contact Dermatitis. 2012 Sep;67(3):125-9.

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North American Contact Dermatitis Group patch test results: 2009 to 2010.
Dermatitis. 2013 Mar-Apr;24(2):50-9.

Zirwas M, Moennich J.
Shampoos.
Dermatitis. 2009 Mar-Apr;20(2):106-10.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.