What we need to know about environmental toxins [PODCAST]

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“Even low dose mercury toxicity can be harmful to human health in a variety of ways: enhanced free radical stress, reduced glutathione levels, increase in apolipoprotein E g4 genotype expression, promotion of neurofibrillary tangles and altered immune sensitivity. It has been implicated in contributing to autism, Alzheimer’s disease, Parkinsonism, and even lupus erythematosus, an autoimmune disease that may have neurologic involvement. Mercury toxicity has been reported as an occupational risk to dental staff, goldminers, and chloralkali factory workers. My father, a dentist, developed neurological symptoms of mercury poisoning after handling many dental amalgams, so I have some firsthand experience with its danger. Even in remote parts of the world like the Amazonian basin evidence of neurotoxic levels of methyl mercury contamination has been observed. Testing adults in a remote village on the Tapajos River, investigators found that loss of manual dexterity and visual contrast acuity correlated with mercury levels even in a range considered non-toxic.”

Arnold R. Eiser is an internal medicine physician.

He shares his story and discusses his book, Preserving Brain Health in a Toxic Age: New Insights from Neuroscience, Integrative Medicine, and Public Health.

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show, we have Arnold Eiser. He is an internal medicine physician, and he’s the author of the book Preserving Brain Health in a Toxic Age: New Insights from Neuroscience, Integrative Medicine, and Public Health. Arnold, welcome to the show.

Arnold R. Eiser: Thank you very much, Kevin. Good to be here.

Kevin Pho: So we’ll get into your book in a little bit, but first off, can you share your story and journey to where you are today?

Arnold R. Eiser: Sure. It’s a bit of a convoluted one. In the first half of my career, I was an academic nephrologist at the Mount Sinai School of Medicine in New York City. Then, mid-career, I switched to running academic general internal medicine divisions and was chief of general medicine at the University of Illinois at Chicago, where I was also involved in health services research and bioethics research. I then moved back east to the Philadelphia area to run graduate medical education programs for both the Mercy Health System and Drexel University College of Medicine.

Towards the end of that time, I wrote a first book called The Ethos of Medicine in Postmodern America. When I retired from that, I looked around to write another book. I started writing a book on diseases increasing in the 21st century, but the publishing world said that’s too broad and asked me to narrow it. They wanted me to focus on one disease. I declined to do that, and I focused on neurodegenerative diseases and the effect of environmental pollutants in increasing their prevalence.

Kevin Pho: All right, so tell me more about that topic, in terms of how you got interested in it and how that eventually led to a book. Tell me about that story.

Arnold R. Eiser: Well, around the same time, I also began writing scholarly articles in the area of neuroscience, starting with a book on why Finland has such a high rate of dementia death. It identified four factors in the environment. One was methyl mercury in the fish that gets consumed there. Another was a moldy, toxic environment in their homes. Helsinki has one of the most humid as well as cold capitals in Europe, and that leads to a promotion of mold growth. The additional factor was that there is a lot of a neurotoxin produced by cyanobacteria, also known as blue-green algae, in the Baltic Sea, and that BMAA can be associated not only with the development of dementia but also with other neurodegenerative disorders. A fourth factor was a deficiency of selenium in the soil in Finland.

Kevin Pho: All right, and that topic certainly has broadened into this book that we’re going to talk about, Preserving Brain Health in a Toxic Age: New Insights from Neuroscience, Integrative Medicine, and Public Health. Now, what are some of the key messages that you want your readers to come away with after reading it?

Arnold R. Eiser: I think for the physician readers, I want them to pay attention to the fact that so many diseases are related to environmental toxins. For the nonclinician readers, I want them to understand there are ways that they can protect themselves from environmental toxins, and that includes learning to recognize where environmental toxins are likely to occur, such as blue-green algae, which can occur on recreational waterways and should be avoided.

Kevin Pho: So let’s go into more detail. I’m a primary care physician. What are some common diseases I may see in the exam room that are associated with environmental toxins?

Arnold R. Eiser: Well, the diseases I focused on primarily were Alzheimer’s dementia and autism spectrum disorder. The latter in particular is increasing at an astonishing rate in the 21st century, and it clearly has an association with an increase in the toxins in our environment. So it is important to learn what those toxins are and how they can be avoided. As recently as a couple of months ago, there were reports of metal toxins in baby food. That should not happen, because infants are significantly susceptible to any kind of toxin, and metal toxins are one of the most serious toxins that can damage the neurological development of an infant. But I describe other issues as well. Disorders that have sometimes been called chronic fatigue syndrome or myalgic encephalitis also appear to be related to environmental toxins.

The other thing is, in writing the book, I had an opportunity to interview many physicians who are involved in the treatment of environmental illnesses. They often identify now as integrative medicine physicians, but they didn’t start out that way. So I asked them, “How did you end up making that switch?” With one exception, they said they got an environmental illness and they needed to go to an integrative physician in order to get treated, which to me was kind of astonishing. As an allopathic medical school professor for close to four decades, I thought we had all the bases covered, but that is not the case. There is a huge gap in terms of treating environmentally related chronic illnesses. The acute illnesses are covered in the emergency medicine departments, but chronic illnesses seem to escape the attention of allopathic physicians and allopathic education, which I think has to change.

Kevin Pho: So you mentioned Alzheimer’s being one of the most common diseases that’s associated with environmental toxins. What kind of things are these integrative medicine physicians testing for that escape allopathic physicians?

