The Exposome: Assessing and Measuring the Body Burden of

Environmental Toxins

Todd LePine, M.D. September 25, 2013

12:00PM EST & 8:00 PM EST

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Christine Stubbe, ND Medical Education Specialist - Asheville

Todd LePine, MD

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The Exposome: Assessing and Measuring the Body Burden of Environmental Toxins Todd LePine, MD Staff Physician at the UltraWellness Center, Lenox MA Consultant for Genova/Metametrix Labs Faculty Member for A4M www.ultrawellnesscenter.com

Essential Amino Acids, Essential Fatty Acids,

Nutrients, Minerals, CoFactors

EndoToxins, Environmental Toxins & Stress

Pharmaceutical/Agricultural Industrial

Complex

The Exposome represents the combined exposure from all sources that reach the internal chemical environment, which can be detected in the blood or serum by signatures or biomarkers

Environment and Disease Risk

22 OCTOBER 2010 VOL 330 SCIENCE

1. If you are sitting on a tack, it takes a lot of aspirin to make it feel good. (SUPPRESSING SYMPTOMS)

2. If you are sitting on two tacks, removing just one does not result in a 50% improvement. (WEB-LIKE RELATIONSHIPS)

• The “Tacks Rule” – Dr. Sidney Baker

• Toxic exposures: Endotoxins & Exotoxins

Detox & Biotransformation

10

“The true burden of environmentally induced cancer has been grossly underestimated... With nearly 80,000 chemicals on the market in the United States, many of which are used by millions of Americans in their daily lives and are un- or understudied and largely unregulated, exposure to potential environmental carcinogens is widespread.”

TIME Magazine – May 2010

• Heavy Metals : mercury, lead, arsenic, cadmium • Chlorinated Pesticides • Organophosphate Pesticides • Phalates and Parabens • PCB’s • Volatile Organic Solvents

Measuring the Body Burden of Toxins

Pesticides and You

These children are also very aggressive. They have very short memories and they are very weak physically. They cannot jump rope long or do a whole lot of other physical tasks. Now these children are reaching puberty. The boys are developing breasts, which are very painful and they have mammary tissue in those breasts. Pesticides and You Warren Porter, Ph.D.Vol. 27, No. 4, 2007-08

Pesticides and You Warren Porter, Ph.D.

Vol. 27, No. 4, 2007-08

“scientists at the University of Maryland and the US Department of Agriculture have identified a witch’s brew of pesticides and fungicides contaminating pollen that bees collect to feed their hives.”

SOURCE: www.qz.com

“Thus more attention must be paid to how honey bees are exposed to pesticides outside of the field in which they are placed. We detected 35 different pesticides in the sampled pollen, and found high fungicide loads”

A Phenolic Chemical Used in the Manufacture of Polycarbonate Plastics and Epoxy Resins

Bisphenol A Affects Mitosis

According to vom Saal, bisphenol A has exhibited endocrine disruption in animals and humans at ppb doses. “There are situations where bisphenol A is causing effects at a thousand times lower than the amount in the average human body,” he said, adding that current global production of bisphenol A runs about 7 billion pounds per year.

According to the National Institute of Environmental Health Sciences, a wide range of substances, both natural and human-made, are

thought to cause endocrine disruption, including pharmaceuticals, dioxin and dioxin-like

compounds, polychlorinated biphenyls (PCBs), DDT and other pesticides, and plasticizers such

as bisphenol A.

• Avoid polycarbonate containers that contain BPA, which usually have a #7 or a #3 on the bottom

• Reduce your use of canned foods • BPA can leach from plastic when there is a change

in pH or when heated.

Identifying Exposure Sources 27

Molecular Interventions P450s: From Knowledge to Exploitation F. Peter Guengerich

Molecular Interventions P450s: From Knowledge to Exploitation F. Peter Guengerich

• Contractions in head • High blood pressure • Prone to anxiety

Chief Complaints 72-Year-old Female

• Had many chemicals on golf course • Has a lot of crowns —used to have lots

of amalgam fillings, that were removed • She likes tuna sushi — used to eat a lot

of swordfish • “ I Want to get tested for Toxins”

Environmental Exposure Hx

Supplements

• MVI • Fish oil • Vitamin D

• CoQ10 • Calcium • Lipoic acid

• Cozaar – 100 mg, 1 tab once a day • Lipitor – 40 mg, 1 tab once a day • Doxazosin – 2 mg, 1 tab once a day • Bystolic – 5 mg, 1 tab once a day

Medications

• Continue Cozaar, Doxazosin and Bystolic • Start CoQ10 – 200 mg po qd • Stop Lipitor • Start CatecholeCalm – 2–3 caps po bid • Start NAC – 600 mg po bid • Start Alpha Lipoic Acid – 800 mg po qd

Initial Empiric Treatment

PCB’s

38

39

Notes: The levels shown on this figure represent the sum of the 12 PCB compounds that resemble dioxin, widely recognized as the most toxic of all industrial pollutants, and linked to cancer as well as to damage of the nervous, reproductive, and immune systems. PCB concentrations are shown as toxic equivalents (TEQs) of 2,3.7,8-Tetrachlorodibenzo-p-dioxin, the benchmark of dioxin chemical. Source: EWG analysis of data from Axys (2003), Easton et al. (2002), EPA (2000a and 2000b), Fiedler et al. (2000), Jacobs et al. (2002), NMFS (2002), NAS (2003), Schecter et al. (2001), and USDA (2002).

