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Nick #RespiratorsFilterPathogens😷 Anderegg Profile picture
@NickAnderegg
Aug 15, 2024 • 20 tweets • 9 min read • Read on X
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My thoughts on this new finding? AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA

"The consumption of BW [bottled water] is associated with heightened risk for certain health conditions," such as:
- hypertension (+5% increased risk)
- diabetes (+9%)
- GI ulcers (+21%)
- kidney stones (+17%)

1/10 Published Aug 15, 2024 in IJERPH: "Consumption of Bottled Water and Chronic Diseases: A Nationwide Cross-Sectional Study" Abstract: "...On average, a liter of bottled water includes about 240,000 tiny pieces of plastic. ... Utilizing data from the Italian National Institute of Statistics’ “Aspects of Daily Life” survey (N = 45,597), we employed logistic regression to explore the correlation between BW consumption and the prevalence of various chronic diseases,... Adjustments were made for covariates such as education, age, gender, and economic resources. Our analysis indicat...
This was a very large cross-sectional study that looked at a national population, conducted by Italy's census agency. They controlled for covariates including socioeconomic status, age, and gender, then clustered and stratified the population as appropriate.

Solid methods!

2/10
"Data on BW consumption were obtained from the “Aspects of Daily Life” survey on households, conducted by the Italian National Institute of Statistics (ISTAT) [19]. ... The aim of the survey is to identify a variety of behavioral dimensions and aspects of daily life. ... We analyzed data from the 2021 edition of the survey, which included 45,597 individuals and 20,000 families, focusing on those who were 18 years or older at the time of the survey. ... a distinct stratum of municipalities with larger populations, labeled as self-representative (SR), and other municipalities, designated...
"The following variables were included in the analysis: educational level, age, gender, economical resources in the last 12 months, body mass index, smoking, alcohol consumption, physical activity, hypertension, diabetes, presence of kidney stones, presence of gastric or duodenal ulcer."
Analysis is *conceptually* straightforward:

- They built models to understand how bottled water + EACH confounding variable interacts to impact health outcomes.
- They combined those models into one big model to analyze all the variables together for each possible outcome.

3/10 "Bivariate analyses were performed to study the association between BW consumption and relevant variables, using chi-square tests. Logistic regression models were developed to control for confounding variables and assess the factors independently linked with BW consumption (1 if BW consumption is present; 0 if not). ... In cases of poor fit, stepwise regression, using AIC and BIC criteria, was utilized to select between models and discriminate between covariates. Regarding health outcomes, we considered the dichotomized presence of the following chronic diseases: hypertension (1 = yes, ...
In this sample, slightly over half of the population usually drank bottled water. Bottled water consumption was also associated with lower socioeconomic status (less education, less economic resources), showing that this is yet ANOTHER issue where wealth=health.

4/ "A total of 22,217 subjects usually drank BW, representing 56.8% of participants (95% confidence interval, CI 56.27–57.25). In terms of prevalence, bivariate analyses (Table 1) highlighted a higher prevalence of BW consumption in people aged 18 to 44 years (N = 6972, 58.4%, p-value < 0.05) with no statistically significant difference between males and females. Considering education, people with a middle school diploma showed the highest prevalence of BW consumption (N = 6111, 59.3%, p-value < 0.05), as did people with scarce economic resources (N = 6197, 58.6%, p-value < 0.05). Regarding ...
For all four of the examined health outcomes, individuals with any one of those conditions (diabetes, ulcers, kidney stones, hypertension) were more likely than not to regularly consume bottled water.

Moreover, although the difference wasn't significant for hypertension...

5/ "Focusing on stratification according to health outcomes, higher prevalence was found among people with diabetes (N = 1898, 59.2%, p-value ≤ 0.05), gastric/duodenal ulcers (N = 662, 61.6%, p-value ≤ 0.05), and kidney stones (N = 700, 60.7%, p-value ≤ 0.05). Concerning the presence of hypertension, even if people affected by it showed a higher prevalence (N = 5551, 57.3%, p-value > 0.05) at the bivariate analysis, the difference with people not affected did not reach statistical significance. As shown in Table 2, the consumption of BW was associated with the presence of hypertension (OR = 1....
The prevalence of bottled water consumption was higher among individuals with these chronic conditions than among individuals without these chronic conditions—even after controlling for sex, age, economic resources, education, BMI, smoking, alcohol, and physical activity.

