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Toxins Have Become the Primary Drivers of Disease Dr. Joseph Pizzorno, ND President Emeritus, Bastyr University Editor, Integrative Medicine: A Clinician’s Journal Chair, Scientific Advisory Board, Bioclinic Naturals President, SaluGenecists, Inc. [email protected] Copyright © 2016
Transcript
Page 1: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Toxins Have Become the

Primary Drivers of Disease

Dr Joseph Pizzorno ND

President Emeritus Bastyr University

Editor Integrative Medicine A Clinicianrsquos Journal

Chair Scientific Advisory Board Bioclinic Naturals

President SaluGenecists Incmail2DrPizzornocom

Copyright copy 2016

1 Worldwide Epidemic of Chronic Disease

2 Causes

3 Methodology Disease Risk to Disease Cause

4 Most Chronic Disease is Now Caused by Toxins

5 The Worst Toxins

6 Sources of Toxins

7 Toxicity has Become the New Normal ldquoNormalrdquo Laboratory Ranges Are Toxic Ranges

8 Summary

Overview

There is Some Good Newsbull Banning lead in gasoline

and paint workedmdashblood levels down dramatically

bull No threshold for safety ndash

Children who had whole blood

lead concentrations of lt5 microgdL

(supposedly safe) associated

with decreased IQ

24 million children at levels

between 5 and 99 ugdL

bull July 2012 CDC changed recommended level to intervene in children from 10 to 50 ugdL Also eliminated term ldquolevel of concernrdquo to avoid giving false sense of safety

Iqbal S et al Estimated burden of blood lead levels 5 microgdl in 1999-2002 and declines from 1988 to 1994

Environ Res 2008

httpwwwcdcgovncehleadacclppcdc_response_lead_exposure_recspdf

httpwwwenvironmentuclaedureportcardarticle3772html

bull Human data

bull Primarily US as a lot more research available

bull Spot checking toxins in other countries shows the same toxin overload but variations in which are most prevalent

Australia (higher PDBEs)

Canada (higher lead)

New Zealand (higher cadmium)

Sweden (higher most toxic metals)

UK (highest PDBEs in world 3x OCP of US)

A Note About the Data

AD

HD

Ep

idem

ic

httpwwwcdcgovmmwrpreviewmmwrhtmlmm6433a11htm

Obesity Epidemic

httpwwwtheobesityepidemicorgintroduction (Accessed 616)

Kidney Disease Epidemic

Stevens L httpwwwslidesharenetringer21liaison-meeting-esrd-presentation (accessed 616)

Dia

be

tes

Ep

ide

mic

Diabetes Increasing World-Wide

SourcesAIHW analysis of ABS NHS 1989ndash90 1995 2001 2004ndash05 and 2007ndash08 NHS (reissue) and ABS 2011ndash12 Australian

Health Survey data (Release 7 June 2013)

Co-ordinaring Committee Epidemiology Study of Childhood amp Adolescent Diabetes Hong Kong KF Huen et al

Australian Adults

Childhood diabetes in Hong Kong

WHY THE CHRONIC DISEASE

EPIDEMICS

Increase in Diabetes Due to Sugar

httpwholehealthsourceblogspotcom201202by-2606-us-diet-will-be-100-percenthtml

Dia

bete

s 1

How About Persistent Organic Pollutants

Neel BA Robert M Sargis RM The paradox of progress Environmental disruption of metabolism and the diabetes epidemic DIABETES 2011 601838-48

Lars Jaumlrup Br Med Bull 200368167-182copy The British Council 2003 all rights reserved

Global Production and Consumption of

Selected Toxic Metals 1850ndash1990

Cadmium World Production

Mercury in the Air

EPA-452R-97-003 December 1997

Mercury in Water

httpwaterepagovscitechdataitmodelsmapspostercfm

Ground Water Sources of Arsenic

bull 10 of US public water supplies have levels of arsenic known to induce disease

bull No data on private water supplies

httpwwwatsdrcdcgovcsemarsenicdocsarsenicpdf (accessed 2015-08-18)

Example POPs

Chemical Abbr Uses Exposure

Bisphenol A BPA Plastics Canned food

Organochlorine

pesticides

OCPs Pesticide Food fumigation

Organophosphate

pesticides

OPPs Pesticide Food

Polybrominated

diphenyl ethers

PBDEs Flame retardant Clothing

Polychlorinated

biphenyls

PCBs Industrial Everywhere

Perflourinated PFOAs Non-stick stain prevention

water repellant

Teflon Gortex

Scotchguard

Phthalates Plastics fragrances Shower curtains

cosmetics

POPs - Prediabetes

bull Over 1200 participants fasting

glucose and OGTT performed

with serum levels of 5 POPs

bull All individual POPs tested were

associated with progressive

increase in prevalence of

prediabetes

bull More than triple prevalence of

prediabetes seen in those in the

5th quartile with a synergistic

effect from 5 POPs

Ukropec J et al High prevalence of prediabetes and diabetes in a population exposed to high levels of an organochlorine cocktail

Diabetologia 2010 May53(5)899-906

POPs and Diabetes Risk

Graph httpwwwourstolenfutureorgNewScienceobesity20062006-0715leeetalhtml

Data Lee DH Lee IK Song K et al A strong dose-response relation between serum

concentrations of persistent organic pollutants and diabetes results from the National Health and

Examination Survey 1999-2002 Diabetes Care 2006 Jul29(7)1638-44

Toxic Load and Disease Risk

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 2: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

1 Worldwide Epidemic of Chronic Disease

2 Causes

3 Methodology Disease Risk to Disease Cause

4 Most Chronic Disease is Now Caused by Toxins

5 The Worst Toxins

6 Sources of Toxins

7 Toxicity has Become the New Normal ldquoNormalrdquo Laboratory Ranges Are Toxic Ranges

8 Summary

Overview

There is Some Good Newsbull Banning lead in gasoline

and paint workedmdashblood levels down dramatically

bull No threshold for safety ndash

Children who had whole blood

lead concentrations of lt5 microgdL

(supposedly safe) associated

with decreased IQ

24 million children at levels

between 5 and 99 ugdL

bull July 2012 CDC changed recommended level to intervene in children from 10 to 50 ugdL Also eliminated term ldquolevel of concernrdquo to avoid giving false sense of safety

Iqbal S et al Estimated burden of blood lead levels 5 microgdl in 1999-2002 and declines from 1988 to 1994

Environ Res 2008

httpwwwcdcgovncehleadacclppcdc_response_lead_exposure_recspdf

httpwwwenvironmentuclaedureportcardarticle3772html

bull Human data

bull Primarily US as a lot more research available

bull Spot checking toxins in other countries shows the same toxin overload but variations in which are most prevalent

Australia (higher PDBEs)

Canada (higher lead)

New Zealand (higher cadmium)

Sweden (higher most toxic metals)

UK (highest PDBEs in world 3x OCP of US)

A Note About the Data

AD

HD

Ep

idem

ic

httpwwwcdcgovmmwrpreviewmmwrhtmlmm6433a11htm

Obesity Epidemic

httpwwwtheobesityepidemicorgintroduction (Accessed 616)

Kidney Disease Epidemic

Stevens L httpwwwslidesharenetringer21liaison-meeting-esrd-presentation (accessed 616)

Dia

be

tes

Ep

ide

mic

Diabetes Increasing World-Wide

SourcesAIHW analysis of ABS NHS 1989ndash90 1995 2001 2004ndash05 and 2007ndash08 NHS (reissue) and ABS 2011ndash12 Australian

Health Survey data (Release 7 June 2013)

Co-ordinaring Committee Epidemiology Study of Childhood amp Adolescent Diabetes Hong Kong KF Huen et al

Australian Adults

Childhood diabetes in Hong Kong

WHY THE CHRONIC DISEASE

EPIDEMICS

Increase in Diabetes Due to Sugar

httpwholehealthsourceblogspotcom201202by-2606-us-diet-will-be-100-percenthtml

Dia

bete

s 1

How About Persistent Organic Pollutants

Neel BA Robert M Sargis RM The paradox of progress Environmental disruption of metabolism and the diabetes epidemic DIABETES 2011 601838-48

Lars Jaumlrup Br Med Bull 200368167-182copy The British Council 2003 all rights reserved

Global Production and Consumption of

Selected Toxic Metals 1850ndash1990

Cadmium World Production

Mercury in the Air

EPA-452R-97-003 December 1997

Mercury in Water

httpwaterepagovscitechdataitmodelsmapspostercfm

Ground Water Sources of Arsenic

bull 10 of US public water supplies have levels of arsenic known to induce disease

bull No data on private water supplies

httpwwwatsdrcdcgovcsemarsenicdocsarsenicpdf (accessed 2015-08-18)

Example POPs

Chemical Abbr Uses Exposure

Bisphenol A BPA Plastics Canned food

Organochlorine

pesticides

OCPs Pesticide Food fumigation

Organophosphate

pesticides

OPPs Pesticide Food

Polybrominated

diphenyl ethers

PBDEs Flame retardant Clothing

Polychlorinated

biphenyls

PCBs Industrial Everywhere

Perflourinated PFOAs Non-stick stain prevention

water repellant

Teflon Gortex

Scotchguard

Phthalates Plastics fragrances Shower curtains

cosmetics

POPs - Prediabetes

bull Over 1200 participants fasting

glucose and OGTT performed

with serum levels of 5 POPs

bull All individual POPs tested were

associated with progressive

increase in prevalence of

prediabetes

bull More than triple prevalence of

prediabetes seen in those in the

5th quartile with a synergistic

effect from 5 POPs

Ukropec J et al High prevalence of prediabetes and diabetes in a population exposed to high levels of an organochlorine cocktail

Diabetologia 2010 May53(5)899-906

POPs and Diabetes Risk

Graph httpwwwourstolenfutureorgNewScienceobesity20062006-0715leeetalhtml

Data Lee DH Lee IK Song K et al A strong dose-response relation between serum

concentrations of persistent organic pollutants and diabetes results from the National Health and

Examination Survey 1999-2002 Diabetes Care 2006 Jul29(7)1638-44

Toxic Load and Disease Risk

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 3: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

There is Some Good Newsbull Banning lead in gasoline

and paint workedmdashblood levels down dramatically

bull No threshold for safety ndash

Children who had whole blood

lead concentrations of lt5 microgdL

(supposedly safe) associated

with decreased IQ

24 million children at levels

between 5 and 99 ugdL

bull July 2012 CDC changed recommended level to intervene in children from 10 to 50 ugdL Also eliminated term ldquolevel of concernrdquo to avoid giving false sense of safety

Iqbal S et al Estimated burden of blood lead levels 5 microgdl in 1999-2002 and declines from 1988 to 1994

Environ Res 2008

httpwwwcdcgovncehleadacclppcdc_response_lead_exposure_recspdf

httpwwwenvironmentuclaedureportcardarticle3772html

bull Human data

bull Primarily US as a lot more research available

bull Spot checking toxins in other countries shows the same toxin overload but variations in which are most prevalent

