‘Memory manipulation is inevitable’: How rewriting memory in the lab might one day heal humans

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By Corinne Purtill, Los Angeles Times

LOS ANGELES — We often think of memories like the contents of a museum: static exhibits that we view to understand the present and prepare for the future.

The latest research, however, suggests they are more like well-thumbed library books that wear and change a little bit every time they’re pulled off the shelf.

Think of one of your happiest memories. For real. Sit with the recollection. Let your mind’s eye wander around the scene. See if you can feel a spark of the joy or hope you felt at the time. Let a minute pass. Maybe two.

If you played along with this experiment, you are physically different now than you were a few minutes ago.

When you began to reminisce, brain cells dormant just seconds before began firing chemicals at one another. That action triggered regions of your brain involved in processing emotions, which is why you may have re-experienced some feelings you did at the time of the event.

Chemical and electrical signals shot out to the rest of your body. If you were stressed before you began this exercise, your heart rate probably slowed and stabilized as levels of cortisol and other stress hormones decreased in your blood. If you were already calm, your heart rate may have quickened with excitement.

In either case, regions of the brain that light up when you get a reward jittered with dopamine.

The memory changed you. But by pulling this memory to mind, neuroscientist Steve Ramirez says, you also changed the memory.

Some elements of the memory heightened in importance. Others receded. Your brain snipped out and inserted details without your conscious knowledge. The mood you were in at the time of reminiscence left emotional fingerprints on the memory, as neurons activated by your mental environment synced up with those activated by the recollection.

Every time you revisit this heartwarming scene you change it a little bit, both as a subjective experience and a physical network of cells.

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Humans have engaged in this two-way operation of memory revision for as long as we’ve been conscious. But over the last two decades, neuroscientists have found mind-bending ways to control this process (in mice, at least): implanting false memories, deleting real ones, resurrecting memories thought lost to brain damage, detaching the memory of an emotional reaction to one event and attaching it to the memory of another.

“It is all part of a larger revolution brewing in science to make memory manipulation a commonplace practice in the lab,” Ramirez writes in his recent book, “How to Change a Memory: One Neuroscientist’s Quest to Alter the Past” (Princeton University Press). “A memory may transform me entirely, but I have the power to transform it as well — both with my mind and with my science.”

In movies about stuff like this, there’s often a sinister air around the memory-tweaking scientist character. Ramirez, a Boston University professor, is friendly, earnest and keeps a giant inflatable T-rex named Henry in his office.

He sees this research not as the next frontier of coercive mind control but as another way to alleviate mental suffering, alongside medications and cognitive therapies.

“It’s amazing that we can do these things in contemporary neuroscience,” Ramirez said recently from his lab in Boston. “But the real-life, overarching goal of all of this is to restore health and well-being to an organism. … Memory manipulation is another antidote [that] can be part of our toolkit in the clinic.”

Memory is the reason Ramirez exists at all.

His father was once kidnapped at gunpoint by soldiers in his native El Salvador and falsely accused of being a left-wing guerrilla. (Their “evidence”: He had a beard.) He was spared execution when one of his captors took a second look at his face and recognized him as the generous schoolmate who used to share his lunch.

Both of Ramirez’s parents emigrated to the U.S. before his birth, and raised him and his older siblings in Boston. Ramirez got a bachelor’s in neuroscience from Boston University in 2010 and his doctorate from MIT in 2017. As a graduate student he joined the lab of Nobel laureate Susumu Tonegawa, where he was paired with a postdoc fellow named Xu Liu.

Both Ramirez and Liu were drawn to the study of memory as a possible therapeutic tool, and instantly hit it off as friends and lab partners.

Their first major breakthrough together came in 2012.

Three years earlier, a University of Toronto team identified the neurons that lit up when a mouse was exposed to a scary stimulus — in this case, a sound that earlier accompanied a shock. The Toronto researchers then injected the mice with a toxin that killed only those brain cells that lit up when they heard the sound.

