Environmental Toxins: The polar bear in the desert Mark Pettus MD March 11, 2015

1. Environmental Toxins: The polar bear in the desert Mark Pettus MD March 11, 2015 www.thehealthedgepodcast.com

3. The Polar Bear in the Desert Disease-death by a thousand cuts.

4. Disease (how things appear) Pre-diabetes, Diabetes, Obesity, Metabolic Syndrome, Heart Disease, Stroke, Depression, Autoimmunity, Alzheimer’s, Cancer, Fibromyalgia, Chronic fatigue ADDHD, GAD, PTSD, Autism spectrum Long-Latency Diseases Core Metabolic Imbalances (what drives them) Environmental Toxins-detoxification Insulin Resistance Inflammation Microbiome (Gut-Immune) HPA Axis (fight-flight) Root Causes (what are their origins) Gene-Epigenome-Environment Nutrition Movement Stress Response Environmental toxins Sleep Social Connection Trauma Conflict Management Mindfulness Spirituality-Meaning in Work, Love, Play

5. Learning objectives • Review some common sources of environmental toxins that pervade daily living. • Examine how the growing burden of environmental toxic exposure effects health and quality of life. • Examine lifestyle, behavioral, and supplement strategies that can reduce our toxic burden and optimize our capacity for detoxification.

6. The Precautionary Principle “We as physicians must act on facts…and on the most accurate interpretation of them, using the best scientific information. That does not mean that we must sit back until we have 100% evidence about everything. When the state of the health of the people is at stake…we should be prepared to take action to diminish those risks even when the scientific knowledge is not conclusive” Horton. Lancet. 1998;352(9124):251

12. Exposure to environmental toxins • Since WWII, more than 85,000 new synthetic chemicals have been released into the environment. • As a species we are exposed to 6 million lbs mercury and 2.5 billion lbs of other toxic chemicals each year. • Most have not been tested for potential toxicity in adults (few in children) • Over 4 billion lbs of pesticides are used annually in the US. • Current law allows 350 pesticides to be used on the foods we eat. • The average home contains 3-10 gallons of hazardous materials. • Traces > 280 synthetic chemicals can be found in the average newborn

13. Toxic Load Food Supply Skin Care Mind-Body Resistance Household Products Mercury

19. The Effects of Toxins • Fatigue • Muscle aches / joint pain • Brain fog • Headaches • Sinus congestion and allergies • Digestive problems • Skin problems • PMS and hormone imbalances • Weight gain

20. Plausible evidence links toxic exposure with risk of: • Immune: Autoimmune diseases, allergies, asthma, chronic dermatitis, and multiple chemical sensitivities (MCS) • Mitochondrial and Metabolic: Chronic fatigue, fibromyalgia, PD, autism spectrum, obesity, insulin resistance • Endocrine and reproductive disorders: weight gain, PMS, PCOS, Infertility, Endometriosis, Fibroids • Digestive disorders: IBS, nausea and vomiting • Neurological disorders e.g. Parkinson’s, ALS, Alzheimer’s disease, autism spectrum, and multiple sclerosis • Behavioral health disorders e.g. depression, anxiety, attention deficit and hyperactivity • Diabetes and cardiovascular diseases

21. Parkinson’s, Autism, ALS, MS, Dementia • Fibromyalgia • Chronic fatigue • Complex pain syndromes • Congestive heart failure • Pre-diabetes/diabetes

30. Phthalates are used in many common products easily released into the environment. Exposure is airborne, from food and from direct contact. • They disrupt endocrine function and are associated with cancer e.g., breast

31. Prevalent environmental toxic exposures: • Persistent Organic Pollutants“POPS” e.g. PCBs, dioxin, DDT, organochlorine pesticides, petrochemical fertilizers, herbicides • Perfluorooctanoic acid“PFOA”: water repellant in scotchguard, gortex, carpeting, upolstery and PTFE in teflon • Polybrominated compounds: PBDEs, flame retardants in TVs, computers, etc. “21st century PCBs” • PCBsin meat, fish, dairy • Bisphenol A“BPA” polycarbinated plastics, canned foods, cash register receipts • Atrazineagricultural pesticide and herbicide seeps into drinking water

33. Phthalates and Parabens (hair and skin care products) Fragrance (shampoos, deodorants, skin and body care) Diethanolamine (DEA) Triethanolamine(TEA) (found in many cosmetics) Diazolidinyl Urea, Imidazolidinyl Urea, and Quarternium-15 (skin and hair products)…all release formaldehyde..sensitivities Sodium Lauryl Sulfate (SLS) Sodium Laureth Sulfate (SLES) found in makeup, shampoos, conditioners and toothpaste. When combined with DEA and TEA they form nitrosamines which are carcinogenic Triclosan: a synthetic antibacterial in skin cleaners and household products…a hormone disrupter Cosmetics: looking good ≠ good health Cosmetic Safety Database www.cosmeticdatabase.com Natural Cosmetics: www.drhauschka.com; www.avalonorganics.com; www.evanhealy.com; www.sumbody.com