Australia (higher PDBEs)

Canada (higher lead)

New Zealand (higher cadmium)

Sweden (higher most toxic metals)

UK (highest PDBEs in world 3x OCP of US)

A Note About the Data

AD

HD

Ep

idem

ic

httpwwwcdcgovmmwrpreviewmmwrhtmlmm6433a11htm

Obesity Epidemic

httpwwwtheobesityepidemicorgintroduction (Accessed 616)

Kidney Disease Epidemic

Stevens L httpwwwslidesharenetringer21liaison-meeting-esrd-presentation (accessed 616)

Dia

be

tes

Ep

ide

mic

Diabetes Increasing World-Wide

SourcesAIHW analysis of ABS NHS 1989ndash90 1995 2001 2004ndash05 and 2007ndash08 NHS (reissue) and ABS 2011ndash12 Australian

Health Survey data (Release 7 June 2013)

Co-ordinaring Committee Epidemiology Study of Childhood amp Adolescent Diabetes Hong Kong KF Huen et al

Australian Adults

Childhood diabetes in Hong Kong

WHY THE CHRONIC DISEASE

EPIDEMICS

Increase in Diabetes Due to Sugar

httpwholehealthsourceblogspotcom201202by-2606-us-diet-will-be-100-percenthtml

Dia

bete

s 1

How About Persistent Organic Pollutants

Neel BA Robert M Sargis RM The paradox of progress Environmental disruption of metabolism and the diabetes epidemic DIABETES 2011 601838-48

Lars Jaumlrup Br Med Bull 200368167-182copy The British Council 2003 all rights reserved

Global Production and Consumption of

Selected Toxic Metals 1850ndash1990

Cadmium World Production

Mercury in the Air

EPA-452R-97-003 December 1997

Mercury in Water

httpwaterepagovscitechdataitmodelsmapspostercfm

Ground Water Sources of Arsenic

bull 10 of US public water supplies have levels of arsenic known to induce disease

bull No data on private water supplies

httpwwwatsdrcdcgovcsemarsenicdocsarsenicpdf (accessed 2015-08-18)

Example POPs

Chemical Abbr Uses Exposure

Bisphenol A BPA Plastics Canned food

Organochlorine

pesticides

OCPs Pesticide Food fumigation

Organophosphate

pesticides

OPPs Pesticide Food

Polybrominated

diphenyl ethers

PBDEs Flame retardant Clothing

Polychlorinated

biphenyls

PCBs Industrial Everywhere

Perflourinated PFOAs Non-stick stain prevention

water repellant

Teflon Gortex

Scotchguard

Phthalates Plastics fragrances Shower curtains

cosmetics

POPs - Prediabetes

bull Over 1200 participants fasting

glucose and OGTT performed

with serum levels of 5 POPs

bull All individual POPs tested were

associated with progressive

increase in prevalence of

prediabetes

bull More than triple prevalence of

prediabetes seen in those in the

5th quartile with a synergistic

effect from 5 POPs

Ukropec J et al High prevalence of prediabetes and diabetes in a population exposed to high levels of an organochlorine cocktail

Diabetologia 2010 May53(5)899-906

POPs and Diabetes Risk

Graph httpwwwourstolenfutureorgNewScienceobesity20062006-0715leeetalhtml

Data Lee DH Lee IK Song K et al A strong dose-response relation between serum

concentrations of persistent organic pollutants and diabetes results from the National Health and

Examination Survey 1999-2002 Diabetes Care 2006 Jul29(7)1638-44

Toxic Load and Disease Risk

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 4: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

bull Human data

bull Primarily US as a lot more research available

bull Spot checking toxins in other countries shows the same toxin overload but variations in which are most prevalent

Australia (higher PDBEs)

Canada (higher lead)

New Zealand (higher cadmium)

Sweden (higher most toxic metals)

UK (highest PDBEs in world 3x OCP of US)

A Note About the Data

AD

HD

Ep

idem

ic

httpwwwcdcgovmmwrpreviewmmwrhtmlmm6433a11htm

Obesity Epidemic

httpwwwtheobesityepidemicorgintroduction (Accessed 616)

Kidney Disease Epidemic

Stevens L httpwwwslidesharenetringer21liaison-meeting-esrd-presentation (accessed 616)

Dia

be

tes

Ep

ide

mic

Diabetes Increasing World-Wide

SourcesAIHW analysis of ABS NHS 1989ndash90 1995 2001 2004ndash05 and 2007ndash08 NHS (reissue) and ABS 2011ndash12 Australian

Health Survey data (Release 7 June 2013)

Co-ordinaring Committee Epidemiology Study of Childhood amp Adolescent Diabetes Hong Kong KF Huen et al

Australian Adults

Childhood diabetes in Hong Kong

WHY THE CHRONIC DISEASE

EPIDEMICS

Increase in Diabetes Due to Sugar

httpwholehealthsourceblogspotcom201202by-2606-us-diet-will-be-100-percenthtml

Dia

bete

s 1

How About Persistent Organic Pollutants

Neel BA Robert M Sargis RM The paradox of progress Environmental disruption of metabolism and the diabetes epidemic DIABETES 2011 601838-48

Lars Jaumlrup Br Med Bull 200368167-182copy The British Council 2003 all rights reserved

Global Production and Consumption of

Selected Toxic Metals 1850ndash1990

Cadmium World Production

Mercury in the Air

EPA-452R-97-003 December 1997

Mercury in Water

httpwaterepagovscitechdataitmodelsmapspostercfm

Ground Water Sources of Arsenic

bull 10 of US public water supplies have levels of arsenic known to induce disease

bull No data on private water supplies

httpwwwatsdrcdcgovcsemarsenicdocsarsenicpdf (accessed 2015-08-18)

Example POPs

Chemical Abbr Uses Exposure

Bisphenol A BPA Plastics Canned food

Organochlorine

pesticides

OCPs Pesticide Food fumigation

Organophosphate

pesticides

OPPs Pesticide Food

Polybrominated

diphenyl ethers

PBDEs Flame retardant Clothing

Polychlorinated

biphenyls

PCBs Industrial Everywhere

Perflourinated PFOAs Non-stick stain prevention

water repellant

Teflon Gortex

Scotchguard

Phthalates Plastics fragrances Shower curtains

cosmetics

POPs - Prediabetes

bull Over 1200 participants fasting

glucose and OGTT performed

with serum levels of 5 POPs

bull All individual POPs tested were

associated with progressive

increase in prevalence of

prediabetes

bull More than triple prevalence of

prediabetes seen in those in the

5th quartile with a synergistic

effect from 5 POPs

Ukropec J et al High prevalence of prediabetes and diabetes in a population exposed to high levels of an organochlorine cocktail

Diabetologia 2010 May53(5)899-906

POPs and Diabetes Risk

Graph httpwwwourstolenfutureorgNewScienceobesity20062006-0715leeetalhtml

Data Lee DH Lee IK Song K et al A strong dose-response relation between serum

concentrations of persistent organic pollutants and diabetes results from the National Health and

Examination Survey 1999-2002 Diabetes Care 2006 Jul29(7)1638-44

Toxic Load and Disease Risk

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 5: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

AD

HD

Ep

idem

ic

httpwwwcdcgovmmwrpreviewmmwrhtmlmm6433a11htm

Obesity Epidemic

httpwwwtheobesityepidemicorgintroduction (Accessed 616)

Kidney Disease Epidemic

Stevens L httpwwwslidesharenetringer21liaison-meeting-esrd-presentation (accessed 616)

Dia

be

tes

Ep

ide

mic

Diabetes Increasing World-Wide

SourcesAIHW analysis of ABS NHS 1989ndash90 1995 2001 2004ndash05 and 2007ndash08 NHS (reissue) and ABS 2011ndash12 Australian

Health Survey data (Release 7 June 2013)

Co-ordinaring Committee Epidemiology Study of Childhood amp Adolescent Diabetes Hong Kong KF Huen et al

Australian Adults

Childhood diabetes in Hong Kong

WHY THE CHRONIC DISEASE

EPIDEMICS

Increase in Diabetes Due to Sugar

httpwholehealthsourceblogspotcom201202by-2606-us-diet-will-be-100-percenthtml

Dia

bete

s 1

How About Persistent Organic Pollutants

Neel BA Robert M Sargis RM The paradox of progress Environmental disruption of metabolism and the diabetes epidemic DIABETES 2011 601838-48

Lars Jaumlrup Br Med Bull 200368167-182copy The British Council 2003 all rights reserved

Global Production and Consumption of

Selected Toxic Metals 1850ndash1990

Cadmium World Production

Mercury in the Air

EPA-452R-97-003 December 1997

Mercury in Water

httpwaterepagovscitechdataitmodelsmapspostercfm

Ground Water Sources of Arsenic

bull 10 of US public water supplies have levels of arsenic known to induce disease

bull No data on private water supplies

httpwwwatsdrcdcgovcsemarsenicdocsarsenicpdf (accessed 2015-08-18)

Example POPs

Chemical Abbr Uses Exposure

Bisphenol A BPA Plastics Canned food

Organochlorine

pesticides

OCPs Pesticide Food fumigation

Organophosphate

pesticides

OPPs Pesticide Food

Polybrominated

diphenyl ethers

PBDEs Flame retardant Clothing

Polychlorinated

biphenyls

PCBs Industrial Everywhere

Perflourinated PFOAs Non-stick stain prevention

water repellant

Teflon Gortex

Scotchguard

Phthalates Plastics fragrances Shower curtains

cosmetics

POPs - Prediabetes

bull Over 1200 participants fasting

glucose and OGTT performed

with serum levels of 5 POPs

bull All individual POPs tested were

associated with progressive

increase in prevalence of

prediabetes

bull More than triple prevalence of

prediabetes seen in those in the

5th quartile with a synergistic

effect from 5 POPs

Ukropec J et al High prevalence of prediabetes and diabetes in a population exposed to high levels of an organochlorine cocktail

Diabetologia 2010 May53(5)899-906

POPs and Diabetes Risk

Graph httpwwwourstolenfutureorgNewScienceobesity20062006-0715leeetalhtml

Data Lee DH Lee IK Song K et al A strong dose-response relation between serum

concentrations of persistent organic pollutants and diabetes results from the National Health and

Examination Survey 1999-2002 Diabetes Care 2006 Jul29(7)1638-44

Toxic Load and Disease Risk

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 6: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Obesity Epidemic

httpwwwtheobesityepidemicorgintroduction (Accessed 616)

Kidney Disease Epidemic

Stevens L httpwwwslidesharenetringer21liaison-meeting-esrd-presentation (accessed 616)

Dia

be

tes

Ep

ide

mic

Diabetes Increasing World-Wide

SourcesAIHW analysis of ABS NHS 1989ndash90 1995 2001 2004ndash05 and 2007ndash08 NHS (reissue) and ABS 2011ndash12 Australian