The result: The treated mice no longer demonstrated a fear response when the sound was played. Essentially, the scientists had erased a specific memory.

If a memory could be deleted in the lab, Ramirez and Liu reasoned, one could be implanted.

For their experiment, the pair identified brain cells in a mouse hippocampus that activated when the animal received a startling shock. Then they took the mouse out of the enclosure where the shock occurred and placed it in a new box with no sights or other sensory cues associated with the memory of its old environment. Next, using millisecond-long pulses of light, they activated those same brain cells — without the physical shock of the earlier stimulus.

The mouse acted exactly as it had when the shock happened, even though no shock occurred.

You can’t interview a mouse about its memories. Researchers base their conclusions on the animal’s behavior. And in this case, it appeared that they’d turned a memory on.

“It just blew everyone away,” said Sheena Josselyn, a University of Toronto neuroscientist who led the 2009 work on erasing fear memories. “When you can do those sorts of things to memories, you know you have found the neural basis of a memory.”

In 2013, Ramirez and Liu set a mouse loose in a box — let’s call it, as Ramirez does in his book, Box A — and took note of the brain cells that activated as it explored the environment.

They then scooped it up and placed it in a second box, Box B. With minuscule pulses of light, they reactivated the cells that lit up in Box A, triggering a memory of that earlier environment as it explored the new one. At the same time, they gave the mouse a shock.

When they put the mouse back in Box A, a place where it had never been harmed, it froze in fear.

The mouse’s negative memory of being shocked in Box B had, essentially, been remapped to what was previously a neutral memory of Box A. The scientists had created a false memory, another seminal feat.

For their final project together, they put a mouse in an enclosure with other mice and took note of the neurons that fired as it responded positively to the social interaction.

Then they moved that mouse to a smaller cage than usual, where it was alone.

At first, this rodent equivalent of downsizing dimmed the mouse’s mood.

Given the choice between plain and sugary water, healthy mice prefer the latter. But when stressed or depressed, mice show no preference. That’s how Ramirez and Liu’s lonely mouse acted initially.

But when the scientists activated neurons associated with the memory of hanging out with other mice, the mouse’s behavior suddenly changed. It enthusiastically slurped the sweet water. Remembering better times had changed its behavior to resemble that of a healthy mouse.

The paper was published in 2015 in the prestigious journal Nature. But unlike their past shared achievements, this one couldn’t be celebrated together. As it was going through the review process, Liu died suddenly at the age of 37.

Grief, Ramirez writes, is not so different from memory: “Both endure across the entire lifespan, forever changing us, helping us to decide what matters most.”

Ramirez, now 37, opened his own lab at Boston University in 2017. In the years since, memory researchers have made impressive strides: restoring memories lost to amnesia, activating a memory while suppressing the emotions attached to it, detaching the emotional reaction to one memory and attaching it to another. The tools now exist to erase whole events and corresponding emotions from mouse brains, or to artificially jump-start memories and all the feelings that go with them.

But there is no expectation in the research community that laser-wielding doctors will one day artificially reshape human patients’ memories.

For one, these experiments are possible only with mice that have been genetically modified to have brain cells that light up when exposed to lasers. Genetically altering a human in this manner, researchers interviewed for this story said, is neither ethical nor practical.

It’s also not necessary.

“We don’t need to generate technophobic fears of a digital future where our memories will be distorted — our memories can already be distorted very effectively by nondigital means,” memory scientists Ciara Greene and Gillian Murphy wrote in “Memory Lane: The Perfectly Imperfect Ways We Remember,” published in 2025.

Humans are suggestible creatures with extremely pliable memories. Armed with little more than a few leading questions, researchers have found that most humans can be easily manipulated into believing that they did or saw something they didn’t. We don’t need lasers to activate our memories, which can be summoned at will or triggered by any number of sensory cues, or to edit their contents, which our brains do constantly without any conscious input from us.

The real goal of research like his, Ramirez said, is to establish the biological mechanisms of memory and apply that knowledge to noninvasive therapies.