6/ Table 2. Chronic diseases associated with BW consumption at logistic regression analysis. All models have been adjusted for sex, age, economic resources, level of education, BMI, smoking status, alcohol consumption, and physical activity. Outcome, Odds Ratio (OR), p-Value, C.I. Hypertension, 1.05, 0.05, 1.00-1.11 Diabetes, 1.09, 0.005, 1.01-1.18 Kidney stones, 1.17, 0.013, 1.03-1.32 Gastric/duodenal ulcers, 1.21, 0.003, 1.07-1.38
Here's how you interpret the stats (using ulcers stats):

- The higher prevelance of BW drinkers among those with ulcers is statistically significant (unlikely to be due to random variation).
- BW drinkers are 21% more likely to have ulcers than someone who doesn't drink BW.

7/

"Focusing on stratification according to health outcomes, higher prevalence was found among people with ... gastric/duodenal ulcers (N = 662, 61.6%, p-value ≤ 0.05)... ...the consumption of BW was associated with ... gastric or duodenal ulcer (OR = 1.21, C.I. 1.07-1.38, p-value = 0.003)."
The difference in rates of bottled water drinking between those with and without ulcers was statistically significant (p<0.01)-meaning there is less than a 1% chance that this difference between the groups is caused by random variation. Out of the 20,238 people who do NOT have gastric/duodenal ulcers, 56.7% are bottled water drinkers. Out of the 662 people who DO have gastric/duodenal ulcers, 61.6% are bottled water drinkers.
Those who consume bottled water regularly are 21% more likely to have gastric/duodenal ulcers than those who don't consume bottled water. This means, roughly, there is only a 0.3% chance that a random sample would produce these same results if the null hypothesis (null hypothesis="BW has no association") is true.
What's it mean? First, note that these results don't show a *causal* link, only a *strong association* between habitual BW consumption and these chronic conditions.

Not *causal* = Maybe people with these conditions consume BW because of their condition, or simply prefer BW!

8/ "Nevertheless, some limitations should be acknowledged. Due to the observational nature of this study, we cannot claim any causal link between BW consumption and the presence of the investigated chronic diseases. Moreover, since all data are declarative, there is potential for declarative or recall bias in our sample. Specifically, we did not have information on the exact quantity of BW consumption in terms of bottles, liters, or other quantifiable measures that could have been useful in better estimating the associations with chronic diseases."
Importantly, these results generally line up with what we would expect to see, however, based on previous research. Micro- and nanoplastics have been found to cause all kinds of issues with biological tissues in vitro!

9/10
"... These effects on cardiovascular and endocrine systems are likely to be multifactorial, but both population-based and experimental studies point to inflammation, oxidative stress, and hormone imbalances as potential mediators. Chemical compounds that are usually present in the composition of plastics have been seen to have endocrine-disrupting properties and can alter both hormone homeostasis and signal transduction pathways [26], thereby increasing the risk of adverse health outcomes. So, from cellular and endocrine signal disruption, chronic exposure may lead to relevant and mani...
"Moreover, as well as cardiovascular diseases, a recent systematic review and meta-analysis showed that, also in kidney diseases, bisphenol A has been counted among possible risk factors . An in vitro study showed that MNPs can enter the cells through endocytosis, causing damage to cellular microstructures and an increase in the expression of JNK1/2/3 and TNF-a, a pathway involved in cancer-related pathways [28]. Regarding the gastrointestinal tract (GIT), we found an increased likelihood between the assumption of BW and the presence of gastric or duodenal ulcers. Some animal models ha...
Bottled water "has been found to be a possible major source of exposure" to microplastics. "Policymakers and public health institutions can no longer delay initiatives aimed at reducing plastic production, consumption, and use..."