Health Survey data (Release 7 June 2013)

Co-ordinaring Committee Epidemiology Study of Childhood amp Adolescent Diabetes Hong Kong KF Huen et al

Australian Adults

Childhood diabetes in Hong Kong

WHY THE CHRONIC DISEASE

EPIDEMICS

Increase in Diabetes Due to Sugar

httpwholehealthsourceblogspotcom201202by-2606-us-diet-will-be-100-percenthtml

Dia

bete

s 1

How About Persistent Organic Pollutants

Neel BA Robert M Sargis RM The paradox of progress Environmental disruption of metabolism and the diabetes epidemic DIABETES 2011 601838-48

Lars Jaumlrup Br Med Bull 200368167-182copy The British Council 2003 all rights reserved

Global Production and Consumption of

Selected Toxic Metals 1850ndash1990

Cadmium World Production

Mercury in the Air

EPA-452R-97-003 December 1997

Mercury in Water

httpwaterepagovscitechdataitmodelsmapspostercfm

Ground Water Sources of Arsenic

bull 10 of US public water supplies have levels of arsenic known to induce disease

bull No data on private water supplies

httpwwwatsdrcdcgovcsemarsenicdocsarsenicpdf (accessed 2015-08-18)

Example POPs

Chemical Abbr Uses Exposure

Bisphenol A BPA Plastics Canned food

Organochlorine

pesticides

OCPs Pesticide Food fumigation

Organophosphate

pesticides

OPPs Pesticide Food

Polybrominated

diphenyl ethers

PBDEs Flame retardant Clothing

Polychlorinated

biphenyls

PCBs Industrial Everywhere

Perflourinated PFOAs Non-stick stain prevention

water repellant

Teflon Gortex

Scotchguard

Phthalates Plastics fragrances Shower curtains

cosmetics

POPs - Prediabetes

bull Over 1200 participants fasting

glucose and OGTT performed

with serum levels of 5 POPs

bull All individual POPs tested were

associated with progressive

increase in prevalence of

prediabetes

bull More than triple prevalence of

prediabetes seen in those in the

5th quartile with a synergistic

effect from 5 POPs

Ukropec J et al High prevalence of prediabetes and diabetes in a population exposed to high levels of an organochlorine cocktail

Diabetologia 2010 May53(5)899-906

POPs and Diabetes Risk

Graph httpwwwourstolenfutureorgNewScienceobesity20062006-0715leeetalhtml

Data Lee DH Lee IK Song K et al A strong dose-response relation between serum

concentrations of persistent organic pollutants and diabetes results from the National Health and

Examination Survey 1999-2002 Diabetes Care 2006 Jul29(7)1638-44

Toxic Load and Disease Risk

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 7: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Kidney Disease Epidemic

Stevens L httpwwwslidesharenetringer21liaison-meeting-esrd-presentation (accessed 616)

Dia

be

tes

Ep

ide

mic

Diabetes Increasing World-Wide

SourcesAIHW analysis of ABS NHS 1989ndash90 1995 2001 2004ndash05 and 2007ndash08 NHS (reissue) and ABS 2011ndash12 Australian

Health Survey data (Release 7 June 2013)

Co-ordinaring Committee Epidemiology Study of Childhood amp Adolescent Diabetes Hong Kong KF Huen et al

Australian Adults

Childhood diabetes in Hong Kong

WHY THE CHRONIC DISEASE

EPIDEMICS

Increase in Diabetes Due to Sugar

httpwholehealthsourceblogspotcom201202by-2606-us-diet-will-be-100-percenthtml

Dia

bete

s 1

How About Persistent Organic Pollutants

Neel BA Robert M Sargis RM The paradox of progress Environmental disruption of metabolism and the diabetes epidemic DIABETES 2011 601838-48

Lars Jaumlrup Br Med Bull 200368167-182copy The British Council 2003 all rights reserved

Global Production and Consumption of

Selected Toxic Metals 1850ndash1990

Cadmium World Production

Mercury in the Air

EPA-452R-97-003 December 1997

Mercury in Water

httpwaterepagovscitechdataitmodelsmapspostercfm

Ground Water Sources of Arsenic

bull 10 of US public water supplies have levels of arsenic known to induce disease

bull No data on private water supplies

httpwwwatsdrcdcgovcsemarsenicdocsarsenicpdf (accessed 2015-08-18)

Example POPs

Chemical Abbr Uses Exposure

Bisphenol A BPA Plastics Canned food

Organochlorine

pesticides

OCPs Pesticide Food fumigation

Organophosphate

pesticides

OPPs Pesticide Food

Polybrominated

diphenyl ethers

PBDEs Flame retardant Clothing

Polychlorinated

biphenyls

PCBs Industrial Everywhere

Perflourinated PFOAs Non-stick stain prevention

water repellant

Teflon Gortex

Scotchguard

Phthalates Plastics fragrances Shower curtains

cosmetics

POPs - Prediabetes

bull Over 1200 participants fasting

glucose and OGTT performed

with serum levels of 5 POPs

bull All individual POPs tested were

associated with progressive

increase in prevalence of

prediabetes

bull More than triple prevalence of

prediabetes seen in those in the

5th quartile with a synergistic

effect from 5 POPs

Ukropec J et al High prevalence of prediabetes and diabetes in a population exposed to high levels of an organochlorine cocktail

Diabetologia 2010 May53(5)899-906

POPs and Diabetes Risk

Graph httpwwwourstolenfutureorgNewScienceobesity20062006-0715leeetalhtml

Data Lee DH Lee IK Song K et al A strong dose-response relation between serum

concentrations of persistent organic pollutants and diabetes results from the National Health and

Examination Survey 1999-2002 Diabetes Care 2006 Jul29(7)1638-44

Toxic Load and Disease Risk

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 8: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Dia

be

tes

Ep

ide

mic

Diabetes Increasing World-Wide

SourcesAIHW analysis of ABS NHS 1989ndash90 1995 2001 2004ndash05 and 2007ndash08 NHS (reissue) and ABS 2011ndash12 Australian

Health Survey data (Release 7 June 2013)

Co-ordinaring Committee Epidemiology Study of Childhood amp Adolescent Diabetes Hong Kong KF Huen et al

Australian Adults

Childhood diabetes in Hong Kong

WHY THE CHRONIC DISEASE

EPIDEMICS

Increase in Diabetes Due to Sugar

httpwholehealthsourceblogspotcom201202by-2606-us-diet-will-be-100-percenthtml

Dia

bete

s 1

How About Persistent Organic Pollutants

Neel BA Robert M Sargis RM The paradox of progress Environmental disruption of metabolism and the diabetes epidemic DIABETES 2011 601838-48

Lars Jaumlrup Br Med Bull 200368167-182copy The British Council 2003 all rights reserved

Global Production and Consumption of

Selected Toxic Metals 1850ndash1990

Cadmium World Production

Mercury in the Air

EPA-452R-97-003 December 1997

Mercury in Water

httpwaterepagovscitechdataitmodelsmapspostercfm

Ground Water Sources of Arsenic

bull 10 of US public water supplies have levels of arsenic known to induce disease

bull No data on private water supplies

httpwwwatsdrcdcgovcsemarsenicdocsarsenicpdf (accessed 2015-08-18)

Example POPs

Chemical Abbr Uses Exposure

Bisphenol A BPA Plastics Canned food

Organochlorine

pesticides

OCPs Pesticide Food fumigation

Organophosphate

pesticides

OPPs Pesticide Food

Polybrominated

diphenyl ethers

PBDEs Flame retardant Clothing

Polychlorinated

biphenyls

PCBs Industrial Everywhere

Perflourinated PFOAs Non-stick stain prevention

water repellant

Teflon Gortex

Scotchguard

Phthalates Plastics fragrances Shower curtains

cosmetics

POPs - Prediabetes

bull Over 1200 participants fasting

glucose and OGTT performed

with serum levels of 5 POPs

bull All individual POPs tested were

associated with progressive

increase in prevalence of

prediabetes

bull More than triple prevalence of

prediabetes seen in those in the

5th quartile with a synergistic

effect from 5 POPs

Ukropec J et al High prevalence of prediabetes and diabetes in a population exposed to high levels of an organochlorine cocktail

Diabetologia 2010 May53(5)899-906

POPs and Diabetes Risk

Graph httpwwwourstolenfutureorgNewScienceobesity20062006-0715leeetalhtml

Data Lee DH Lee IK Song K et al A strong dose-response relation between serum

concentrations of persistent organic pollutants and diabetes results from the National Health and

Examination Survey 1999-2002 Diabetes Care 2006 Jul29(7)1638-44

Toxic Load and Disease Risk

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 9: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Diabetes Increasing World-Wide

SourcesAIHW analysis of ABS NHS 1989ndash90 1995 2001 2004ndash05 and 2007ndash08 NHS (reissue) and ABS 2011ndash12 Australian

Health Survey data (Release 7 June 2013)

Co-ordinaring Committee Epidemiology Study of Childhood amp Adolescent Diabetes Hong Kong KF Huen et al

Australian Adults

Childhood diabetes in Hong Kong

WHY THE CHRONIC DISEASE

EPIDEMICS

Increase in Diabetes Due to Sugar

httpwholehealthsourceblogspotcom201202by-2606-us-diet-will-be-100-percenthtml

Dia

bete

s 1

How About Persistent Organic Pollutants

Neel BA Robert M Sargis RM The paradox of progress Environmental disruption of metabolism and the diabetes epidemic DIABETES 2011 601838-48

Lars Jaumlrup Br Med Bull 200368167-182copy The British Council 2003 all rights reserved

Global Production and Consumption of

Selected Toxic Metals 1850ndash1990

Cadmium World Production

Mercury in the Air

EPA-452R-97-003 December 1997

Mercury in Water

httpwaterepagovscitechdataitmodelsmapspostercfm

Ground Water Sources of Arsenic

bull 10 of US public water supplies have levels of arsenic known to induce disease

bull No data on private water supplies

httpwwwatsdrcdcgovcsemarsenicdocsarsenicpdf (accessed 2015-08-18)

Example POPs

Chemical Abbr Uses Exposure

Bisphenol A BPA Plastics Canned food

Organochlorine

pesticides

OCPs Pesticide Food fumigation

Organophosphate

pesticides

OPPs Pesticide Food

Polybrominated

diphenyl ethers

PBDEs Flame retardant Clothing

Polychlorinated

biphenyls

PCBs Industrial Everywhere

Perflourinated PFOAs Non-stick stain prevention

water repellant

Teflon Gortex

Scotchguard

Phthalates Plastics fragrances Shower curtains

cosmetics

POPs - Prediabetes

bull Over 1200 participants fasting

glucose and OGTT performed

with serum levels of 5 POPs

bull All individual POPs tested were

associated with progressive

increase in prevalence of

prediabetes

bull More than triple prevalence of

prediabetes seen in those in the

5th quartile with a synergistic

effect from 5 POPs

Ukropec J et al High prevalence of prediabetes and diabetes in a population exposed to high levels of an organochlorine cocktail