If researchers understand exactly how to retrieve a memory from a mouse hippocampus that brain damage has rendered inaccessible, for example, that information could be the basis for a drug that helps preserve or strengthen certain types of memory in people suffering from dementia or other cognitive disorders.

Understanding how an animal brain encodes memories and the emotional responses they evoke could lead to better cognitive therapies for post-traumatic stress disorder.

The obvious dark side of this line of research is that someone who understands how to boost well-being through memory manipulation could just as easily use the same knowledge for pernicious ends.

“The idea of artificially changing our own memories might elicit uneasy feelings of a dystopic future where relationships are erased, identities are replaced, and governmental powers implant thoughts in our heads to mind-control society,” Ramirez writes in his book. But, he said, any tool in existence can be used to harm or help, and he’d rather make well-intended progress than none at all.

“The idea of memory manipulation, to me, makes sense if we have an ethically bounded goal, and that ethically bounded goal is to restore health and nourish human well being,” he said. “Exercise is an antidote for the brain, and social enrichment is an antidote [and] a good night’s sleep is an antidote. What if toggling with memories in a therapeutic manner can also be an antidote? Then we’re in business.”

©2026 Los Angeles Times. Visit at latimes.com. Distributed by Tribune Content Agency, LLC.

Advertisements promising patients a ‘dream body’ with minimal risk get little scrutiny

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By Fred Schulte, KFF Health News

Lenia Watson-Burton, a 37-year-old U.S. Navy administrator, expected that cosmetic surgery would get rid of stubborn fat quickly and easily — just as the web advertising promised.

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Instead, she died three days after a liposuction-like procedure called AirSculpt at the San Diego office of Elite Body Sculpture, a cosmetic surgery chain with more than 30 offices across the U.S. and Canada, court records show.

Cosmetic surgery chains setting up shop in multiple states depend heavily on advertising to attract customers: television, print, social media influencers, even texts hawking discounted holiday rates. The pitches typically promise patients life-changing body shaping with minimal pain and a quick recovery.

Yet there’s no federal requirement that surgery companies post evidence supporting the truth and accuracy of these marketing claims. No agency tracks how frequently patients persuaded by sales pitches sustain painful complications such as infections, how effectively surgeons and nursing staff follow up and treat injuries, or whether companies selling new aesthetic devices and methods have adequately trained surgeons to use them safely.

In 2023, Watson-Burton’s husband and six children and stepchildren sued Elite Body Sculpture and plastic surgeon Heidi Regenass for medical malpractice, alleging that the thin cannula the surgeon used to remove fat perforated Watson-Burton’s bowel, causing her death.

The suit also accused Elite Body Sculpture of posting false or misleading advertising on its website, such as describing the clinic’s branded procedure AirSculpt as “gentle on the body” and stating: “Our patients take the fewest possible risks and get back to their regular routine as soon as 24-48 hours post-operation.”

Watson-Burton was one of three patients who died after having liposuction and fat transfer operations performed by Regenass from October 2022 to February 2023, court records state. Families of all three women sued the surgeon, who denied wrongdoing in legal filings. The parties settled the Watson-Burton family case in 2024. Two other wrongful death cases are pending, including a suit by an Ohio woman who alleges her mother relied on promises on Regenass’ website that the operation in California would be safe with a quick recovery.

Neither Regenass nor her attorneys responded to repeated requests for comment. Emails and phone calls to Elite Body Sculpture’s Miami headquarters were not returned.

State and federal authorities do have the power to prohibit false or misleading medical advertising of all types, though enforcement is spotty, particularly when promotions pop up online. That means patients must do their own homework in evaluating cosmetic surgery marketing pitches.

“While consumers should be able to trust that ad claims are substantiated because the law requires them to be, the reality is that it pays for consumers to bring a skeptical eye,” said Mary Engle, an executive vice president at BBB National Programs.

