the exposome - assessing and measuring the body burden of environmental toxins
TRANSCRIPT
The Exposome: Assessing and Measuring the Body Burden of
Environmental Toxins
Todd LePine, M.D. September 25, 2013
12:00PM EST & 8:00 PM EST
© Genova Diagnostics
Christine Stubbe, ND Medical Education Specialist - Asheville
Todd LePine, MD
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The Exposome: Assessing and Measuring the Body Burden of Environmental Toxins Todd LePine, MD Staff Physician at the UltraWellness Center, Lenox MA Consultant for Genova/Metametrix Labs Faculty Member for A4M www.ultrawellnesscenter.com
Essential Amino Acids, Essential Fatty Acids,
Nutrients, Minerals, CoFactors
EndoToxins, Environmental Toxins & Stress
Pharmaceutical/Agricultural Industrial
Complex
The Exposome represents the combined exposure from all sources that reach the internal chemical environment, which can be detected in the blood or serum by signatures or biomarkers
Environment and Disease Risk
22 OCTOBER 2010 VOL 330 SCIENCE
1. If you are sitting on a tack, it takes a lot of aspirin to make it feel good. (SUPPRESSING SYMPTOMS)
2. If you are sitting on two tacks, removing just one does not result in a 50% improvement. (WEB-LIKE RELATIONSHIPS)
• The “Tacks Rule” – Dr. Sidney Baker
• Toxic exposures: Endotoxins & Exotoxins
Detox & Biotransformation
10
“The true burden of environmentally induced cancer has been grossly underestimated... With nearly 80,000 chemicals on the market in the United States, many of which are used by millions of Americans in their daily lives and are un- or understudied and largely unregulated, exposure to potential environmental carcinogens is widespread.”
TIME Magazine – May 2010
• Heavy Metals : mercury, lead, arsenic, cadmium • Chlorinated Pesticides • Organophosphate Pesticides • Phalates and Parabens • PCB’s • Volatile Organic Solvents
Measuring the Body Burden of Toxins
Pesticides and You
These children are also very aggressive. They have very short memories and they are very weak physically. They cannot jump rope long or do a whole lot of other physical tasks. Now these children are reaching puberty. The boys are developing breasts, which are very painful and they have mammary tissue in those breasts. Pesticides and You Warren Porter, Ph.D.Vol. 27, No. 4, 2007-08
Pesticides and You Warren Porter, Ph.D.
Vol. 27, No. 4, 2007-08
“scientists at the University of Maryland and the US Department of Agriculture have identified a witch’s brew of pesticides and fungicides contaminating pollen that bees collect to feed their hives.”
SOURCE: www.qz.com
“Thus more attention must be paid to how honey bees are exposed to pesticides outside of the field in which they are placed. We detected 35 different pesticides in the sampled pollen, and found high fungicide loads”
A Phenolic Chemical Used in the Manufacture of Polycarbonate Plastics and Epoxy Resins
Bisphenol A Affects Mitosis
According to vom Saal, bisphenol A has exhibited endocrine disruption in animals and humans at ppb doses. “There are situations where bisphenol A is causing effects at a thousand times lower than the amount in the average human body,” he said, adding that current global production of bisphenol A runs about 7 billion pounds per year.
According to the National Institute of Environmental Health Sciences, a wide range of substances, both natural and human-made, are
thought to cause endocrine disruption, including pharmaceuticals, dioxin and dioxin-like
compounds, polychlorinated biphenyls (PCBs), DDT and other pesticides, and plasticizers such
as bisphenol A.
• Avoid polycarbonate containers that contain BPA, which usually have a #7 or a #3 on the bottom
• Reduce your use of canned foods • BPA can leach from plastic when there is a change
in pH or when heated.
Identifying Exposure Sources 27
Molecular Interventions P450s: From Knowledge to Exploitation F. Peter Guengerich
Molecular Interventions P450s: From Knowledge to Exploitation F. Peter Guengerich
• Contractions in head • High blood pressure • Prone to anxiety
Chief Complaints 72-Year-old Female
• Had many chemicals on golf course • Has a lot of crowns —used to have lots
of amalgam fillings, that were removed • She likes tuna sushi — used to eat a lot
of swordfish • “ I Want to get tested for Toxins”
Environmental Exposure Hx
Supplements
• MVI • Fish oil • Vitamin D
• CoQ10 • Calcium • Lipoic acid
• Cozaar – 100 mg, 1 tab once a day • Lipitor – 40 mg, 1 tab once a day • Doxazosin – 2 mg, 1 tab once a day • Bystolic – 5 mg, 1 tab once a day
Medications
• Continue Cozaar, Doxazosin and Bystolic • Start CoQ10 – 200 mg po qd • Stop Lipitor • Start CatecholeCalm – 2–3 caps po bid • Start NAC – 600 mg po bid • Start Alpha Lipoic Acid – 800 mg po qd
Initial Empiric Treatment
PCB’s
38
39
Notes: The levels shown on this figure represent the sum of the 12 PCB compounds that resemble dioxin, widely recognized as the most toxic of all industrial pollutants, and linked to cancer as well as to damage of the nervous, reproductive, and immune systems. PCB concentrations are shown as toxic equivalents (TEQs) of 2,3.7,8-Tetrachlorodibenzo-p-dioxin, the benchmark of dioxin chemical. Source: EWG analysis of data from Axys (2003), Easton et al. (2002), EPA (2000a and 2000b), Fiedler et al. (2000), Jacobs et al. (2002), NMFS (2002), NAS (2003), Schecter et al. (2001), and USDA (2002).