Original paper:

10/10 mdpi.com/1660-4601/21/8…
"Despite several worldwide efforts, the production and use of plastic is constantly increasing [31]; and a growing body of evidence points out that the presence of plastics poses potential risks to human health via ingestion [32]. Among exposure pathways, BW has been found to be a possible major source of exposure due to the higher presence of micro- and nano plastic particles due to possible breakdown over time. This exposure can reach estimated concentration values 10 to 100 times greater than those estimated in the past [3]. These minuscule particles can invade individual cells and ...
This study just used a dichotomized (binary) variable, meaning a simple yes/no whether or not someone says they regularly drink bottled water.

However, that's perfectly adequate for logistic regression models!

11/10

"Discussion The results of this study showed interesting associations between the consumption of BW and several chronic diseases, including hypertension, diabetes, kidney stones, and gastric or duodenal ulcers. This finding has important public health implications, considering that over 56% of our sample reported using BW. Furthermore, our data differ from a survey by CSA Research, which indicates that about 70% of Italians rely on bottled water for their daily hydration needs (ALOR Italy). These findings may be in accordance with previous studies that observed an association betwee...
I'm genuinely baffled how this is unclear, but this study is in reference to water in disposable plastic bottles.

If something is unclear, I provide the source for clarity! But I also refer to microplastics in the thread, so like... I can't *read* for you!

12/10 Screenshot showing that the first part of the abstract (including a sentence that was highlighted and included in the original alt text) mentions the word "plastic" six times: "Abstract: Plastic pollution is a growing concern. It can form smaller particles called microplastics (<5 mm), Microplastics can break down into even smaller pieces called nanoplastics (41 um). These minute particles can infiltrate human cells and tissues, with their health impacts still largely undetermined. On average, a liter of bottled water includes about 240,000 tiny pieces of plastic. The purpos...
I welcome questions and criticisms!

I only take issue with ONE thing: A reply to the first tweet in a thread which asks a question that I made sure to address within the thread (or which is *also* addressed in the screenshot in the first tweet).

Just read the damn thing!

13/10
Some of these replies are absolutely baffling. Holy fuck.

I can't read things for you!

14/10
While I don't know how the specifics of this paper would apply to that situation, it's just generally true that reusable water bottles are better constructed than disposable plastic bottles. Durability is a factor in microplastic concentrations

15/10
As with anything, the dose makes the poison. If your organs are exposed to toxins only occasionally, they're more likely to be able to clear out the contaminants and repair any damage than if they were exposed constantly.

16/10
At the very least, it probably hasn't *helped*, considering the known impacts certain plastics can have on renal function.

However, it's also worth noting mild COVID can have serious long-term impacts on the kidneys as well:

17/10
pandemicpatients.org/home/covid-19-…

"Regarding kidney disease, again our results seem to be in agreement with what is actually known about plastic exposure and the higher prevalence of kidney health issues. It has been observed that melamine, a versatile compound with many industrial applications, including plastic production, can leak from bottles, plates, cups, and utensils into food and water when exposed to acids or high temperatures. This compound can then cause renal tubular cell injury through inflammation, fibrosis, and apoptosis, suggesting that melamine-induced apoptosis and/or necrosis may subsequently result ...
Reusable plastics are definitely at the *least concerning* end of the spectrum. A very large portion of the microplastics in a container come from mechanical abrasion (i.e. the friction of the contents), and hard plastics are more resistant to this type of wear!

18/10
All else being equal, I’d expect the total plastic particle content of bottled water to be something like

Smart Water [least] < Aquafina (when it’s in the same bottles as Pepsi) < All the super cheap plastic bottles that most bottled water comes in [most]

19/10

Smart Water, which has a fairly rigid plastic bottle
Aquafina often comes in the same bottles as carbonated beverages, which are fairly sturdy bottles.
Other beverages in plastic containers will likely also contain some level of microplastics, but to a lesser extent if the bottle is better constructed. At the bare minimum, I’m going to avoid bottled water that comes in super cheap bottles with no structural integrity!