‘Up a Cup’

Founded by cosmetic surgeon Aaron Rollins, Elite Body Sculpture says in Securities and Exchange Commission filings that it offers a “premium patient experience and luxurious, spa-like atmosphere” at its growing network of centers. The publicly traded company, based in Miami Beach and backed by private equity investors, markets AirSculpt as being “much less invasive than traditional liposuction” and providing “faster healing with superior results.” The ads say that AirSculpt “requires no scalpel, or stitches, and only leaves behind a freckle-sized scar!” and that patients “remain awake the whole time and can walk right out of their procedure, enjoying dramatic results!” Some risks are disclosed.

Rollins, who recently made headlines for putting his Indian Creek mansion on the market for $200 million, did not respond to repeated requests for comment. A lawyer for Rollins, Robert Peal, responded to an email but didn’t comment. On Nov. 4, the company announced that Rollins had resigned as executive chairman of the board of directors of AirSculpt Technologies and as a member of the board.

Many AirSculpt patients opt to have fat that is removed from their stomachs or other places injected into their buttocks, often called a Brazilian butt lift. Others use the fat to enhance their breasts, a procedure the company brands as “Up a Cup.” Since March 2023, at least seven patients have filed lawsuits accusing Elite Body Sculpture of running misleading advertising or misrepresenting results, arguing, among other things, that they felt more pain or healed much more slowly than the ads led them to believe they would, court records show. One of the lawsuits has been dismissed, and the company has denied the allegations in others.

The Watson-Burton family argued in their lawsuit that some marketing claims about AirSculpt were simply not true.

For instance, Elite Body Sculpture’s website stated that AirSculpt has “automated technology” set to “turn off” before the cannula penetrates the body too deeply and possibly causes serious injury, according to the suit. That feature didn’t protect Watson-Burton, who paid $12,000 for the operation, hoping for a “quick and timely recovery” before a scheduled U.S. Navy deployment, according to the lawsuit.

Rather than being gentle on the body, AirSculpt was “extremely painful, highly invasive, unsafe, required more than a short 24-hour recovery period and could and did damage internal organs,” according to the suit.

Watson-Burton called the San Diego center on Oct. 27, 2022, a day after the operation, to report “severe pain” in her upper abdomen, but staffers took no action to evaluate her, according to the suit. The next morning, an ambulance rushed her to a hospital, where emergency surgery confirmed the gravity of her injuries. Surgeons noted her injuries included three perforations of the small bowel and sepsis.

Watson-Burton died on Oct. 29, 2022. An autopsy report cited complications of the cosmetic surgery, ruling she died after becoming “septic following intraoperative small bowel perforation.” Her death certificate lists the cause as “complications of abdominoplasty.”

In court filings, Elite Body Sculpture said Watson-Burton had “experienced an uncommon surgical complication.” The company denied that it made any “specific guarantee or representation that injury to organs could not occur.” It denied any liability or that its ads made misrepresentations.

The dispute never played out fully in court. The parties settled the case in August 2024, when Elite Body Sculpture agreed to pay Watson-Burton’s family $2 million, the maximum under its insurance policy. Regenass, the surgeon, who did not carry liability insurance, agreed to pay $100,000 more, according to the settlement agreement.

Promises Not Kept

Social media pitches and web advertising also led Tamala Smith, 55, of Toledo, Ohio, to Regenass for liposuction and a fat transfer, court records state.

Smith was dead less than two weeks later, one of two other women who died following elective operations Regenass performed from December 2022 to February 2023, court records show. The surgeon operated on the two women at Pacific Liposculpture, which runs three surgery centers in Southern California, court records state.

The families of both women are suing Regenass, a board-certified plastic surgeon, and the surgery center. In both cases, which are pending in California courts, Regenass and the surgery center have denied the allegations and filed dismissal motions that deny responsibility for the deaths.

Smith was a traveling registered nurse working the overnight shift at a hospital in Los Angeles. She chose Regenass after viewing the doctor’s Instagram page, according to a lawsuit filed by Smith’s daughter, Ste’Aira Ballard, who lives in Toledo.

The ads described the surgeon as an “awake liposuction and fat transfer specialist,” while her website assured patients they would feel minimal pain and be “back to work in 24-48 hours,” according to the suit.