Diabetologia 2010 May53(5)899-906

POPs and Diabetes Risk

Graph httpwwwourstolenfutureorgNewScienceobesity20062006-0715leeetalhtml

Data Lee DH Lee IK Song K et al A strong dose-response relation between serum

concentrations of persistent organic pollutants and diabetes results from the National Health and

Examination Survey 1999-2002 Diabetes Care 2006 Jul29(7)1638-44

Toxic Load and Disease Risk

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 10: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

WHY THE CHRONIC DISEASE

EPIDEMICS

Increase in Diabetes Due to Sugar

httpwholehealthsourceblogspotcom201202by-2606-us-diet-will-be-100-percenthtml

Dia

bete

s 1

How About Persistent Organic Pollutants

Neel BA Robert M Sargis RM The paradox of progress Environmental disruption of metabolism and the diabetes epidemic DIABETES 2011 601838-48

Lars Jaumlrup Br Med Bull 200368167-182copy The British Council 2003 all rights reserved

Global Production and Consumption of

Selected Toxic Metals 1850ndash1990

Cadmium World Production

Mercury in the Air

EPA-452R-97-003 December 1997

Mercury in Water

httpwaterepagovscitechdataitmodelsmapspostercfm

Ground Water Sources of Arsenic

bull 10 of US public water supplies have levels of arsenic known to induce disease

bull No data on private water supplies

httpwwwatsdrcdcgovcsemarsenicdocsarsenicpdf (accessed 2015-08-18)

Example POPs

Chemical Abbr Uses Exposure

Bisphenol A BPA Plastics Canned food

Organochlorine

pesticides

OCPs Pesticide Food fumigation

Organophosphate

pesticides

OPPs Pesticide Food

Polybrominated

diphenyl ethers

PBDEs Flame retardant Clothing

Polychlorinated

biphenyls

PCBs Industrial Everywhere

Perflourinated PFOAs Non-stick stain prevention

water repellant

Teflon Gortex

Scotchguard

Phthalates Plastics fragrances Shower curtains

cosmetics

POPs - Prediabetes

bull Over 1200 participants fasting

glucose and OGTT performed

with serum levels of 5 POPs

bull All individual POPs tested were

associated with progressive

increase in prevalence of

prediabetes

bull More than triple prevalence of

prediabetes seen in those in the

5th quartile with a synergistic

effect from 5 POPs

Ukropec J et al High prevalence of prediabetes and diabetes in a population exposed to high levels of an organochlorine cocktail

Diabetologia 2010 May53(5)899-906

POPs and Diabetes Risk

Graph httpwwwourstolenfutureorgNewScienceobesity20062006-0715leeetalhtml

Data Lee DH Lee IK Song K et al A strong dose-response relation between serum

concentrations of persistent organic pollutants and diabetes results from the National Health and

Examination Survey 1999-2002 Diabetes Care 2006 Jul29(7)1638-44

Toxic Load and Disease Risk

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 11: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Increase in Diabetes Due to Sugar

httpwholehealthsourceblogspotcom201202by-2606-us-diet-will-be-100-percenthtml

Dia

bete

s 1

How About Persistent Organic Pollutants

Neel BA Robert M Sargis RM The paradox of progress Environmental disruption of metabolism and the diabetes epidemic DIABETES 2011 601838-48

Lars Jaumlrup Br Med Bull 200368167-182copy The British Council 2003 all rights reserved

Global Production and Consumption of

Selected Toxic Metals 1850ndash1990

Cadmium World Production

Mercury in the Air

EPA-452R-97-003 December 1997

Mercury in Water

httpwaterepagovscitechdataitmodelsmapspostercfm

Ground Water Sources of Arsenic

bull 10 of US public water supplies have levels of arsenic known to induce disease

bull No data on private water supplies

httpwwwatsdrcdcgovcsemarsenicdocsarsenicpdf (accessed 2015-08-18)

Example POPs

Chemical Abbr Uses Exposure

Bisphenol A BPA Plastics Canned food

Organochlorine

pesticides

OCPs Pesticide Food fumigation

Organophosphate

pesticides

OPPs Pesticide Food

Polybrominated

diphenyl ethers

PBDEs Flame retardant Clothing

Polychlorinated

biphenyls

PCBs Industrial Everywhere

Perflourinated PFOAs Non-stick stain prevention

water repellant

Teflon Gortex

Scotchguard

Phthalates Plastics fragrances Shower curtains

cosmetics

POPs - Prediabetes

bull Over 1200 participants fasting

glucose and OGTT performed

with serum levels of 5 POPs

bull All individual POPs tested were

associated with progressive

increase in prevalence of

prediabetes

bull More than triple prevalence of

prediabetes seen in those in the

5th quartile with a synergistic

effect from 5 POPs

Ukropec J et al High prevalence of prediabetes and diabetes in a population exposed to high levels of an organochlorine cocktail

Diabetologia 2010 May53(5)899-906

POPs and Diabetes Risk

Graph httpwwwourstolenfutureorgNewScienceobesity20062006-0715leeetalhtml

Data Lee DH Lee IK Song K et al A strong dose-response relation between serum

concentrations of persistent organic pollutants and diabetes results from the National Health and

Examination Survey 1999-2002 Diabetes Care 2006 Jul29(7)1638-44

Toxic Load and Disease Risk

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 12: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

How About Persistent Organic Pollutants

Neel BA Robert M Sargis RM The paradox of progress Environmental disruption of metabolism and the diabetes epidemic DIABETES 2011 601838-48

Lars Jaumlrup Br Med Bull 200368167-182copy The British Council 2003 all rights reserved

Global Production and Consumption of

Selected Toxic Metals 1850ndash1990

Cadmium World Production

Mercury in the Air

EPA-452R-97-003 December 1997

Mercury in Water

httpwaterepagovscitechdataitmodelsmapspostercfm

Ground Water Sources of Arsenic

bull 10 of US public water supplies have levels of arsenic known to induce disease

bull No data on private water supplies

httpwwwatsdrcdcgovcsemarsenicdocsarsenicpdf (accessed 2015-08-18)

Example POPs

Chemical Abbr Uses Exposure

Bisphenol A BPA Plastics Canned food

Organochlorine

pesticides

OCPs Pesticide Food fumigation

Organophosphate

pesticides

OPPs Pesticide Food

Polybrominated

diphenyl ethers

PBDEs Flame retardant Clothing

Polychlorinated

biphenyls

PCBs Industrial Everywhere

Perflourinated PFOAs Non-stick stain prevention

water repellant

Teflon Gortex

Scotchguard

Phthalates Plastics fragrances Shower curtains

cosmetics

POPs - Prediabetes

bull Over 1200 participants fasting

glucose and OGTT performed

with serum levels of 5 POPs

bull All individual POPs tested were

associated with progressive

increase in prevalence of

prediabetes

bull More than triple prevalence of

prediabetes seen in those in the

5th quartile with a synergistic

effect from 5 POPs

Ukropec J et al High prevalence of prediabetes and diabetes in a population exposed to high levels of an organochlorine cocktail

Diabetologia 2010 May53(5)899-906

POPs and Diabetes Risk

Graph httpwwwourstolenfutureorgNewScienceobesity20062006-0715leeetalhtml

Data Lee DH Lee IK Song K et al A strong dose-response relation between serum

concentrations of persistent organic pollutants and diabetes results from the National Health and

Examination Survey 1999-2002 Diabetes Care 2006 Jul29(7)1638-44

Toxic Load and Disease Risk

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 13: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Lars Jaumlrup Br Med Bull 200368167-182copy The British Council 2003 all rights reserved

Global Production and Consumption of

Selected Toxic Metals 1850ndash1990

Cadmium World Production

Mercury in the Air

EPA-452R-97-003 December 1997

Mercury in Water

httpwaterepagovscitechdataitmodelsmapspostercfm

Ground Water Sources of Arsenic

bull 10 of US public water supplies have levels of arsenic known to induce disease

bull No data on private water supplies

httpwwwatsdrcdcgovcsemarsenicdocsarsenicpdf (accessed 2015-08-18)

Example POPs

Chemical Abbr Uses Exposure

Bisphenol A BPA Plastics Canned food

Organochlorine

pesticides

OCPs Pesticide Food fumigation

Organophosphate

pesticides

OPPs Pesticide Food

Polybrominated

diphenyl ethers

PBDEs Flame retardant Clothing

Polychlorinated

biphenyls

PCBs Industrial Everywhere

Perflourinated PFOAs Non-stick stain prevention

water repellant

Teflon Gortex

Scotchguard

Phthalates Plastics fragrances Shower curtains

cosmetics

POPs - Prediabetes

bull Over 1200 participants fasting

glucose and OGTT performed

with serum levels of 5 POPs

bull All individual POPs tested were

associated with progressive

increase in prevalence of

prediabetes

bull More than triple prevalence of

prediabetes seen in those in the

5th quartile with a synergistic

effect from 5 POPs

Ukropec J et al High prevalence of prediabetes and diabetes in a population exposed to high levels of an organochlorine cocktail

Diabetologia 2010 May53(5)899-906

POPs and Diabetes Risk

Graph httpwwwourstolenfutureorgNewScienceobesity20062006-0715leeetalhtml

Data Lee DH Lee IK Song K et al A strong dose-response relation between serum

concentrations of persistent organic pollutants and diabetes results from the National Health and

Examination Survey 1999-2002 Diabetes Care 2006 Jul29(7)1638-44

Toxic Load and Disease Risk

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 14: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Cadmium World Production

Mercury in the Air

EPA-452R-97-003 December 1997

Mercury in Water

httpwaterepagovscitechdataitmodelsmapspostercfm

Ground Water Sources of Arsenic

bull 10 of US public water supplies have levels of arsenic known to induce disease

bull No data on private water supplies

httpwwwatsdrcdcgovcsemarsenicdocsarsenicpdf (accessed 2015-08-18)

Example POPs

Chemical Abbr Uses Exposure

Bisphenol A BPA Plastics Canned food

Organochlorine

pesticides

OCPs Pesticide Food fumigation

Organophosphate

pesticides

OPPs Pesticide Food

Polybrominated

diphenyl ethers

PBDEs Flame retardant Clothing

Polychlorinated

biphenyls

PCBs Industrial Everywhere

Perflourinated PFOAs Non-stick stain prevention

water repellant

Teflon Gortex

Scotchguard

Phthalates Plastics fragrances Shower curtains

cosmetics

POPs - Prediabetes

bull Over 1200 participants fasting

glucose and OGTT performed

with serum levels of 5 POPs

bull All individual POPs tested were

associated with progressive

increase in prevalence of

prediabetes

bull More than triple prevalence of

prediabetes seen in those in the

5th quartile with a synergistic

effect from 5 POPs

Ukropec J et al High prevalence of prediabetes and diabetes in a population exposed to high levels of an organochlorine cocktail

