Jun 21, 2022

A New Look at Clean – and Life

A couple of years ago I heard a young guy, James Hamblin, on National Public Radio talking about his new book, Clean: The New Science of Skin. He was challenging our modern norms on cleanliness. In his uncontentious style, he explained how important it was to wash our hands a lot. But he also questioned how necessary it was to suds up our forearms every day in a hot shower. Or do we need a daily shower at all?

I was intrigued by his comments and did a quick internet search on him. He's an M.D. who changed careers into journalism. He looks so young that he is still compared to Doogie Howser, the teenage physician from the sitcom by the same name.

I have heard similar things before. A friend of mine told me several years ago that his dermatologist told him he didn't need to wash his feet, that any water and soap from a shower is sufficient cleaning. I haven't deliberately washed my feet since, and they look about the same today as they always have.

I heard that antibacterial soap is not good for your body and regardless, doesn't clean any better than Ivory. So I quit using antibacterial soap whenever possible.

Years ago when one of my sons was in college, he told me that he hadn't washed his hair in over a month. He claimed it was as clean as it had always been. I tried a lite version of what he was selling. I started washing my hair every other day, using as little shampoo as possible.

I quickly noticed that I no longer had to add gel to my hair. My natural oils were apparently providing the same effect as some fancy French product. My hair feels clean but now it isn't nearly as dried out as it was.

Later, I asked the woman who cut my hair for years if she noticed anything different. She kept looking at my hair, ran her hands through it and, mystified, said it looked like it always did. I explained my new hair treatment and she told me that she mostly does the same. She said that shampoo is hard on your hair and shouldn’t be used daily.

I remembered back to my Saturday night baths as a kid. I loved baths, but like most kids, they were once a week. Between baths, I did what most kids in rural Northern Michigan did. I played outside when possible, including a lot of time in the grass and dirt. I don't remember feeling dirty.

By high school, I was into the daily shower, including a heavy lathering of my hair, a routine I maintained for decades, except for an occasional soap brand switch.

There was one notable exception. For three summers over an extended college experience, I lived canoeing and camping in the Northwoods. It was a life I loved, and in my dreams I would spend the rest of my life in a cabin.

My friend's wife found this interesting. She shared with me her longing for the American dream, a house with a white picket fence. I had no such dream. A one-room cabin with a water pump, wood stove and outhouse was all I wanted.

While living in the woods those summers, the daily shower wasn't happening. But I did spend a lot of time in the water. Other than regularly washing my hands, I cleaned up twice a week, mostly in a lake, using a small bar of soap and a bit of dish soap. No gel. No deodorant. No hairdryer.

Modern cleanliness is an attractant for flies, and the longer I was in the woods and the less I washed, the fewer flies I had to fight with. Eventually, I felt like I was part of the nature that surrounded me. I rarely felt dirty. Quite the contrary, it was the best my skin has ever felt, tanned and weathered, and a bit leathery.

My friend's wife got her white picket fence. Like her, I and most of my friends did the same. I have to admit that it is a comfortable life. I like my pick-up. I like being warm and comfortable. But in some alternative universe, a side of me could still spend at least a portion of my life living much closer to nature.

So when I hear someone challenge the value of a daily shower, I'm curious. After listening to Mr. Hamblin's simple and clear message that modern society has probably overdone what it means to be clean, possibly to our detriment, I started on a new journey, cautiously following the path of less may be more when it comes to clean. My wife notices nothing different. And the only difference for me is my morning bathroom drill is faster than ever.

I finally read Mr. Hamblin's book. It is quite intriguing. It is not a scorched earth assault on modern life and he never suggests that the world follow his lead. What he does, though, is present a short history of cleanliness and the factors that may have pushed our society too far from its roots. He is suggesting a more moderate approach to health and cleanliness, one that may appear more radical than it actually is.

Mr. Hamblin has done extensive research exploring how we got here, examining both the science and the culture of clean. He talks to various medical doctors, scientists, marketeers, capitalists and many others exploring the meaning of clean and its effect on our bodies. He finds that contrary to public perception, the concept of cleanliness is tied up more with class and beauty than with heath and germs.

It is said that we all come from nature and we all eventually return to nature, so staying close to nature may be a good plan for your time alive. This has been my experience.

The currently accepted theory for many diseases is that they come from germs. Modern life leans heavily on removing these pathogens from our environments, which leads neatly into keeping ourselves and our environments clean.

However, contrary to what many want to believe, our bodies do not exist alone. Rather, they are part of a microbiome, the microbes such as bacteria, fungi, viruses, and their genes that naturally live on our bodies, the people we connect with and all of nature that surrounds us.

Humans cannot live apart from their microbiome. Each of us has literally trillions of microorganisms that live inside us and on our skin. We and these microorganisms have evolved together.

In our efforts to rid ourselves of “germs,” Mr. Hamblin presents strong evidence that we have introduced new medical problems. These problems could come from daily showers, over-processed food, sanitizers, separation from nature and the outdoors, and even antibiotics.

Mr. Hamblin’s suggestion is that we move closer to our microbiome that we are inexorably connected with, that we slow down this senseless fight and that we instead embrace the complexities of the nature that we are intricately part of, that is itself an extension of ourselves. His claim is that our obsession with being clean is harming the microbiome that keeps us healthy. That is, cleanliness is probably bad for our health.

