Are Your Fashion Choices Making You Sick?

Toxic chemicals and materials in clothing can take a toll on your health.

A recent Wall Street Journal article questioning whether clothes were better 50 years ago inspired me to reflect on fashion, which I have always loved. Their investigation revealed clothes today (or rather the textiles they are made of) are thinner, stretchier (accomplished by blending with Spandex®), rarely lined, more tightly cut (meaning more sustained direct contact with our skin), and more frequently are made of synthetic materials like polyester. Yesterday’s consumers had fewer clothes, mostly made in the USA, and they paid more for them (not that those clothes were entirely healthy). No question, most modern clothes have become less expensive (fast fashion) and more comfortable, but at what price? While much has been written on the planetary and human rights impacts of the fashion industry, comparatively, there is less focus on the daily impact of fashion’s chemicals on our health.

In the 1960s, 95 percent of Americans’ clothes were manufactured domestically (with plenty of “sins” committed even then). Textile manufacturing significantly changed with two pieces of legislation: the Clean Water Act (1972) and the North American Free Trade Act (implemented in the 1990s). Textile companies and brands now had more incentives to move production offshore to countries with abundant supplies of cheap labor, few labor protections or enforcement, and little, if any, restrictions on the use and disposal of chemicals. When production moved overseas, fashion brands got carte blanche with little oversight. 


Truth is, we really do not know. It is difficult for a consumer, even an informed one, as there is no ingredient list. Look at your clothing labels. Compared to food and cosmetic labels, you will not find much there. Clothing labels usually list the type of fabric (cotton, wool, silk, polyester, etc.), where it was made (often China, the leading exporter of textiles, India, Vietnam, among others), and performance functions such as wrinkle-free, stain-proof, or waterproof, etc. According to the Environmental Working Group (EWG), “The Federal Trade Commission asks U.S. clothing retailers to share only fiber content, country of origin, and the identity of the manufacturer on labels.”

Let’s start with clothing fibers. Today, almost 70 percent of our clothes are made of polyester and other synthetics derived from petroleum. They do not biodegrade (even recycled polyester) and constantly leach harmful chemicals and microfibers into our air and water. Eventually, these clothes wind up in landfills. One of the biggest culprits is microplastics (particles below five millimeters), also known as microfibers (a plastic-based thread thinner than a human hair). Microfibers are found in polyester, nylon, polyamide, and acrylic. When these textiles are manufactured, washed, worn or dried, they continually release or shed these tiny plastic fibers. A quote on a U.K. site, Friends of the Earth, posted, “One washing load of clothes could be shedding up to 17 million tiny plastic fibers.”
You’ve probably heard about the impact of microplastics in our oceans (the textile industry is the largest contributor), but think about this: they are also lurking in your home’s air and the clothes touching your skin. According to, “Of all the floating dust in a household, 33% of it is microplastics from textiles.” The bad news: we are breathing and ingesting these particles daily, not to mention they are polluting outdoor air across the globe.  
What makes our clothes stretchier today is Spandex, also known as elastane. It, too, is a petroleum-based fiber sourced from polyurethane. You will find it on most clothing labels today, ranging from undergarments to performance athletic wear to daytime and evening wear. If a garment is smooth, tight, and clingy, it probably has Spandex.

What else is missing in those labels? Likely a lot. It is the hidden toxic chemicals and dyes applied to fabrics (even natural fabrics) we should worry about. More than 8,000 synthetic chemicals are used in textile manufacturing. Some of the most harmful are polyfluorinated substances or PFAS (frequently used for stain-and-water-resistance). You have probably heard them also referred to as “forever chemicals.” EWG states that PFAS are “a large family of thousands of fluorinated chemicals, linked to a higher risk of cancer, reproductive harm, immune system damage and other serious health problems.” These chemicals are so insidious in our environment. They are found in everything from skincare products to bedding to furniture and clothing textiles. In fact, according to the CDC, “their presence in human blood is a near-universal phenomenon in the United States.”

Ninety percent of our clothes are dyed synthetically (even those made from natural fibers). Azo dyes are used in 60 to 70 percent of fabric colors, particularly vivid colors as well as black and brown. (Some of these dyes can break down into aromatic amines that can come off fabrics and are carcinogenic in high levels.) According to the ACCC (Australian Competition & Consumer Commission), “Aromatic amines can migrate from clothing and leather articles and be absorbed through the skin where there is direct and prolonged contact. The amount of aromatic amines released can increase with body heat, sweat and saliva.” Too, heavy metals such as lead and chromium are also often used in the dyeing process, especially to achieve vivid colors.

Volatile organic compounds such as formaldehyde can be used to make clothes wrinkle-resistant. And phylates, recognized as endocrine disrupters, are often used in the decorative printing process. Chlorine bleach can be used to prep natural fibers and polyester for dyeing. Then, there are flame-retardants, since synthetic fabrics are not naturally fire-resistant like wool.  