• PCBs (both dioxin-like and non-dioxin-like) induce apoptosis of monocytes and thymocytes.
• Dioxin-like PCBs can cause thymic atrophy and immnosuppression.
• Dietary PCB exposure can lead to increased rates of certain cancers (especially liver and lung).
Immune System Effects of PCB’s
• PCBs adversely affect thyroid levels, including elevated anti-thyroid antibodies.
• As PCB serum levels increase, the thyroid hormones triiodothyronine (T3) and thyroxine (T4) decrease.
• PCBs and other chlorinated compounds lead to increased risk for type 2 diabetes.
Endocrine Effects 41
Dioxin Poisoning
• PCB 126 is associated with estrogenic and adrenal effects and is immunotoxic.
• PCB 153 was significantly associated with diabetes risk.
• The sum of PCBs 28, 52, 101, 118, 138, 153, and 180 was associated with low T4 and elevated Gamma Glutamyl Transpeptidase (GGT).
Specfic PCB Effects 43
http://www.scientificamerican.com/article.cfm?id=obesity-insulin-resistance-organic-pollutants-fat-diet
About 200 pollutants were measured by either blood or urine test in the NHANE participants. Cave's team narrowed it down — and, he says, “ended up with a list of 111 chemical pollutants which were commonly found in at least 60% of NHANES subjects.” Among the chemicals studied were lead, mercury, and organochlorine pesticides. “And, so from this list, we found several chemicals associated with a dose-dependent increased risk for abnormal liver enzymes,” he says.
• Increase normal bowel excretion of fat soluble toxins using Rice Bran Fiber and Chlorophyll containing foods
Treatment Options to Lower PCB’s (POP’s) 46
47
Inclusion of olestra in the diet resulted in interruption of enterohepatic circulation of hexachlorobenzene and reduction in all tissues even during the periods of caloric restriction. These observations suggest that an appropriate regimen for the removal of lipophilic toxins is the combination of caloric restriction and the interruption of enterohepatic circulation with a nonabsorbable fat.
Volatile Solvents
Chlorinated Pesticides
Whole Blood Toxic Elements
Metals Result µ/g creat Reference Range In Range High Very High
Aluminum 3.0 < 35
Antimony 0.3 < 0.4
Arsenic 34 < 117
Barium 2.2 < 7
Beryllium < DL < 0.6
Bismuth 0.2 < 15
Cadmium 1.1 < 1
Cesium 7.1 < 10
Gadolinium 12 < 0.4
Lead 11 < 2
Mercury 110 < 4
Nickel 6.1 < 12
Tellurium < DL < 0.3
Thallium 0.7 < 0.5
Tin 4.3 < 10
Titanium N/A < 15
Tungsten 0.1 < 0.4
Uranium < DL < 0.04
Method: ICP-MS Provoking Agent: DMPS Post Provocative
Creatinine: 30.3 mg/dL Reference Range: 35–225
Porphyrins
58
Toxic Effects Porphyrins Profile Interpretive Guide Metametrix Laboratory
SNP Testing
Evidence of Increased Glutathione Demand
• Feeling much better! – Headaches gone off Lipitor (on 40 mg before) nervous feeling gone:
“better than in years”
• Blood pressure better, saw cardiologist – – 24 hr monitor in June good 24 hr average 137/65 with sleep 126/60
• ? PCB’s and HTN
Follow-up at 6 weeks
Conclusions: In this cross-sectional study, serum concentrations of PCBs, especially those congeners with multiple ortho chlorines, were strongly associated with both systolic and diastolic blood pressure. Alexey Goncharov, Marian Pavuk, Herman R. Foushee, David O. Carpenter Environmental Health Perspectives, Nov 2, 2010
• Start DMSA – 250 mg 1 three times daily before meals for three days (M,T,W) every other week for 3 months
• Continue NAC – 600 mg po bid and Alpha Lipoic Acid 800 mg po qd, add in Vit C 2,000 mg/day
• Sauna therapy • Avoid mercury containing fish and farmed salmon
Follow-up Note
• Start Rice Bran Fiber– 2 Tbsps daily • Start Cholestyramine 4 grams twice a day • Investigate solvent exposure source(s) (paint, carpet, new car,
etc.) • Take Glycine 1 gram twice a day to support detoxification • Begin Botanical Antimicrobial along with Probiotic twice a day
Follow-up Note
Q & A Session
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The Exposome: Assessing and Measuring the Body Burden of
Environmental Toxins
Todd LePine, M.D. September 25, 2013
12:00PM EST & 8:00 PM EST
© Genova Diagnostics