During the three-hour operation on Feb. 8, 2023, at Pacific Liposculpture’s Newport Beach office, Regenass removed fat from Smith’s abdomen and flanks and redistributed it to her buttocks, according to the suit. Smith called the office at least twice in subsequent days to report pain and swelling, but a staffer told her that was normal, according to the suit. Smith never spoke to the surgeon, according to the suit.

When Ballard couldn’t reach her mother, she called the hospital only to learn Smith hadn’t turned up for her overnight shift for two days. The hospital called police and asked for a welfare check at the extended-stay hotel in Glendale, California, where Smith had been living.

An officer discovered her body on the bed “surrounded by towels and sheets that are stained with brown and green fluids,” according to a coroner’s report in the court file. A countertop in the room was “covered in medical paperwork detailing post-operative instructions from a liposuction clinic,” according to the report. Ballard said she learned of her mother’s death when she called Smith’s cellphone; a police officer answered and delivered the devastating news.

“Oh, my God, I fell to the floor,” Ballard said in an interview with KFF Health News and NBC News. Ballard said she still has not gotten over the shock and grief. “It bothers me because how does someone that dedicated their life to save other people’s lives end up deceased in a hotel, as if her life didn’t matter?” she asked.

Ballard said her mother trusted Regenass based on her web persona. She believes her mother, a registered nurse, would not have gone to the surgeon had she known someone had died after an operation Regenass performed at the Pacific Liposculpture San Diego office. Terri Bishop, 55, a truck driving instructor who lived in Temecula, California, died on Dec. 24, 2022, about three weeks after undergoing liposuction and fat transfer at Pacific Liposculpture, a company with a history of run-ins with state regulators.

Pacific Liposculpture did not respond to requests for comment. In court filings, the company has denied that the operations played a role in either patient’s death and moved to dismiss the cases. The company also argued that Ballard waited too long to file suit.

Bishop, who had a history of smoking, diabetes, and high blood pressure, died from “arteriosclerotic cardiovascular disease aggravated by viral pneumonia (Influenza A H1 2009),” according to a Riverside County medical examiner’s report made part of the court record. The family disagrees and is arguing that Bishop died from blood clots, a known complication of surgery. A trial is set for June 2026.

In Smith’s case, the Los Angeles County medical examiner ruled the nurse died of “renal failure of unknown cause.” The autopsy report noted: “This is a natural death since an injury directly from the surgery cannot be identified.”

Ballard is demanding further investigation to get to the bottom of what happened to her mother.

“I don’t think they were straightforward with the risk and complications that could occur,” Ballard said. “I think they are promising people stuff they can’t deliver.”

Ballard filed a complaint against Regenass with the California Medical Board, which the board is investigating, according to documents she provided to KFF Health News and NBC News. She believes regulators need to be more transparent about the backgrounds of surgeons who offer services to the public. She also hopes the investigation will shake loose more details of what happened to her mother.

“I just don’t understand how she came back to me in a body bag,” she said.

“I think they are promising people stuff they can’t deliver.”

‘Buyer Beware’

Concerns about sales pitches for cosmetic surgery date back decades.

Witnesses testifying at a June 1989 congressional hearing held by a subcommittee of the House Small Business Committee in Washington heard a litany of horror stories of patients maimed by surgeons with dubious training and credentials. Subcommittee Chairman Ron Wyden (D-Ore.) said patients were victimized by deceptive and false ads that promised a “quick, easy and painless way to change your life — all through the cosmetic surgery miracle.”

Calling for reform, Wyden added: “So, cosmetic surgery consumers are largely on their own. It’s back to a buyer beware market, and it smacks more of used car sales than medicine.” Wyden now represents Oregon in the U.S. Senate.

All these years later, there’s far more territory to police: an onslaught of web advertising, such as splashy “before and after” photos, online posts, and podcasts by social media influencers and others courted by surgery companies in a costly effort to attract business. Elite Body Sculpture, for instance, spent $43.9 million in “selling expenses” in 2024. That came to $3,130 per “customer acquisition,” according to the company’s SEC filings.