20/10

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More from @NickAnderegg

Nick #RespiratorsFilterPathogens😷 Anderegg Profile picture
Sep 7
Let’s talk about systemic risk from negligent public health: Catastrophe doesn’t require population-wide illness.

The worst case isn’t sickness. Worst case is infrastructure collapse due to overstressed resources.

You know power plants need stable power to operate?

1/many “8. Performance of Nuclear Power Plants Affected by the Blackout On August 14, 2003, nine U.S. nuclear power plants experienced rapid shutdowns (reactor trips) as a consequence of the power outage. Seven nuclear power plants in Canada operating at high power levels at the time of the event also experienced rapid shutdowns. […]. Many non-nuclear generating plants in both countries also tripped during the event. Numerous other nuclear plants observed disturbances on the electrical grid but continued to generate electrical power without interruption. […] - The severity of the grid transient...
If there is a widespread disruption in the service area of, e.g., a nuclear power plant, it shuts down for safety. Massive blackouts like in 2003 or in Spain this year are caused by safety systems!

If too much trips out at once, it has a ripple effect across the grid
2/ Source: https://www.insurancejournal.com/news/international/2025/04/29/821703.htm Why Restarting a Power Grid After Massive Collapse Is So Hard April 29, 2025 by Rachel Morison and William Mathis It’s a worst case scenario that grid operators plan for but hope never to encounter. After one of the worst blackouts in Europe in more than a decade, electricity grid operators in Spain and Portugal are trying to get networks back up and running from the ground up. The initial estimate from grid operator Red Electrica was that restoring all power supply in Spain may take between six and 10 hour...
Frequency Factor So far, the only information about what caused the crisis was a comment from grid operator Red Electrica that the blackout was a result of “oscillation,” which suggests a disruption in the grid’s frequency or voltage — both crucial factors for maintaining stability. The frequency, which normally stays pretty steady around 50 hertz, is the heartbeat of the grid. Frequency monitoring specialist Gridradar said it identified a rapid movement in frequency just after noon in Spain — right before the blackout hit. Such oscillations can cause chain reactions that ultimately lead ...
In 2003, it took 2 days to fully restore most power. The infrastructure is 20 years older than it was back then and higher demand creates risk of cascading failure.

As of 2003, recommendations from blackouts in 1965, 1977, 1982, 1996, and 1998 had not been implemented.
3/ “Recommendations to Prevent or Minimize the Scope of Future Blackouts As reported in previous chapters, the blackout on August 14, 2003, was preventable. It had several direct causes and contributing factors, including: • Failure to maintain adequate reactive power support • Failure to ensure operation within secure limits • Inadequate vegetation management • Inadequate operator training • Failure to identify emergency conditions and communicate that status to neighboring systems • Inadequate regional-scale visibility over the bulk power system.”
“Further, as discussed in Chapter 7, after each major blackout in North America since 1965, an expert team of investigators has probed the causes of the blackout, written detailed technical reports, and issued lists of recommendations to prevent or minimize the scope of future blackouts. Yet several of the causes of the August 14 blackout are strikingly similar to those of the earlier blackouts. Clearly, efforts to implement earlier recommendations have not been adequate. Accordingly, the recommendations presented below emphasize comprehensiveness, monitoring, training, and enforcement of r...
“1. Market mechanisms should be used where possible, but in circumstances where conflicts between reliability and commercial objectives cannot be reconciled, they must be resolved in favor of high reliability. 2. Regulators and consumers should recognize that reliability is not free, and that maintaining it requires ongoing investments and operational expenditures by many parties. Regulated companies will not make such outlays without assurances from regulators that the costs will be recoverable through approved electric rates, and unregulated companies will not make such outlays unless th...
“3. Recommendations have no value unless they are implemented. Accordingly, the Task Force emphasizes strongly that North American governments and industry should commit themselves to working together to put into effect the suite of improvements mapped out below. Success in this area will require particular attention to the mechanisms proposed for performance monitoring, accountability of senior manage-ment, and enforcement of compliance with standards. 4. The bulk power systems are among the most critical elements of our economic and social infrastructure. Although the August 14 blackout ...
Read 20 tweets
Nick #RespiratorsFilterPathogens😷 Anderegg Profile picture
Sep 4
If Florida drops vaccine mandates, society is probably officially over. I really, really, really don’t think most people get that herd immunity is the only thing keeping measles from ripping through the population, and a measles infection wipes out all pre-existing immunity