Diabetologia 2010 May53(5)899-906

POPs and Diabetes Risk

Graph httpwwwourstolenfutureorgNewScienceobesity20062006-0715leeetalhtml

Data Lee DH Lee IK Song K et al A strong dose-response relation between serum

concentrations of persistent organic pollutants and diabetes results from the National Health and

Examination Survey 1999-2002 Diabetes Care 2006 Jul29(7)1638-44

Toxic Load and Disease Risk

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 15: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Mercury in the Air

EPA-452R-97-003 December 1997

Mercury in Water

httpwaterepagovscitechdataitmodelsmapspostercfm

Ground Water Sources of Arsenic

bull 10 of US public water supplies have levels of arsenic known to induce disease

bull No data on private water supplies

httpwwwatsdrcdcgovcsemarsenicdocsarsenicpdf (accessed 2015-08-18)

Example POPs

Chemical Abbr Uses Exposure

Bisphenol A BPA Plastics Canned food

Organochlorine

pesticides

OCPs Pesticide Food fumigation

Organophosphate

pesticides

OPPs Pesticide Food

Polybrominated

diphenyl ethers

PBDEs Flame retardant Clothing

Polychlorinated

biphenyls

PCBs Industrial Everywhere

Perflourinated PFOAs Non-stick stain prevention

water repellant

Teflon Gortex

Scotchguard

Phthalates Plastics fragrances Shower curtains

cosmetics

POPs - Prediabetes

bull Over 1200 participants fasting

glucose and OGTT performed

with serum levels of 5 POPs

bull All individual POPs tested were

associated with progressive

increase in prevalence of

prediabetes

bull More than triple prevalence of

prediabetes seen in those in the

5th quartile with a synergistic

effect from 5 POPs

Ukropec J et al High prevalence of prediabetes and diabetes in a population exposed to high levels of an organochlorine cocktail

Diabetologia 2010 May53(5)899-906

POPs and Diabetes Risk

Graph httpwwwourstolenfutureorgNewScienceobesity20062006-0715leeetalhtml

Data Lee DH Lee IK Song K et al A strong dose-response relation between serum

concentrations of persistent organic pollutants and diabetes results from the National Health and

Examination Survey 1999-2002 Diabetes Care 2006 Jul29(7)1638-44

Toxic Load and Disease Risk

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 16: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Mercury in Water

httpwaterepagovscitechdataitmodelsmapspostercfm

Ground Water Sources of Arsenic

bull 10 of US public water supplies have levels of arsenic known to induce disease

bull No data on private water supplies

httpwwwatsdrcdcgovcsemarsenicdocsarsenicpdf (accessed 2015-08-18)

Example POPs

Chemical Abbr Uses Exposure

Bisphenol A BPA Plastics Canned food

Organochlorine

pesticides

OCPs Pesticide Food fumigation

Organophosphate

pesticides

OPPs Pesticide Food

Polybrominated

diphenyl ethers

PBDEs Flame retardant Clothing

Polychlorinated

biphenyls

PCBs Industrial Everywhere

Perflourinated PFOAs Non-stick stain prevention

water repellant

Teflon Gortex

Scotchguard

Phthalates Plastics fragrances Shower curtains

cosmetics

POPs - Prediabetes

bull Over 1200 participants fasting

glucose and OGTT performed

with serum levels of 5 POPs

bull All individual POPs tested were

associated with progressive

increase in prevalence of

prediabetes

bull More than triple prevalence of

prediabetes seen in those in the

5th quartile with a synergistic

effect from 5 POPs

Ukropec J et al High prevalence of prediabetes and diabetes in a population exposed to high levels of an organochlorine cocktail

Diabetologia 2010 May53(5)899-906

POPs and Diabetes Risk

Graph httpwwwourstolenfutureorgNewScienceobesity20062006-0715leeetalhtml

Data Lee DH Lee IK Song K et al A strong dose-response relation between serum

concentrations of persistent organic pollutants and diabetes results from the National Health and

Examination Survey 1999-2002 Diabetes Care 2006 Jul29(7)1638-44

Toxic Load and Disease Risk

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 17: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Ground Water Sources of Arsenic

bull 10 of US public water supplies have levels of arsenic known to induce disease

bull No data on private water supplies

httpwwwatsdrcdcgovcsemarsenicdocsarsenicpdf (accessed 2015-08-18)

Example POPs

Chemical Abbr Uses Exposure

Bisphenol A BPA Plastics Canned food

Organochlorine

pesticides

OCPs Pesticide Food fumigation

Organophosphate

pesticides

OPPs Pesticide Food

Polybrominated

diphenyl ethers

PBDEs Flame retardant Clothing

Polychlorinated

biphenyls

PCBs Industrial Everywhere

Perflourinated PFOAs Non-stick stain prevention

water repellant

Teflon Gortex

Scotchguard

Phthalates Plastics fragrances Shower curtains

cosmetics

POPs - Prediabetes

bull Over 1200 participants fasting

glucose and OGTT performed

with serum levels of 5 POPs

bull All individual POPs tested were

associated with progressive

increase in prevalence of

prediabetes

bull More than triple prevalence of

prediabetes seen in those in the

5th quartile with a synergistic

effect from 5 POPs

Ukropec J et al High prevalence of prediabetes and diabetes in a population exposed to high levels of an organochlorine cocktail

Diabetologia 2010 May53(5)899-906

POPs and Diabetes Risk

Graph httpwwwourstolenfutureorgNewScienceobesity20062006-0715leeetalhtml

Data Lee DH Lee IK Song K et al A strong dose-response relation between serum

concentrations of persistent organic pollutants and diabetes results from the National Health and

Examination Survey 1999-2002 Diabetes Care 2006 Jul29(7)1638-44

Toxic Load and Disease Risk

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 18: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Example POPs

Chemical Abbr Uses Exposure

Bisphenol A BPA Plastics Canned food

Organochlorine

pesticides

OCPs Pesticide Food fumigation

Organophosphate

pesticides

OPPs Pesticide Food

Polybrominated

diphenyl ethers

PBDEs Flame retardant Clothing

Polychlorinated

biphenyls

PCBs Industrial Everywhere

Perflourinated PFOAs Non-stick stain prevention

water repellant

Teflon Gortex

Scotchguard

Phthalates Plastics fragrances Shower curtains

cosmetics

POPs - Prediabetes

bull Over 1200 participants fasting

glucose and OGTT performed

with serum levels of 5 POPs

bull All individual POPs tested were

associated with progressive

increase in prevalence of

prediabetes

bull More than triple prevalence of

prediabetes seen in those in the

5th quartile with a synergistic

effect from 5 POPs

Ukropec J et al High prevalence of prediabetes and diabetes in a population exposed to high levels of an organochlorine cocktail

Diabetologia 2010 May53(5)899-906

POPs and Diabetes Risk

Graph httpwwwourstolenfutureorgNewScienceobesity20062006-0715leeetalhtml

Data Lee DH Lee IK Song K et al A strong dose-response relation between serum

concentrations of persistent organic pollutants and diabetes results from the National Health and

Examination Survey 1999-2002 Diabetes Care 2006 Jul29(7)1638-44

Toxic Load and Disease Risk

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 19: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

POPs - Prediabetes

bull Over 1200 participants fasting

glucose and OGTT performed

with serum levels of 5 POPs

bull All individual POPs tested were

associated with progressive

increase in prevalence of

prediabetes

bull More than triple prevalence of

prediabetes seen in those in the

5th quartile with a synergistic

effect from 5 POPs

Ukropec J et al High prevalence of prediabetes and diabetes in a population exposed to high levels of an organochlorine cocktail

Diabetologia 2010 May53(5)899-906

POPs and Diabetes Risk

Graph httpwwwourstolenfutureorgNewScienceobesity20062006-0715leeetalhtml

Data Lee DH Lee IK Song K et al A strong dose-response relation between serum

concentrations of persistent organic pollutants and diabetes results from the National Health and

Examination Survey 1999-2002 Diabetes Care 2006 Jul29(7)1638-44

Toxic Load and Disease Risk

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 20: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

POPs and Diabetes Risk

Graph httpwwwourstolenfutureorgNewScienceobesity20062006-0715leeetalhtml

Data Lee DH Lee IK Song K et al A strong dose-response relation between serum

concentrations of persistent organic pollutants and diabetes results from the National Health and

Examination Survey 1999-2002 Diabetes Care 2006 Jul29(7)1638-44

Toxic Load and Disease Risk

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 21: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Toxic Load and Disease Risk

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 22: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

References for Toxins and Disease Risk

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 23: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Converting Disease Risk to Caused

Attributable Fraction Calculation

p = underlying prevalence of risk factor in the population

rr = relative risk (risk of contracting a disease in an exposed population divided by the risk of contracting the disease in an unexposed population)

AF = of disease due to the toxin

Levin M The occurrence of lung cancer in man Acta Unio Int Contra Cancrum 1953 9 531-541

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 24: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Example Smoking and Lung Cancer

B = 5Number of smokers

who contract Lung Cancer notdue to smoking

A = 5Number of smokerswho contract Lung

Cancer due to smoking

C = 15Number of

nonsmokerswho contract Lung Cancer

0

2

4

6

8

10

12

14

16

Smokers (N=100) Nonsmokers (N=300)Num

ber

of

people

who c

ontr

act

Lung C

ancer

per

year

Baseline Additional due to smoking

Number of smokers and nonsmokers who contract lung cancer

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 25: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Our Process In Summary

1 Determine threshold for increased disease risk

2 Determine of population above threshold

3 Determine incidence of disease (OR) in those above threshold

4 Determine incidence of disease in ldquounexposed populationrdquo

5 Calculate AF ie of disease

As whole population is exposed probably UNDERESTIMATES of disease

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 26: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

To

xic

ity H

as B

eco

me t

he N

ew

ldquoN

orm

alrdquo

Toxin Type Use Threshold for

disease

association

of US

above

threshold

Disease Associations

Chlordane OC pesticide Termites corn citrus lawns

gardens

145ngg lipid 63

(diabetes)

Diabetes (20)

BPA Plasticizer Water bottles canned food

water pipes thermal sales

receipts

48 men 51

women (urine

ngmL)

~18

(diabetes)

Diabetes hypertension

Octachloro

dibenzo-p-

dioxin

(OCDD)

Polychlorinated

dibenzo-p-

dioxin

Incineration or burning of

waste bleaching processes

used in pulp and paper mills

1010 pgg

lipid (highest

quartile)

10-25

(hypertensio

n)

Hypertension (79 for

women highest

quartile) diabetes (21)

obesity learning

disability (272)

MEP

(mono-

ethyl

phthalate)

