Clinical Pharmacist and Master’s student in Clinical Pharmacy with research interests in pharmacovigilance, behavioral interventions in mental health, and AI applications in clinical decision support. Experience includes digital health research with Bloomsbury Health (London) and pharmacovigilance practice in patient support programs. Published work covers drug awareness among healthcare providers, postpartum depression management, and patient safety reporting. 
Clinical Pharmacist and Master’s student in Clinical Pharmacy with research interests in pharmacovigilance, behavioral interventions in mental health, and AI applications in clinical decision support. Experience includes digital health research with Bloomsbury Health (London) and pharmacovigilance practice in patient support programs. Published work covers drug awareness among healthcare providers, postpartum depression management, and patient safety reporting. What was reviewed?
This comprehensive review examined the scientific literature regarding aluminum’s toxicity, human exposure routes, and its alleged association with neurotoxicity, Alzheimer’s disease, and breast cancer. The review sourced publications from PubMed and SCOPUS, supplemented by the authors’ expertise in occupational and environmental medicine. Aluminum’s ubiquity as the third most common element in the Earth’s crust, and its widespread presence in food, packaging, cosmetics, and pharmaceuticals, underscores the importance of understanding exposure risks. The review focused on internal aluminum loads measured by aluminum concentrations in urine and blood as more accurate indicators of risk than external exposure estimates. Regulatory and reference values, such as the European Food Safety Authority’s tolerable weekly intake (TWI) of 1 mg/kg body weight and the German Federal Environmental Agency’s internal reference values (<15 μg l urine, <5 serum), were central to the discussion, especially in relation occupational and environmental health standards.< p>
Who was reviewed?
The review synthesized findings from diverse populations, including the general public, individuals with high dietary or environmental aluminum exposure, patients receiving aluminum-based pharmaceuticals or vaccines, and workers in aluminum production and processing industries. Particular emphasis was placed on occupationally exposed groups such as aluminum welders and powder production workers, who are at risk of surpassing established reference values. The review also considered case–control and epidemiological studies on patients with Alzheimer’s disease and breast cancer, as well as experimental data from animal models and in vitro studies. These various cohorts enabled a multifaceted evaluation of both acute and chronic health effects across a spectrum of exposure scenarios.
Most important findings
| Key Finding | Relevance to Certification Programs |
|---|---|
| Reference values for internal aluminum loads are <15 μg l in urine and <5 serum for the general population.< td> | These values serve as critical thresholds for certification and monitoring in occupational and consumer safety programs. |
| The EFSA TWI (1 mg/kg BW/week) can be reached or slightly exceeded through diet alone, especially in children, but this does not necessarily indicate an acute health risk. | Certification programs should emphasize regular biomonitoring for workers and ensure exposures stay below critical limits. |
| Dialysis patients exposed to high aluminum levels (via contaminated dialysate) developed encephalopathy and dementia, but this syndrome is distinct from Alzheimer’s disease. | Highlights the need for stringent controls in medical and industrial settings to prevent acute toxicity. |
| Epidemiological studies show no consistent link between aluminum exposure (including antiperspirant use) and breast cancer or Alzheimer’s disease, despite higher aluminum levels being found in diseased tissue. | Demonstrates that current evidence does not warrant stricter consumer-level regulation for these endpoints, but continued research is needed. |
| Only a small fraction (~0.1%) of orally ingested aluminum is absorbed; dermal absorption from antiperspirants is even lower (0.01%-0.06%). | Oral and dermal routes pose minimal risk; focus for certification should be on inhalation and occupational exposures. |
| The EFSA TWI (1 mg/kg BW/week) can be reached or slightly exceeded through diet alone, especially in children, but this does not necessarily indicate acute health risk. | Certification programs should consider cumulative exposure but focus on maintaining internal levels below reference values. |
Key implications
For heavy metal certification programs, the most actionable implication is that internal aluminum concentrations, specifically in urine and blood, are the most reliable indicators of potential toxicity. Programs should prioritize biomonitoring in occupational settings, ensuring urinary excretion remains below 50 μg/g creatinine, as adverse neurotoxic effects are unlikely at or below this threshold even with long-term exposure. The review finds no consistent epidemiological evidence linking aluminum exposure to breast cancer or Alzheimer’s disease, supporting current regulatory stances that do not impose additional restrictions on consumer products like antiperspirants. However, as aluminum’s neurotoxicity is well-established in dialysis patients and at extreme exposures, ongoing monitoring and adherence to established biological tolerance values remain essential. Overall, the review supports a precautionary approach—minimizing exposure while recognizing that most consumer and dietary exposures do not reach levels associated with subclinical or manifest toxicity.
Citation
Klotz K, Weistenhöfer W, Neff F, Hartwig A, van Thriel C, Drexler H. The health effects of aluminum exposure. Dtsch Arztebl Int. 2017;114:653–9. doi:10.3238/arztebl.2017.0653
Heavy metals are high-density elements that accumulate in the body and environment, disrupting biological processes. Lead, cadmium, arsenic, mercury, nickel, tin, aluminum, and chromium are of greatest concern due to persistence, bioaccumulation, and health risks, making them central to the HMTC program’s safety standards.