1/3
Measles specifically infects the cells that are responsible for “remembering” which pathogens your body has encountered before. So they ALL get wiped out, and all you’re left with is cells that remember your measles infection and nothing else.

2/3
Every infection, vaccination, and other pathogenic exposure you’ve ever had? Your body no longer knows how to detect them after a measles infection. The only immunity you’ll be left with is immunity to measles. That’s it. Open season for every other pathogen encountered.

3/3
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Nick #RespiratorsFilterPathogens😷 Anderegg Profile picture
Jun 30
Can I say something? I have a BA in psych, a BPhil in linguistics, and went to grad school for cognitive psych. My research, including an undergrad fellowship, was on the cognitive relationship between written and spoken language…

Audiobooks are NO DIFFERENT than reading print.
In the last hour, there have been a dozen replies from people nitpicking the first tweet

The topic of discussion is "do audiobooks 'count' as reading?," and the answer is "Audiobooks are NO DIFFERENT than reading print."

Maybe read the thread before arguing with it? lmfao
And for all those people with indignant responses who want to nitpick every detail, the fact that so many people hold THIS exact view—that audiobooks are somehow “cheating”—is the ENTIRE point. It leads to people who would benefit from audiobooks depriving themselves the medium
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Nick #RespiratorsFilterPathogens😷 Anderegg Profile picture
Feb 1
Many people are asking for recommendations about what storage media to buy, so here's a buying guide from an experienced data hoarder (me)

The MOST IMPORTANT thing to know is that SOLID-STATE MEDIA IS NOT DURABLE. Flash drives, SSDs, SD cards, etc. are NOT long-term storage.

1/
That's not to say that it's impossible to use solid-state media for long-term storage. It's just that anything with durability guarantees gets prohibitively expensive quickly. Spinning hard drives—as well as DVDs and Blu-ray discs!—are your friend.

2/
- The way data is stored in solid-state media makes it much more susceptible to bit rot than other media.
- In a spinning hard drive, the moving parts are the most common point of failure.
- When you burn a DVD, that shit is fairly permanent.

3/
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Nick #RespiratorsFilterPathogens😷 Anderegg Profile picture
Jan 9
I wish people would understand that insurance underwriters have armies of actuaries calculating risks, and if an insurance company drops you, it's because things have changed in such a way that insuring you will take more out of the financial pool than you're putting in

1/
It sucks, but it's a direct result of the fact that humans are widely inhabiting locations that are rapidly becoming impossible to inhabit safely. If you can't find insurance for your home, it means there's a high likelihood you'll need to move soon anyway.

2/
You get insurance so that you can replace all of your stuff in the event of a disaster. When the insurance company effectively says "the risk of disaster is so high that insuring you would almost certainly cause us to lose a lot of money," it ALSO means your life is in danger

3/
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Nick #RespiratorsFilterPathogens😷 Anderegg Profile picture
Jan 5
So here’s the thing about some of the subtle neuro damage related to SARS-CoV-2 infection that I think a lot of people miss: some of the known deficits are correlated with things like impulsiveness and poor emotional control, so we might expect to see deficits there are well

1/
Consider how impatient people seem to be on the road in the last couple years relative to the 2010s, and I think we have a perfect example of where this is LIKELY already manifesting.

2/
This impact is particularly insidious for the person experiencing it, because poor impulse control, by definition, doesn’t really come on gradually. My biggest concern is how interactions under these circumstances will play out if this impact continues to become more common

3/
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