Under Federal Trade Commission guidelines, medical advertising must be “truthful, not deceptive, and backed up by competent and reliable scientific evidence,” according to Janice Kopec of the agency’s Bureau of Consumer Protection.

Any claims that are “suggested or reasonably implied” by ads also must be accurate. That includes the “net impression” conveyed by text and any charts, graphs, and other images, according to the FTC. The agency declined to elaborate.

Medical businesses are free to decide what documentation, if any, to share with the public. Most cosmetic surgery sites offer little or no such support for specific claims — such as recovery times or pain levels — on their websites.

“There is no requirement that the substantiation be made available to consumers, either on a website or upon demand,” Engle, who is also a former FTC official, said in an email.

The law permits “puffery,” or boastful statements that no person would likely take at face value, or that can’t be proved, such as, “‘You’ve tried all the rest, now try the best,’” Engle said.

Where to draw the line between acceptable boasts and unverified claims can be contentious.

Athēnix, a private equity-backed cosmetic surgery chain with locations in six cities, defended its use of terms such as “safer” and “better results” as puffery in response to a false advertising lawsuit filed against the company by Orange County District Attorney Todd Spitzer in California in August 2022.

Spitzer argued that Athēnix touted its “micro-body-contouring” technique as “safer” than traditional liposuction and offered “outstanding results with less pain and downtime” without backing that up, according to the suit.

“There is no study or evidence to support these statements and no scientific consensus about the use of these new techniques,” Spitzer argued.

The parties settled the case in July 2023 when Athēnix agreed to pay $25,000 without admitting wrongdoing, court records show. Before the settlement, Athēnix argued that its use of terms such as “safer” and “better results” was “subjective” and “puffery” — and not false advertising.

While there’s little indication that local or state authorities are stepping up scrutiny of cosmetic surgery advertising, federal authorities have signaled they intend to crack down on dubious advertising claims made by drug manufacturers.

In a letter sent to drug companies in September, FDA Commissioner Marty Makary wrote that “deceptive advertising is sadly the current norm” on social media platforms and that the agency would no longer tolerate these violations.

‘Bad Advice’

To prove medical negligence, injured patients generally must show that their care fell below what a “reasonably prudent” doctor with similar training would have provided. In their defense, surgeons may argue that complications are a risk of any operation and that a poor outcome doesn’t mean the doctor was negligent.

Some lawsuits filed by injured patients add allegations that advertisements by surgery chains misled them, or that surgeons failed to fully explain possible risks of injuries, a requirement known in medical circles as informed consent.

Caitlin Meehan had such a case. She underwent a $15,000 AirSculpt procedure at Elite Body Sculpture’s clinic in Wayne, Pennsylvania, outside Philadelphia. She agreed to the surgery in March 2023, she said, because the company’s website described it as “Lunch Time Lipo,” according to a lawsuit she filed in late August. The suit alleges that the doctor she discussed the procedure with “maintained that there are no serious, life-threatening, lasting and/or permanent complications,” according to the suit.

During the procedure, however, gases became trapped beneath her skin, causing a widespread swelling called subcutaneous emphysema, according to the suit. Meehan was shocked to see her face, neck, and upper body severely swollen, causing her shortness of breath.

A friend who drove her to the appointment asked the staff to call an ambulance, but staff members said that wasn’t necessary, according to the suit. After an hour’s drive home, Meehan said her skin felt like it was burning and she called 911. She spent four days in the hospital recovering and remains scarred, according to the suit. The suit is pending, and the company has yet to file an answer in court.

Scott Hollenbeck, immediate past president of the American Society of Plastic Surgeons, said recovering from liposuction in a day “seems unrealistic” given the bruising and swelling that can occur.

“The idea that you could return to work 24 hours after effective liposuction seems like extremely bad advice,” Hollenbeck said.