• PCBs (both dioxin-like and non-dioxin-like) induce apoptosis of monocytes and thymocytes.

• Dioxin-like PCBs can cause thymic atrophy and immnosuppression.

• Dietary PCB exposure can lead to increased rates of certain cancers (especially liver and lung).

Immune System Effects of PCB’s

• PCBs adversely affect thyroid levels, including elevated anti-thyroid antibodies.

• As PCB serum levels increase, the thyroid hormones triiodothyronine (T3) and thyroxine (T4) decrease.

• PCBs and other chlorinated compounds lead to increased risk for type 2 diabetes.

Endocrine Effects 41

Dioxin Poisoning

• PCB 126 is associated with estrogenic and adrenal effects and is immunotoxic.

• PCB 153 was significantly associated with diabetes risk.

• The sum of PCBs 28, 52, 101, 118, 138, 153, and 180 was associated with low T4 and elevated Gamma Glutamyl Transpeptidase (GGT).

Specfic PCB Effects 43

http://www.scientificamerican.com/article.cfm?id=obesity-insulin-resistance-organic-pollutants-fat-diet

About 200 pollutants were measured by either blood or urine test in the NHANE participants. Cave's team narrowed it down — and, he says, “ended up with a list of 111 chemical pollutants which were commonly found in at least 60% of NHANES subjects.” Among the chemicals studied were lead, mercury, and organochlorine pesticides. “And, so from this list, we found several chemicals associated with a dose-dependent increased risk for abnormal liver enzymes,” he says.

• Increase normal bowel excretion of fat soluble toxins using Rice Bran Fiber and Chlorophyll containing foods

Treatment Options to Lower PCB’s (POP’s) 46

47

Inclusion of olestra in the diet resulted in interruption of enterohepatic circulation of hexachlorobenzene and reduction in all tissues even during the periods of caloric restriction. These observations suggest that an appropriate regimen for the removal of lipophilic toxins is the combination of caloric restriction and the interruption of enterohepatic circulation with a nonabsorbable fat.

Volatile Solvents

Chlorinated Pesticides

Whole Blood Toxic Elements

Metals Result µ/g creat Reference Range In Range High Very High

Aluminum 3.0 < 35

Antimony 0.3 < 0.4

Arsenic 34 < 117

Barium 2.2 < 7

Beryllium < DL < 0.6

Bismuth 0.2 < 15

Cadmium 1.1 < 1

Cesium 7.1 < 10

Gadolinium 12 < 0.4

Lead 11 < 2

Mercury 110 < 4

Nickel 6.1 < 12

Tellurium < DL < 0.3

Thallium 0.7 < 0.5

Tin 4.3 < 10

Titanium N/A < 15

Tungsten 0.1 < 0.4

Uranium < DL < 0.04

Method: ICP-MS Provoking Agent: DMPS Post Provocative

Creatinine: 30.3 mg/dL Reference Range: 35–225

Porphyrins

58

Toxic Effects Porphyrins Profile Interpretive Guide Metametrix Laboratory

SNP Testing

Evidence of Increased Glutathione Demand

• Feeling much better! – Headaches gone off Lipitor (on 40 mg before) nervous feeling gone:

“better than in years”

• Blood pressure better, saw cardiologist – – 24 hr monitor in June good 24 hr average 137/65 with sleep 126/60

• ? PCB’s and HTN

Follow-up at 6 weeks

Conclusions: In this cross-sectional study, serum concentrations of PCBs, especially those congeners with multiple ortho chlorines, were strongly associated with both systolic and diastolic blood pressure. Alexey Goncharov, Marian Pavuk, Herman R. Foushee, David O. Carpenter Environmental Health Perspectives, Nov 2, 2010

• Start DMSA – 250 mg 1 three times daily before meals for three days (M,T,W) every other week for 3 months

• Continue NAC – 600 mg po bid and Alpha Lipoic Acid 800 mg po qd, add in Vit C 2,000 mg/day

• Sauna therapy • Avoid mercury containing fish and farmed salmon

Follow-up Note

• Start Rice Bran Fiber– 2 Tbsps daily • Start Cholestyramine 4 grams twice a day • Investigate solvent exposure source(s) (paint, carpet, new car,

etc.) • Take Glycine 1 gram twice a day to support detoxification • Begin Botanical Antimicrobial along with Probiotic twice a day

Follow-up Note

Q & A Session

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The Exposome: Assessing and Measuring the Body Burden of

Environmental Toxins

Todd LePine, M.D. September 25, 2013

12:00PM EST & 8:00 PM EST

© Genova Diagnostics