So, why not just wash your clothes? Washing before your first wear may address some chemicals used in shipping and storage, such as biocides and fungicides to control pests and mold in transit. But washing will not address chemicals like azo dyes. ACCC found, “Washing the item may not decrease the concentration of hazardous aromatic amines. Pre- and post-wash test results commissioned by the ACCC didn’t indicate a consistent decrease in the concentrations of hazardous aromatic amines after a single wash. In some cases, the results after a single wash were slightly higher than the pre-wash test results.” And synthetic microfibers never stop shedding.


In late 2010, something strange began happening in major U.S. airlines, beginning at Alaska Airlines. After the issue of new uniforms manufactured by Twin Hill, some flight attendants began experiencing strange and debilitating symptoms. Then in 2016, flight attendants from American (again Twin Hill) and Delta (designed by Zac Posen, manufactured by Land’s End) and then Southwest in 2017 began having similar experiences. As Alden Wicker noted in her must-read 2023 book, To Dye For, “All these uniforms had a few things in common. They boasted water-and-stain repellency. They were anti-wrinkle, anti-fungal, and anti-odor and came in bright, saturated colors of the airlines. It is as close as we are going to get to a control group.”

Further, flight attendants can spend 12 hours or more in their uniforms—even sleeping in them on long-haul international flights. And they wear them for the duration of their trip duty. That is a lot of chemical saturation.
Airline management and the uniform makers kept looking for the smoking gun—the one ingredient or two that would cause these reactions. Although some toxic ingredients were isolated, what they failed to consider was the toxic soup all these coatings and finishes had created. Eventually, lawsuits ensued, and even they though never settled, the airlines eventually revamped their uniforms.

“It’s unlikely that there’s one specific smoking gun type of a chemical that’s causing these issues, but it’s likely to be a unique combination,” Irina Mordukhovich, research associate at Harvard’s T.H. Chan School of Public Health, told Vox for an article in July 2016. She co-authored a 2018 study establishing a connection between the health issues of Alaska Airlines’ flight attendants and their new uniforms.

Taking a lesson from the flight attendants, it’s best to minimize or avoid what is called “performance” fabrics. You can recognize them as water-and-stain repellency, anti-wrinkle, anti-fungal, anti-odor, and anti-mircrobial, just to name a few. Be wary of the “anti-” claims. And the more claims there are, the worse it gets. These effects are usually achieved by applying toxic coatings or finishes to the fabric. 


Without labels, it is not easy. It requires a conscious effort and tenacious research. There are certifying organizations, but remember, brand participation in these programs is voluntary. Also, just because certain products are certified does not mean all products by that brand meet the same criteria. Additionally, if you think by avoiding fast, cheap fashion you are off the hook, think again—you’re not. Some higher-end brands have been found to be just as guilty. Surprisingly, some lower-end brands have made some effort, too. Do your research.
With these disclaimers, here are some organizations or certifications Wicker cited that may help in evaluating products or to look for on product labels or brand websites:

  • Oeko-Tex, a German non-profit that certifies brands, suppliers, and their products
  • bluesign®, a Swiss company, providing chemical management training to brands and manufacturers (I noticed this recently on a bag I purchased at REI.)
  • Global Organic Textile Standard (GOTS)
  • Cradle to Cradle focuses on recycling and biodegradability 
  • Scivera, a service providing a full toxicology report to brands on ingredients in a chemical or fashion product. 
  • California Prop 65 Warning Label on any product containing formaldehyde, lead, cadmium, some phthalates, and BPA.

However, these certifications are not foolproof. For example, “the EPA has identified more than 12,000 PFAS and Oeko-Tex only tests for four dozen,” Wicker noted. Joe Rinkevich the founder of Scivera, told Wicker, “Formulators are smart. They know the list just as well as Oeko-Tex does. And they will find a molecule that performs the exact same way as a restricted substance. It has the same carcinogenic properties or whatever the problem is.” 


Rethink your relationship to fashion. Research to find healthy brands—both for you and the planet. Seek out those that use nontoxic materials and embrace sustainable manufacturing methods and safe labor practices. Invest in timeless pieces that reflect your style and values.  And advocate for more transparency in fashion.

Knowing what I know now, my fashion choices are forever changed. If you dig deeper, yours will be, too.

Lydia Graham

Lydia is a passionate advocate of healthy living. She has launched and positioned many health and wellness-related companies, products, technologies and organizations receiving more than 100 awards nationally and internationally. Her focus in the health sector is specifically on healthy living, aging and longevity. She is a partner and investor in several recognized national brands. She sits on the board of the Buck Institute for Research on Aging whose mission is to eliminate the threat of age-related disease for today’s and future generations. It is the only independent research organization globally dedicated to extending the healthy years of life. Like the scientists at the Buck, Graham envisions it will be possible for people to enjoy life at 95 as much as at 25. To support Buck’s mission, please visit