‘I Felt Horrible’

Ads that promised patients minimal discomfort also have come under attack in patient lawsuits.

More than 20 other medical malpractice cases reviewed by KFF Health News made similar allegations of unexpected pain during operations at cosmetic surgery chains using lidocaine for pain relief in “awake liposuction.”

One patient suing Elite Body Sculpture in Cook County, Illinois, alleged she “was crying due to [the] severe pain” of an operation in September 2023. She alleged the doctor said he couldn’t give her any more local anesthetic and pressed on with the procedure. The defendants have not filed an answer in court. The practice didn’t respond to a request for comment.

Engle, the former FTC official, said that while claims of discomfort are somewhat subjective, they still must be “truthful and substantiated,” such as supported by a “valid, reliable clinical study of patients’ experience.”

NBC News producer Jason Kane contributed to this report.

©2026 KFF Health News. Distributed by Tribune Content Agency, LLC.

Eco-friendly toilet papers are trendy, but their actual environmental impacts vary

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By ISABELLA O’MALLEY

Toilet paper, a product that is used for a few seconds before being disposed of forever, is typically made with trees, energy-intensive manufacturing processes and chemicals that can pollute the environment.

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Experts say more consumers are seeking toilet paper made from recycled content or sustainable materials, but it can be hard to know what to look for.

Sustainable toilet paper often costs more, but can have significant environmental benefits. According to the Environmental Paper Network, a coalition of nonprofits, more than 1 billion gallons (3.8 billion liters) of water and 1.6 million trees could be saved if every American used one roll of toilet paper made from recycled content instead of a roll made from forest fibers.

Here are some recommendations for buying sustainable toilet paper or reducing overall toilet paper use.

Toilet paper made from recycled fibers

North American toilet paper has traditionally been made from fibers from trees in Canada and eucalyptus plantations in Brazil. Pulp made from the trees is bleached to create a bright white color, but the chlorine that’s often used can hurt the environment. Large amounts of electricity and heat are used to remove moisture and form square sheets.

Increasingly, manufacturers are making toilet paper from recycled paper products, which avoids material from freshly cut trees, and are using chlorine-free bleaching techniques. Once used, toilet paper itself is flushed and not recycled.

Looking for recycled content is a good place for environmentally conscious consumers to start, said Gary Bull, professor emeritus of forest economics at the University of British Columbia. Preconsumer materials include scrap materials from manufacturing or unsold paper. Postconsumer materials come from paper products that have already been used.

Toilet paper sits on shelves at Target in Alexandria, Va., Jan. 4, 2026. (AP Photo/Michael Phillis)

Making toilet paper from postconsumer recycled fibers improves its sustainability because paper is “one of the easiest materials on the planet to recycle,” Bull said.

Evaluating sustainability claims

The best way for a scientist to evaluate the carbon footprint of an item is doing a life cycle assessment, which calculates the environmental impacts from when a tree is a seedling to when its fibers are converted into toilet paper and flushed down the drain, Bull said. But that method isn’t within reach of consumers, so advocates have undertaken third-party assessments.

Some companies add those labels to packaging to show that their processes have been vetted. Bull said labels on bath tissue from the Forest Stewardship Council or the Sustainable Forestry Initiative indicate the company is making scientifically-proven efforts to be sustainable. Both groups’ standards include conserving water, wildlife, and biodiversity as well as compliance with applicable forestry laws to keep ecosystems healthy.

The nonprofit Natural Resources Defense Council also publishes an annual report that grades toilet papers from A+ to F, with the highest-ranked products being unbleached or bleached without chlorine, containing recycled content and avoiding harmful forestry practices. Aria, Green Forest, Natural Value, Trader Joe’s and Whole Foods 365 100% Recycled received the highest letter grade in 2025, with all made entirely from recycled materials.

Toilet paper sits on shelves at a Trader Joe’s in Alexandria, Va., Jan. 4, 2026. (AP Photo/Michael Phillis)

The “The Issue with Tissue” report was launched in 2019, and NRDC corporate campaign advocate Ashley Jordan said she has noticed dozens of sustainable toilet paper brands have emerged over the last six years.