Phthalate

(plasticizer

fragrance)

Toothbrushes automobile

parts tools toys and food

packaging aspirin

cosmetics food packaging

gt175 ngmL

(urine)

~60

(diabetes)

Diabetes (148) lower

BMD obesity

pp-DDE DDT

metabolite (OC

pesticide)

Agricultural crops 1560ngg

lipid

25

(diabetes)

Diabetes (23-43)

early menopause

impaired cognitive

function (2-3x 65x in

highest 5th percentile)

peripheral arterial

disease

Arsenic Toxic metal Miningsmelting wood

preservative pesticides

74ugL total

arsenic (urine)

20

(diabetes)

Cancers diabetes (26-

46) dyslipidemia gout

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 27: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

AF OR Prevalence

Rosen L An intuitive approach to understanding the attributable fraction of disease due to a risk factor the case of smoking Int J Environ Res Public Health 2013 Jul 1610(7)2932-43

Smoking Lung cancer

Arsenic Gout in women

BPA Diabetes

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 28: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Status of Our Research

bull 26 toxins and toxin classes eg lead mercury BPA OCPs

100s of chemicals and POPs in some classes

bull 18 cancers

bull 24 chronic diseases

bull 1092 cells in spreadsheet

Large Personal Ongoing Research Investment

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 29: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Huge Amount of Research Work

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 30: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Toxins StudiedAluminum

Arsenic

Cadmium

Fluoride

Lead

Manganese

Mercury

Acrylamide

Acrylonitrile

Benzene

Bisphenol A (BPA)

Chloroform

DDT

Dioxins

Glyphosate

Organochlorine pesticides (OCPs)

Organophosphate pesticides

Parabens

Phthalates

Polybrominated diphenyl ethers (PBDEs)

Polycyclic aromatic hydrocarbons (PAHs)

Polychlorinated biphenols (PCBs)

Vinyl chloride

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 31: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Diseases Studied

ADHD

Alzheimers Disease

ALS

Angiosarcoma

Anxiety

Atopic Conditions

Diabetes

Dyslipidemia

Gout

Fetal Abnormalities

Hyperuricemia

Infertility

Juvenile IQ

Cancer Bladder

Cancer Bone

Cancer Brain

Cancer Breast

Cancer Cervix

Cancer Colorectal

Cancer Endometrial

Cancer Head amp Neck

Cancer Liver

Cancer Lung

Cancer Lymph amp Blood

Cancer Ovarian

Cancer Pancreatic

Cancer Prostate

Cancer Renal

Cancer Skin

Cancer Testicular

Cancer Thyroid

Juvenile Obesity

Metabolic Syndrome

Mitochondrial dysfunction

Myocardial Infarction

Obstructive Lung Disease

Osteoporosis

Peripheral Artery Disease

Peripheral Neuropathy

Prediabetes

Renal Disease

Rheumatoid Arthritis

Thyroid Dysfunction

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 32: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

OC

Ps

Th

rou

gh

ou

t th

e W

orl

d

Rathore HS Nollet LML Pesticides Evaluation of Environmental Pollution CRC Press

2012 page 562

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 33: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Threshold ndash Threshold exposure at which there is an increased risk of disease outcome

Above Threshold ndash Percentage of the population with higher exposure than the threshold

Odds Ratio ndash Increased disease risk in those above threshold

of Dz ndash Percent contribution of the toxin to that disease outcome

How to Interpret the Following Slides

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 34: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Attention Deficit Hyperactivity Disorder

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

DDT 126 ngg

serum (pp-

DDE)

250 18 166 20106937

Lead 23 ugdL 13 254 20 27659349

Mercury 16 24952233

Organophosphate

pesticides

20

Polycyclic

Aromatic

Hydrocarbons

227 ngm3 940 125 190 22440811

PCBs 104 ngg

serum (sum

of 50 PCBs)

250 176 160 20106937

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 35: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

DiabetesToxin Threshold Above

Threshold

Odds

Ratio

of Dz Reference

PMID

Arsenic 165 ugL 200 21 180 18714061

BPA 28 ugL 280 145 112 26119400

DDE 545 ngg serum

(pp-DDE)

200 230 31 26119400

Dioxins2 pgg lipid 50 191 43

26119400

PCBs104 ngg (PCB 153) 250 239 258

26119400

Phthalates175 ugL 690 148 249

26119400

1-naphthalene 167 ugdL 152 182 111 26340343

2-napthalene 414 ugdL 550 224 214 26340343

1-phenanthrene 167 ngL 570 178 151 26340343

1-pyrene 85 ngL 660 180 174 26340343

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 36: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Lung Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Acrylonitrile Uncertain Uncertain 125 25

occupational

exposure

17114112

Arsenic 1213 ugL 436 of Asian

Americans

~01 of total

US population

34 95 in AA

01-1

PMC2682945

Cadmium Uncertain+ Uncertain 467 10 in

smokers

17184399

DDT Any exposure All US pop

below LOD

17 76 increased

risk

8923607

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 37: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Breast Cancer

Toxin Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Cadmium 0580 ugg

creatinine

126 205 479 16788160

PCB 138 396 ngg

creatinine

202 316 630 27717745

PCB 187 108 ngg lipid 600 194 360 21480306

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 38: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Miscellaneous Diseases

Toxin Disease Threshold Above

Threshold

Odds

Ratio

of Dz Reference PMID

Aluminum Alzheimer

Dz

01 mgL

drinking

H20

400 203 05-44 26592479

Benzene AML 100ppmyrs 1-3 320 60 PMC2903550

DDT NHL 0512 ugL 1-2 240 01 17722095

Lead ALS 238 ugdL

blood

330 181 210 25479292

Lead Brain CA 0005 ugdL 14 19 ~500 17164378

Dioxin-like

PCBs

RA 326 ngg

lipid

250 219 220 17589595

PAHs Asthma 124 ngm3 935 200 483 19221603

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 39: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

The Potency of Arsenic

Disease Threshold Above

Threshold

Odds Ratio of Dz Reference

PMID

Bladder CA 10ugL H20 100 27 145 24889821

Pancreatic CA 1332 ugg 200 246 230 23800676

Prostate CA 1332 ugg 200 33 315 23800676

Gout 125 ugL 245 546 522 25499256

Diabetes 165 ugL 200 21 180 18714061

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 40: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Arsenic (180 of Diabetes)

How it causes diabetes

bull Blocks sugar stimulating insulin secretion

bull Epigenetic inhibition of sugar regulation

Where it comes from

bull Water (gt10 of US water supplies have high levels)

bull Rice (naturally absorbs if in the water)

bull Chicken (added to make meat whiter)

Pan W-C Seow WJ Kile ML et al Association of low to moderate levels of arsenic exposure with risk of Type 2 diabetes in Bangladesh American Journal of Epidemiology 2013178(10)1563-70

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 41: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Portion of Population with Toxin Load Which

Doubles Disease Risk

Toxin Disease with Doubled Risk

Polycyclic aromatic hydrocarbons Asthma 94

PCB187 Breast Cancer 60

Phthalates Diabetes 55

Lead ALS 33

Aluminum Alzheimers Disease 25

DDT ADHD 25

PCBs Diabetes 25

Dioxin-like PCBs Rheumatoid Arthritis 25

Arsenic Gout 23

Bisphenol A Diabetes 22

Cigarette smoking Lung Cancer 21

Arsenic Diabetes 20

Polycyclic aromatic hydrocarbons Diabetes 20

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 42: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Huge Detoxification Variability

bull CYP2C19

Proton pump inhibitors and some antidepressants

5-fold difference in activity between poor metabolizers and extensive metabolizers more so if CYP3A4 is also inhibited

Ultrarapid allele in 18 of both Swedes and Ethiopians

bull CYP2D6

Metabolizes a large number of drugs (~25)

7 of Caucasians poor metabolizers

~30 ultra rapid metabolizers in Arabian and Eastern African populations

More adverse effects in poor metabolizers and ineffective dosing in ultrarapid metabolizers

Inhibited by ginger

Desta Z et al Clinical significance of the cytochrome P450 2C19 genetic polymorphism Clin Pharmaco 2002

Sim SC et al A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug

response to proton pump inhibitors and antidepressants Clin Pharmacol Ther 2006

Wilkinson GR Drug metabolism and variability among patients in drug response N Engl J Med 2005

Kirchheiner J et al Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to

CYP2D6 duplication Pharmacogenomics J 2007

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 43: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Toxin Half Lives in BloodToxin ldquoNormalrdquo (mgL) Acute Toxic (mgL) Half-Life

Arsenic 0002-007 005-025 2-4 days (CDC)

Benzene 00002 05-10 days

Cadmium 00003-00065 0015-005 16 years

Chlordane 0001 00025 3-4 days

DDTDDE 2-10 years

Dieldrin 00015 015-030 2-12 months

Ethanol 1000-2000 15hour

Lead 009 04-06 1-15 mo (2+ yrs bone)

Mercury 00015-0002 005-02 2 months (CDC)

PCBs 3-25 years

Toluene 05-3 days

Schulz M et al Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics Crit Care 2012 Jul 2616(4)R136

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 44: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Bioaccumulation (POPs)

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

DDT banned in 1972 PCBs banned in 1977

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 45: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Bioaccumulation (Cd)

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 46: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Think BroadlyExogenous

Metals

Chemicalsbull Inorganic

bull Fluoride

bull Organic

bull POPs

bull Drugs

Particulate matter

Molds

Microbial

Radiationbull Light

bull Medical

bull Cell phone

Endogenous

Gut-derived toxins

Non-end product metabolites

Poorly detoxified hormones

Catecholamines (if SNP)

Toxins of Choice

Alcohol

Marijuana

Food constituents

High fructose corn syrup

Salt (acid-forming diet)

Wheat if zonulin (70)

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 47: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Obesity Epidemic ndash POPs AND HFCS

47Bray GA Fructose should we worry Int J Obes (Lond) 2008 Dec32 Suppl 7S127-31

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 48: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

How Toxins Cause Damage 13

bull Increase free radical production

Cd induces production of ROS

Malathion inhibits catalase and glutathione peroxidase

Homocysteine oxidizes LDL cholesterol

bull Poison enzyme systems (compete with nutritional cofactors for binding sites)

Pb poisons delta aminolevulinic acid dehydratase

Cd inhibits catalase glutathione reductase and lowers

glutathione levels

bull Replace structural minerals

Pb displaces Ca in bone

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 49: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

How Toxins Cause Damage 23

bull Damage DNA

Benzene - causes chromosomal damage

Pesticides ndash fruit growers have more DNA damage

Phthalates and insecticides ndash damage sperm DNA

4-hydroxy catechol estrogen (4-OHE) damages breast DNA

bull Epigenetic dysmodulation

Higher cord blood levels of hexachlorobenzene associated

with 2x greater risk for obesity in children

bull Damage cell membranes

Common mechanism for heavy metals inactivates

membrane enzymes ion channels and pumps

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 50: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