34. High Bluefish Grouper Marlin Tuna (yellowfin, blue, albacore) Tilefish Seabass Mahi Swordfish Low Arctic cod Anchovies Catfish, Crab Flounder Haddock Herring Mackerel Non-farmed salmon Trout Tilapia Oysters Tuna (skipjack and chunk light) Fish and mercury

36. Mercury • Environmentally ubiquitous: levels 30x higher last 2 generations • Enters the air and rain from coal- and oil-fired power plants, incinerators, waste and manufacturing plants that use mercury to produce chlorine-containing plastics, PVC piping, pesticides, etc. • Enters water and soil from natural deposits, volcanic activity, mining ore, and disposal of wastes e.g. batteries • Methyl mercury formed in soil and water by algae and bacteria, then ingested by fish; also in fungicides • Elemental mercury and amalgams used in dental fillings, batteries, electrodes, barometers, fluorescent light bulbs, red tatoo dye, skin-lightening creams and thermostats • Federal Toxic Release Inventory: over 6 million lbs of toxic waste in the form of mercury compounds in toxic waste generated by industry, most of which is released directly into the environment

37. Mercury: Health Effects • Damages enzymes and other proteins by binding sulfhydryl groups, e.g., metallothionein, hemoglobin, glutathione • Promotes oxidative stress by formation of lipid peroxides, H2O2, and hydroxyl radical • Depletes glutathione and selenium • Penetrates nerves and binds to cysteines on Ach receptors • Damage to brain and kidneys • Cognitive dysfunction, depression, irritibility, tremors, changes in vision and hearing • Probable carcinogenic

38. Food Additives

39. MSG and Glutamate • Glutamic acid is a non-essential amino acid found in plant and animal protein. • Glutamate is the most abundant neurotransmitter in the brain. • Glutamate activates or excites cells to “communicate” important messages important for growth, development, learning and memory…essentially a brain stimulant. • MSG or monosodium glutamate is a synthetic chemical added to processed foods to make them more palatable. • The scientific literature regarding the health effects of MSG indicates controversy over the potential of MSG to cause various adverse reactions—from headaches and migraines, altered mood and cognition to endocrine disruption. • ? Genetic susceptibility; “leaky” blood brain barrier

41. Principles of Healthy Detoxification • Minimize your exposure to toxins by eating organic foods, moderating processed foods with refined grain flour, sugar, avoiding large game fish, and … • Drink filtered water • Keep your bowels moving at least once a day • Use of flax seeds, probiotics, and magnesium citrate • Eat organic animal products. • Eat 6-8 servings of colorful vegetables and fruits including cruciferous veggies (broccoli, cauliflower, brussell sprouts, kale) and allium family e.g. garlic, onions, leeks, watercress, green tea, cilantro, berries, etc. • Eliminate nicotine and moderate alcohol intake (e.g. no more than 1 drink/day)

42. Principles of Healthy Detoxification • Exercise: Interval cardio 20-30” twice week; yoga; tai chi; Resistance 20” twice/week; Walk a lot and use stairs • Eliminate white flour and sugar and HFCS • Minimize char-broiled meats (heterocyclic amines) • Don’t be afraid to sweat e.g. sauna, steam • Mercury and dental amalgams • Home testing for mold • Reduce toxic thought-behavioral patterns e.g. Mindfulness practice, CBT • Chelation protocols for heavy metals

43. What else can a person to do to reduce toxic burden? • Buy and eat organic whenever possible • Consider glass or ceramic containers instead of plastic • Decline stain protection treatments for upholstery or floor coverings • Ask about VOCs (volatile organic compounds) in paints, new carpeting, furniture • Avoid polycarbonate plastics with “7” and “3” stamped on bottom. Consider aluminum instead. • Switch to stainless steel or hard-anodized aluminum pots and pans when Teflon cookware wears out • Vacuum/dust at least once per week: Air purification ionizers • Carbon Filter water

44. Cruciferous and Allium Vegetable Families

45. Enhance Blood and Lymph Circulation • Aerobic exercise • Yoga • Massage and body work • Sauna and heat therapy • Skin exfoliation and brushing

46. Mind-Body Detoxification

47. Ewg.org

48. Environmental Working Group ewg.org

49. Free Apps

50. Supplements • Multivitamin with mineral supplementation • Milk Thistle • Curcumin/turmeric and rosemary • Probiotics • Magnesium citrate (400-800 mg/day) • N-Acetyl Cysteine (NAC) (1200-2400mg) • SAMe (400-800) • Vitamin D (2,000-5,000 units/day to level 30+) • Co-Q-10(200-400mg) • Alpha lipoicAcid (400-1000 mg)