Kory Russel, assistant professor of landscape architecture and environmental studies at the University of Oregon, said that when people purchase a sustainable product it sends a message to corporations to make more eco-friendly products available.

Sustainable toilet paper brands typically cost more per square foot than conventional products. But Russel said prices will likely drop if consumers continue buying it and manufacturers expand production.

“If more people are buying sustainable toilet paper and demanding it, there should be economies of scale and prices should fall to match that of conventional toilet paper,” he said.

Mark Pitts, executive director of tissue at the American Forest & Paper Association, whose members include large toilet paper manufacturers such as Kimberly-Clark Corporation and Georgia-Pacific, told The Associated Press that sustainability is a core industry focus and members have reported reductions of greenhouse gas emissions along the supply chain. He said that members follow responsible forestry practices and have increased their use of recycled material.

Bamboo, alternative materials and energy

Alternative materials such as fast-growing bamboo are often billed as more sustainable than toilet paper made from trees, but consumers should focus on toilet paper made with recycled materials instead, said Ronalds Gonzalez, an associate professor at North Carolina State University and expert on fibers used in the hygiene industry.

This photo shows stacked toilet paper in Arlington, Va., Jan. 3, 2026. (AP Photo/Michael Phillis)

Gonzalez said pollution from manufacturing processes can reduce the benefits of using bamboo. Gonzalez recently co-authored a study that found bamboo toilet paper made in China that is available in the U.S. had a higher environmental impact than toilet paper made in the U.S. with imported forest fibers, largely because Chinese manufacturers use electricity generated by coal. The study found the bamboo toilet paper’s environmental impacts could be reduced when it was produced in regions that use renewable energy.

Bidets can remove the need for toilet paper

Bidets are devices that allow people to rinse after using the bathroom so they can reduce or avoid wiping. They’re another way people can reduce their toilet paper use.

Bidets, which are popular in Europe, can be a separate wash basin or a device added to toilets that generate a stream of water. Some people still use a small amount of toilet paper to dry off. Bidets that can be attached to your toilet and don’t use electricity can cost around $30, while toilet seats with fancy options such as heated water and air dryers can exceed $600. Some bidets require a plumber or contractor to install.

Bidets are a sustainable alternative to conventional toilet paper because “you’re not using any sort of logging, it’s water that’s already coming to your household and it’s very little water,” Russel said.

The Associated Press’ climate and environmental coverage receives financial support from multiple private foundations. AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.

Literary calendar for week of Jan. 11

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JD FRATZKE: Chef and author celebrates release of his book “Dharma Butcher,” with music by Molly Maher. After the reading Fratzke hosts a tasting featuring some of the recipes in the book.  4 p.m. Jan. 11, The Velvet Antler on the second floor of The Gnome Pub, 498 Selby Ave., St. Paul.

PEG GUILFOYLE: Discusses her essay collection “An Eye for Joy.” 7 p.m. Thursday, Magers & Quinn, 3038 Hennepin Ave. S., Mpls. Free; registration required at magersandquinn.com.

(Courtesy of the author)

RICARDO LEVINS MORALES: Minnesota artist and organizer who uses his art as a form of political “medicine” to support individual and collective healing discusses his book “The Land Knows the Way: Eco-Social Insights for Liberation” in Friends of the St. Paul Public Library’s Fireside Reading series. 6:30 p.m.  Wednesday, Rondo Community Library at Hallie Q. Brown Community Center, 270 N. Kent St., St. Paul. Free; Zoom information at thefriends.org.

PARKINSON/TOSO: Chandra Parkinson, educator and author of “The Book of Ritual Baths: A Guide to Spiritual Cleansing and Renewal,” in conversation with Maria Tosto, yoga teacher, spiritual somatic coach and author of “Heal What Hurts.” 7 p.m. Wednesday, Magers & Quinn, 3038 Hennepin Ave. S., Mpls. Free; registration required at magersandquinn.com.

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