So how did we get here? Here is what I have learned.

Soap is a product that has been available for a very long time, and works about the same today as it always has. The basic process is trivial and most soaps are nearly identical chemically. The rest is sales and marketing. Surprise, surprise that capitalism and our obsessions with ourselves can get us so far off track.

Soap became a household product once it could be produced economically, and then it went from being a luxury to a requirement for living in modern society. Now to even speak of not showering is, as it has been put to Mr. Hamblin, "not really dinner conversation."

Cleanliness is about more than just the broad availability of soap. In past eras, many more people died of infections and injuries than from chronic diseases. Because of advancement in healthcare, including our ability to fight infections, our life expectancy has risen and chronic disease has now become our leading cause of death.

Eczema, acne, psoriasis, multiple sclerosis, diabetes, Crohn’s disease, asthma, allergies and many other autoimmune diseases are all on the rise, some as much as three times what they were just a few generations ago. For example, hay fever was once almost exclusive to isolated, well-off individuals, while farmers who were regularly exposed to higher levels of pollen almost never got it. Today, it is widespread. And this rise in autoimmune diseases is in spite of advances in skincare and modern medicine.

For example, Mr. Hamblin provides evidence that adolescent skin problems are probably worst today than ever possibly because of our efforts to keep unnecessarily clean. He suggests that it is at least worth a try at dropping the common skin remedies, and instead to start washing our faces far less often.

Some of this rise in chronic conditions is because so many people now live longer than in generations past. But other factors include our move from a rural society to an urban society, and our obsession with cleanliness, at least partially because our brains still disproportionately fear infections.

Excessive cleanliness and urban life both further remove us from our microbiome, which may be a big part of our problem with rising chronic illnesses. He notes how children who grow up on farms tend to have lower rates of asthma, hay fever and allergies compared to city kids. Microbiologists have found that Amish people, who spend most of their lives working on farms, have very low rates of autoimmune conditions and associated inflammation.

There is strong evidence in reverse, that low rates of asthma, allergies, eczema and skin problems, are strongly correlated with low rates of skin cleaning.

Science is coming to understand that there is a complicated relationship between our bodies and microbes. This includes their important role in developing our immune systems. Most skin microbes are harmless. They create antimicrobial substances that protect us from pathogens by competing with them for space and resources, lessening the likelihood of autoimmune conditions.

If we scrub off these microbes and the natural oils on which they feed, we lose some of our exposure to the microbes that surround us, microbes that are mostly needed by our bodies, and this may contribute to the increase in autoimmune diseases.

This “biodiversity hypothesis” doesn’t propose that hygiene is bad but that the loss of different kinds of microbes is bad—that modern inflammatory and autoimmune diseases are linked to us being deprived of exposure to the microbes we evolved to be exposed to, including pathogens, as well as beneficial and neutral microbes. And we aren’t just deprived of them by washing and using antibacterial products, but in all the ways we are today isolated and sterile, living in a world that may be too clean.

When people now spend most of their lives indoors, scrubbing all the microorganism they can, they are lacking the wealth of bacterial particles that used to temper our immune systems.

The best advice right now is to think of hygiene as similar to medicine—extremely important in some scenarios, and also very possible to overdo. The same goes for exposure to microbes. Historically, exposure has been a much bigger danger than over-cleaning. Now, in much of the world, it is the reverse.

Which brings us back to our morning shower, sudsing ourselves with our favorite antibacterial deodorant soap, making sure our forearms are clean enough for modern society. I’ve known people who carry the daily shower over to other areas, daily washing every towel and every piece of clothing worn by the family, including the kids’ pajamas.

I spent some time researching this topic, and found little written on it. Most of the mainstream websites – Mayo Clinic, WebMD, CDC, Cleveland Clinic – sell the same message as soap manufacturers. They even note that a daily shower may be needed for your mental health.

Wikipedia has an entry on the “hygiene hypothesis.” It notes that studies have shown that various immunological and autoimmune diseases are much less common in the developing world than the industrialized world, and that immigrants to the industrialized world from the developing world increasingly develop immunological disorders.

I found suggestions that kids shouldn’t be protected from dirt, that eating some dirt is probably good for your system and its ability to fight off infections.

About the only consensus, though, is that you should wash your hands a lot, brush your teeth every day and avoid antibacterial soap. The rest is up for discussion.

Mr. Hamblin suggests a measured, more minimalist approach. As for showers, the consensus is to use them “conservatively." Mr. Hamblin once went five years without a shower.

I quit washing my feet years ago, I quit showering every day and my hair gets a small fraction of the shampoo it once did. I brush, floss and shave daily. After that, it varies. My wife notices nothing different, and I’m sure no one else notices anything different, either. My hair isn’t nearly so dry. I use a lot less water.

I’m being far more cautious than Mr. Hamblin, but I intend to keep pushing the parameters, taking a measured approach. I’ve always maintained that fighting Mother Nature is a bad plan. For all our Western independence, we’re far more locked into the living world we inhabit that any of us want to believe.

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