How Toxins Cause Damage 33

bull Block insulin receptor sites

PCBs and phthalates

bull Highest levels associated with a 4 to 20-fold greater diabetes risk

bull Imbalance hormones many toxin examples

Arsenic

bull Disrupts thyroid hormone and retinoic acid receptors

Phthalates

bull Act as anti-androgens

bull More than 75 of the US population has measurable levels of

several phthalate metabolites in the urine

PCBs

bull Lower testosterone levels in men

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 51: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Which are the Worst Toxins

bull According to the CDC

Toxicity

Population toxic load

Prevalence in toxic waste sites

bull According to clinical importance

Exposure

of disease

Ability of the body to detoxifyexcrete

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 52: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Ag

en

cy

fo

r T

oxic

Su

bs

tan

ce

s a

nd

Dis

ea

se

Reg

istr

y

Pri

ori

ty L

ist

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 53: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

The Worst Toxins Clinically

My Rank Toxin Diseases Primary Sources

1 Arsenic Cancers diabetes gout Water chicken rice

2 DDT ADHD dementia diabetes Everywhere

3 Phthalates ADHD diabetes Soft plastics HABAs

4 PBDEs ADHD diabetes Flame retardant fabrics

5 PAHs ADHD cancers dyslipidemia Smoking charbroiling

6 PCBs Cancers diabetes MI RA Everywhere

7 Mercury Dementia ldquoSilverrdquo fillings fish

8 Lead Cardiovascular disease IQ Paint water

Glyphosate Research invalid

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 54: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Conventional Laboratory Tests Reflect

Toxic Load in ldquoNormalrdquo Range

bull Surprising number show toxin exposure

CBC RBC WBC platelet count hemoglobin basophilic

stippling

Liver enzymes ALT GGTP

Inflammatory markers CRP

Lipids LDL oxLDL triglycerides

Blood sugar insulin FBS 2-hour PP

Metabolites bilirubin uric acid homocysteine 8-OHdG

Thyroid T3 T4 TSH

bull The historic ldquonormalrdquo range has been changing as the population has become more toxic

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 55: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

WBC Lowered by PCB and OCP Exposure

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

0

1

2

3

4

5

6

7

8

1st Quartrile 2nd Quartile 3rd Quartile 4th Quartile

WBCbull Strong inverse correlation with PCBs and OCPs and CBC

bull Linear with almost all PCBs

bull High variability with OCPs

bull Within ldquonormalrdquo range

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 56: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Effects on WBC Worsen with Years

of Exposure to Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 57: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Platelet Count Decreases with Years

of Exposure tp Benzene and CO

bull Petrol filling workers

bull ldquoHealthyrdquo non-smokers

Uzma N Salar BM Kumar BS et al Impact of organic solvents and environmental pollutants on the physiological function in petrol filling workers Int J Environ Res Public Health 2008 Sep5(3)139-46

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 58: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Solvents Decrease Platelet Count

bull Compared workers exposed 23 hrday to those exposed most of day to toluene

bull All wore face masks and protective gear

bull Platelet count 14 lower 252 versus 216ml

bull Impairment of sympathetic nerves (OR = 413)

bull Impairment of peripheral nerves (OR = 694)

bull Positive relationship between neurological abnormalities and a self-reported neuropsychiatric measurement (r = 035-066)

Shih HT et al Subclinical abnormalities in workers with continuous low-level toluene exposure Toxicol Ind Health 2011 Sep27(8)691-9

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 59: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Basophilic Stippling of Red Cells

Toxinsbull Arsenic

bull Lead

Diseasesbull Alpha-thalassemia HbH Disease

bull Beta thalassemia

bull Hereditary pyrimidine 5-nucleotidase deficiency

bull Myelodysplastic syndrome

bull Sideroblastic anemia

bull Thrombotic thrombocytopenic purpura

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 60: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

GGT Indirect Measure of POPsbull Glutathione is key intracellular defense against oxidative stress

bull Cellular GGT metabolizes extracellular GSH allowing precursor amino acids to be reutilized for intracellular GSH

bull Exposure to POPs induces GGT as a defensive mechanism

bull Within normal range predicts type 2 diabetes coronary heart disease hypertension stroke dyslipidemia chronic kidney disease and cancer

bull Men with GGT gt50 UI had ~26 fold risk for diabetes compared to those with lt10 Those with 40-49 had a ~20 fold risk

bull Levels within normal range occur with obesity xs alcohol cigarette smoking physical inactivity high meat low fruit and vegetable intake

bull Cumulative biomarker for environmental pollutants

Lee DH et al (2003) Gamma-glutamyltransferase and diabetesmdasha 4 year follow-up study Diabetologia 46359ndash364

Pamela A et al Serum gamma-glutamyltransferase linking together environmental pollution redox equilibria and progression of atherosclerosis Clin Chem

Lab Med 200947(12)1583-4

Lee DH et al Serum gamma-glutamyltransferase new insights about an old enzyme J Epidemiol Community Health 2009 Nov63(11)884-6

Lee DH et alSerum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28838 middle-aged men and

women Eur Heart J 2006272170ndash6

Lee DH et al Gamma-glutamyltransferase and diabetes--a 4 year follow-up study Diabetologia 2003 Mar46(3)359-64

Lee DH et al Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes Diabetologia 2008

Mar51(3)402-7

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 61: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

GGT and Alcohol Consumption

bull GGT directly correlates with alcohol consumption

bull In a non-uniform population 40 gd will elevate GGT ~15

bull Watch for false negatives

bull Genomic variation

bull Are these the ones most

sensitive todamaged by

chemical toxins

bull Could up-regulation of GGT in light alcohol consumption be reason for benefit

0

10

20

30

40

50

60

70

80

0 200 400 600 800

Grams of Ethanol per Week

Adapted from Nagaya T et al Dose-response relationships between drinking and serum tests in Japanese men

aged 40ndash59 years Alcohol 1999 Feb 17(2) 133ndash8

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 62: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

GGT Correlates With Toxic Metal Levels

Lee DH et al Graded associations of blood lead and urinary cadmium concentrations with oxidative-stress-related markers in the

US population results from the third National Health and Nutrition Examination Survey Environ Health

perspect 2006 Mar114(3)350-4

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 63: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

GGT and Diabetes Risk

0

5

10

15

20

25

30

lt10 10-19 20-29 30-39 40-49 gt50

Dia

bete

s R

isk

GGT

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 64: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

bull GGT over 50 associated with tripling of death rate

bull 30-40 associated with doubling

GGT Levels

Correlate with

Risk of Death

Brenner H et al Distribution determinants and prognostic value of gamma-glutamyltransferase for all-cause

mortality in a cohort of construction workers from southern Germany Prev Med 1997 26 305ndash10

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 65: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

GGT From Small US Company

with Young Workers

0

10

20

30

40

50

60

0 20 40 60 80 100

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 66: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

GGT Data from Canadian Oil Field

Workers

0

50

100

150

200

250

300

350

400

450

lt10 10-20 20-30 30-40 40-50 50-60 60-07 70-80 80-90 90-100 100-110 110-120 gt120

GGTP

20-fold increased risk of diabetes

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 67: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Uric Acid Indirect Measure of POPs

bull Poly-fluorinated hydrocarbons (PFOA and PFOS) associated

with increased serum uric acid

Lin CY et al Association among serum perfluoroalkyl chemicals glucose homeostasis and metabolic syndrome

in adolescents and adults Diabetes Care 2009 Apr32(4)702-7

Steenland K et al Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric

acid among adults with elevated community exposure to PFOA Environ Health Perspect 2010 Feb118229-33

Steenland 2010 Open Access

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 68: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

ALT Indirect Measure of POPs

bull ALT (proxy marker) elevation in 104 (not including viral

hepatitis hemochromatosis or alcoholic liver disease) of

NHANES 03-04 subset

bull Risk of elevated ALT increased dose-dependently with

cadmium lead mercury and PCB exposure

bull 100 of individuals had detectable PCBs 925 mercury

and 996 had detectable lead

bull In 2005-08 prevalence of NAFLD in US was 11 a

growing cause of chronic liver disease

Cave M et al Polychlorinated biphenyls lead and mercury are associated with liver disease in American adults

NHANES 2003-2004 Environ Health Perspect 2010 Dec118(12)1735-42

Younossi ZM et al Changes in the prevalence of the most common causes of chronic liver diseases in the United

States from 1988 to 2008 Clin Gastroenterol Hepatol 2011 Jun9(6)524-530e1

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 69: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Bilirubin as a Marker of POPs

bull Degree of serum bilirubin increase is prognostically significant in chronic liver dysfunction

bull Mono-ortho PCB TEQ values were found to be significantly positively associated with bilirubin (β=071 P=0008) following adjustment for multiple potential confounders

bull Bilirubin levels significantly correlated with PCBs -105-118-126 and -194

bull Smoking appears to be the biggest confounder

Dufour DR et al 2000 Diagnosis and monitoring of hepatic injury II Recommendations for use of laboratory

tests in screening diagnosis and monitoring Clin Chem 46 2050ndash68

Kumar J et al Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample

of men and women Environ Res 2014134251-256

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 70: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Perf

luo

rin

ate

dP

OP

s a

nd

Co

mm

on

Blo

od

Tests

Gleason JA et al Associations of perfluorinated chemical serum concentrations and biomarkers of liver function and uric acid in the

US population (NHANES) 2007-2010 Environ Res 20151368-14

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 71: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Liver Enzymes Reflect Toxic Load

bull AST ALT and GGT increase with body load of PCBs and OCPs

bull Some non-linear

bull Oxychlordanetop quartile

ALT 10

GGT 25

Serdar B et al Potential effects of polychlorinated biphenyls (PCBs) and selected organochlorine pesticides

(OCPs) on immune cells and blood biochemistry measures a cross-sectional assessment of the NHANES 2003-

2004 data Environ Health 201413114

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 72: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

LDL-Cholesterol as Measure of POPs

bull 5-year prospective study to determine if POP levels predict future elevation in LDL-cholesterol

bull 598 subjects initially at age 70

bull Looked at 23 POPs

bull Best correlation with PCB 194

Penell J Lind L Salihovic S et al Persistent organic pollutants are related to change in circulating

lipid levels during a 5 year follow-up Environ Res 134(2014)190ndash197

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 73: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

oxLDL as Measure of POPs

bull 992 70-year old individuals (50 women)

bull Sum of PCBs showed strong significant positive associations with ox-LDL and significant negative associations with glutathione-related markers (GSSG and GSSGGSH)

bull A number of POPs (PCB-99 138 153 156 170 180 194 206 and 209) showed strong significant positive association with ox-LDL

Kumar J et al Influence of persistent organic pollutants on oxidative stress in population-based samples

Chemosphere 2014114303-309

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 74: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Homocysteine is Increased by Pb amp Cd

Guallar E et al Confounding of the relation between homocysteine and peripheral arterial disease by lead cadmium and renal function Am J Epidemiol 2006 Apr 15163(8)700-8

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 75: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Nutrient Deficiencies Accentuate

Effects of Lead on Homocysteine

bull Deficiencies in folate B6 or B12 make lead more toxic

Lee YM Et al Association of homocysteine levels with blood lead levels and micronutrients in the US general population J Prev Med Public Health 2012 Nov45(6)387-93

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 76: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

T4 amp T3 and PCBs

bull PCBs decrease T4 production

bull PCBs inhibit iodotyrosinedeiodinase activity

bull Study done in pregnant women which implies effect on fetus IQ

Kim S Park J Kim HJ et al Association between several persistent organic pollutants and thyroid hormone levels in serum among the pregnant women of Korea Environ Int 2013 Sep59442-8Shimizu R Yamaguchi M Uramaru N et al Structure-activity relationships of 44 halogenated compounds for iodotyrosinedeiodinase-inhibitory activity Toxicology 2013 Dec 6314(1)22-9

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 77: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

T4 amp T3 and PCBs

bull Not just humans being affected

bull Large study of dolphins shows exactly the same effects

Schwacke LH Zolman ES Balmer BC et al Anaemia hypothyroidism and immune suppression associated with polychlorinated biphenyl exposure in bottlenose dolphins (Tursiops truncatus) Proceed Royal Society B doi101098rspb20110665

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 78: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

8-OHdG

bull Oxidized nucleoside

bull Direct measure of DNA damage

bull Indirect measure of oxidative stress and toxin load

bull Correlates with

Multiple cancers

Mitochondrial damage

Rate of aging

Smoking

Several toxinsWalter Crinnion ldquoTotal Toxic Loadrdquo AANP 2015

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 79: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

8-OHdG Correlates with Pack-Years

of Smoking

Yano T et al Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients Lung Cancer

2009 Jan63(1)111-4

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 80: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

8-OHdG Correlates

with Mercury

Chen C et al Increased oxidative DNA damage as assessed by urinary 8-hydroxy-2-deoxyguanosine

concentrations and serum redox status in persons exposed to mercury Clin Chem 2005 Apr51(4)759-67

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 81: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Toxin Effects Worse with Aging

bull Thyroid function decreases with PFOA levels

bull But only after age 63

Shrestha S Bloom MS Yucel R et al Perfluoroalkyl substances and thyroid function in older adults Environ Int 2015 Feb75206-14

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 82: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Insightful 23-Year Prospective Study

1 lt 50 there is no difference between those with the lowest and highest PCBs

2 In youngest group insulin production increases in response to toxin level As expected since blocking of

insulin receptor sites by PCBs

requires more insulin

3 That adaptive ability decreases with aging

4 At age 50 all the measures show very strong toxin-dose response

Cumulative damage impairs ability to adapt

Suarez-Lopez JR et al Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up Environ Res 2015 Feb137485-94

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 83: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Recommendations

High body toxic load

GGT gt 25

Uric acid gt 50 mgdl

ALT gt30 UL

Bilirubin gt08 mgdl

CBC lt 6000

Platelet lt 250000

Low T3 andor T4

Monitor Total Toxic Load

8-OHdG gt4

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 84: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

ldquoUnconventionalrdquo Laboratory Tests

bull Challenge testing

bull Hair analysis

bull Direct measures of solvents and POPs in blood urine adipose tissue

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 85: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Evaluation of Metal Exposure ndash Provocation

bull Provocation ndash the use of a chelating agent ndash before urine collection often done clinically but several limitations

No ldquoofficialrdquo reference range for provoked urine

Most chelating agents do not extract metals from all tissues thus

does not necessarily represent total body burden

bull Example Brain is one of the main target organs for both elemental and organic

mercury yet agents do not chelate brain mercury

bull Despite limitations widely used and advocated by clinicians in part to see efficacy of chelating agent as a guide to treatment and based on empirical evidence

Rooney JP The role of thiols dithiols nutritional factors and interacting ligands in the toxicology of mercury

Toxicology 2007

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 86: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Is Challenge Testing Valid

bull Poor correlations of standard tests for mercury

bull Unpublished research from corporate wellness project

bull Published amalgam number correlation

bull Published fish consumption correlation

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 87: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

What We Found In Canada

bull Deviations from the mean of 14 29 and 91 respectively

bull DMPS is spreading distribution suggesting that it is better at differentiating mercury body load

bull Some VERY high

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 88: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Hg Assessment Correlations

bull Extensive measurements in 65 Whole blood Hg

Oral DMPS challenge

Amalgam surfaces

bull Correlations Whole blood w pre urine r = 040

Whole blood w post urine r = 057

Pre urine w post urine r = 068

Amalgams w pre urine r = 026

Amalgams w whole blood r = 036

Amalgams with post urine 044

bull Clear documentation that

challenge testing is better00

100

200

300

400

500

600

0 10 20 30 40 50

Po

st

Uri

ne H

g u

gg

Number of amalgams

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 89: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Modest Correlation with of Fillings

bull Very large study

bull Surprisingly only reported none versus 1 or more fillings

bull Huge overlap

bull Not controlled for fish consumption

Dutton DJ et al The association between amalgam dental surfaces and urinary mercury levels in a sample of

Albertans a prevalence study J Occup Med Toxicol 20138(1)22

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 90: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Strong Correlation with Fish

Consumption

bull Compared 0 to 1-2 to 3 or more servings per week

bull First urine showed essentially no differentiation

bull Challenge testing showed clear correlation

bull Still a lot of variation

Ruha AM et al Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters Arch

Pathol Lab Med 2009133(1)87-92

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 91: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Measuring POP

Levels Directly

bull Urine sample

bull 150+ environmental chemicals

bull $287

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 92: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Sources of Toxins

bull 70 Food

bull 10 Water

bull 10 House and yard chemicals

bull 5 Air

bull 5 Health and beauty aids

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 93: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Eating Conventionally Grown Foods

Dramatically Increases POP Load

bull Study done in Seattle children

bull 10-fold increase in POPs doubles ADHD

bull Levels drop measurably within 3 days of eating only organically grown foods

Curl CL et al Organophosphorus pesticide exposure of urban and suburban preschool children with organic and

conventional diets Env Health Perspect 2003111377-82

Bouchard MF et al Attention-deficithyperactivity disorder and urinary metabolites of organophosphate pesticides

Pediatrics 2010 Jun125(6)e1270-7

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 94: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Hg From Fish

bull Total Hg urinary excretion proportional to amount of fish eaten

bull Impaired psychomotor performance

R = 038 blood

R = 077 urine

bull Huge variation in amount of Hg in fish

94

Apostoli P ICortesi I Mangili A et al Assessment of reference values for mercury in urine the results of an Italian

polycentric study The Science of the Total Environment 289 (2002)13-24

Carta P et al Sub-clinical neurobehavioral abnormalities associated with low level of mercury exposure through

fish consumption NeuroToxicology 24 (2003) 617ndash623

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 95: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

POPs Fish

Consumption and

Breast Feedingbull Eating fish increases POPs

bull Breast feeding decreases POPs

Bjermo H et al Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population Environ Int 2013 Jan5188-96

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 96: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

BPA Canned Versus Home-Made Soup

Soymilk in Cans Versus Glassbull One 12oz serving daily for 1 week of

either fresh soup or canned soup (Progresso)

12-fold increase in BPA

bull 2 servings of 6 ounces Soy milk in can compared to glass

16-fold increase in BPA

Systolic BP elevated 45 mm Hg

bull Diabetes risk thresholdCarwile JL1 Ye X Zhou X et al Canned soup consumption and urinary bisphenol A a randomized

crossover trial JAMA 2011 Nov 23306(20)2218-20

Bae S1 Hong YC2 Exposure to bisphenol A from drinking canned beverages increases blood

pressure randomized crossover trial Hypertension 2015 Feb65(2)313-9

0

5

10

15

20

25

Soy in Glass Soy in Can Made Soup Canned Soup

BPA (ugL urine)

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 97: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

HABAs Can Be Significant

Source of POPs

Duty SM et al Personal care product use predicts urinary concentrations of some phthalate monoesters Environ

Health Perspect 2005 Nov113(11)1530-5

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 98: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Case Histories

bull gt35 at wwwthetoxinsolutioncom

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 99: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Am I Losing my

Mind April 2012bull 67 yo white woman

bull I had the odd feeling that I was living in a fog that things were very fuzzy and that my memory was very sporadic I was having trouble sleeping and had a lot of muscle aches during the night I always had a metal taste in my mouth and felt that my breath lacked freshness other than the first few minutes after brushing my teeth My skin and scalp were always sore and especially dry

Hg = 50

2 years IV chelation discontinued

due to side effects amp no benefit

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 100: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

November 2012

bull I do know that things really improved once I started your protocol and I was happy to see the light at the end of the Mercury tunnel

Hg = 12

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 101: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

June 2013

bull With each successive test the symptoms were lessening and I was feeling more normal

Hg = 73

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 102: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

December 2013

bull It was a day of celebration when I received the last test results

bull I would caution people to remember that clearing mercury out of onersquos system is a long process but it is worth the effort even if it takes many years Being healthy is a good reward for all the patience required to do the heavy mercury lifting

bull Good luck with your seminars I will always be in your debt for your help

Hg = 35

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 103: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

No More Kidney Stonesbull 40 yo male (emergency room physician)

bull Wants to enter space medicine BUT

Kidney stone attack every 4-6 months

bull Otherwise healthy

bull Intervention

50 decrease in salt intake

Increased attention to Mediterranean diet with emphasis

on whole citrus fruit

Calcium carbonate 05 g bid

Magnesium citrate 250 mg bid

Potassium citrate 50 mg bid

bull No attacks for 3 years

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 104: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

ldquoNormalrdquo is Degeneration with Aging

But the Degeneration is Actually

Accumulated Avoidable Damage

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 105: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

4 G

en

era

tio

ns

Mo

torc

yclin

g A

ustr

alia o

n t

he

ldquoW

ron

g S

ide

of

the

Ro

ad

rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 106: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

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ustr

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ide

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rdquo

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 107: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

Summary

1 Toxins are now ubiquitous in the industrialized world

2 Toxins are now the primary drivers of chronic disease

3 Standard laboratory tests now include in ldquonormalrdquo range the bodyrsquos adaptations to and damage from toxins

Thank you

Chrissie Cirovic ND amp Geoff Bender ND

For Your Excellent Research Work

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND

Page 108: Toxins Have Become the Primary Drivers of Disease · Peripheral Artery Disease Peripheral Neuropathy Prediabetes Renal Disease Rheumatoid Arthritis Thyroid Dysfunction. World Rathore

2 New Books

The Toxin Solution

Clinical Environmental Medicine

With Walter Crinnion ND


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