Arnold R. Eiser: Well, one kind of toxin that can be tested in individuals is the metal toxins. Now, testing for metal toxins is not simply drawing blood levels and ascertaining it that way, because many of the metal toxins quickly leave the bloodstream. They stay a little longer in the urine, but they leave that too. So to actually screen for metal toxins, you also need to check nail or hair samples.

Kevin Pho: Where would a typical patient be exposed to these toxins? Is it where their house is located? Is it in the water, the food they eat? Where does one typically get exposed to these environmental toxins?

Arnold R. Eiser: OK, that is a very good question, because it’s all of the above. You can breathe in particulate matter 2.5, which has definitely been shown to be associated with an increased risk of Alzheimer’s. You can consume arsenic in drinking water. I recently, with some research collaborators, completed a clinical study of people with cognitive impairment, and the finding of metal toxicity was not uncommon.

You can also get it in food. There are, for example, many cold cereals that have contained glyphosate, a substance which has properties that are likely to be neurotoxic. So consuming organic foods instead of regular fruits and vegetables is one step in that direction, but it’s far from the only one, because we have all these organochemicals in the environment, so-called endocrine disruptors, that are unfortunately ubiquitous in personal care products and other products as well, and maybe also in the water supply. To check on your local water supply, I recommend consumers look at the data from the Environmental Working Group.

Kevin Pho: Now, if I’m a physician and I see a chronic disease that I suspect is from an environmental toxin, are these effects reversible by simply reducing the exposure to the toxin? Can we help cure some of these chronic diseases that we see?

Arnold R. Eiser: It is at least theoretically possible, and also there does need to be a great deal more research in this area. But I’ll give you an example. Individuals, particularly females, are predisposed to develop copper toxicity if they are also taking contraceptive pills. You can check serum copper levels, and when they are elevated, the treatment is fairly simple and straightforward and does not require chelation. The treatment involves taking some zinc, so it’s relatively straightforward in the hierarchy.

Kevin Pho: Talk about it from a patient perspective. What are patients to do? You mentioned going to an integrative medicine physician, where they can be tested for a variety of environmental toxins. That’s one option. Are there any signs that they should be looking for that would cause them to take that next step and be screened for environmental toxins?

Arnold R. Eiser: I think they have to consult with their personal physicians, as the field is not at all clarified. As I point out in the book, there are shortcomings in terms of clinical research within integrative medicine, but at least they’re trying to address the problem. For some reason, allopathic medicine has sort of turned the other way in this regard. For example, many of the issues that need to be addressed are studied in schools of public health, and public health professors of environmental health are knowledgeable in this, but they don’t treat individuals. So that’s how it has sort of evolved, and that’s why I had to mention integrative medicine in the book. I didn’t start out to do that, but it sort of evolved that way.

Kevin Pho: What are some of the reasons why you think allopathic medicine has turned a proverbial blind eye to environmental toxins?

Arnold R. Eiser: Well, I think in the pursuit of evidence-based medicine, clinical research has come too much under the control of for-profit corporate pharmaceutical companies that really have no interest in pursuing this part at all. There are chemical companies, so they’re part of the chemical industry that is part of the problem to begin with. For example, you can find research within allopathic medical schools, in departments of pharmacology, pertaining to environmental toxins, but you can’t find a clinical counterpart to that with regard to chronic exposures. I mean, a little bit in industrial medicine.

The chapter that appears on KevinMD, a portion of chapter two of my book, describes in particular mercury toxicity. It was Paracelsus, who was a 15th-century physician, who first called attention to mercury toxicity, and his fellow physicians did not read this news at all positively. But nevertheless, he was on to something that was important. He was a contemporary of Leonardo da Vinci, and he already was thinking this. He was an Austrian physician. He also wrote the first treatise on occupational medicine.

But I think it has not captured any of the established divisions within allopathic academic medicine, so it hasn’t really been covered sufficiently. There are a number of chronic illnesses that are falling in between and require more research. I think there is a bright spot, in that the NIH has now founded a National Center for Complementary and Integrative Health, so they’re starting to fund some of the research in this area. But their budget is quite small compared to the rest of the NIH, and I do hope to see that continue to grow, so that they can study things that are not going to have a big financial return, which the pharmaceutical companies are not going to be interested in studying, but which may be very effective, may have low toxicity, and may be useful to a wide swath of patients that are currently not being served.

Kevin Pho: We’re talking to Arnold Eiser. He’s an internal medicine physician, and he’s the author of the book Preserving Brain Health in a Toxic Age: New Insights from Neuroscience, Integrative Medicine, and Public Health. Arnold, where do you see the future regarding that intersection between allopathic medicine and environmental toxins? Do you see this remaining in the realm of integrative medicine, or do you see a better adoption and acceptance of environmental toxins within the allopathic realm?

Arnold R. Eiser: Well, I hope it’s the latter. I have an article about the growth of neurotoxins related to climate change on the website The Conversation, and when people read it, they say it’s quite frightening, and it is. The forest fires are contributing a severe increase in particulate matter, which is neurotoxic. The flooding that’s occurring from worsening hurricanes and the like damages buildings and causes mold toxicity in those buildings. And the excessive use of fertilizer causes the phosphate runoff that causes the large blooms of blue-green algae, which is clearly neurotoxic.

One state that’s taken a lead on this is actually Ohio, and they have encouraged their farmers not to fertilize when it’s going to rain or when the ground is saturated. The reason they’re dealing with it is that their water supplies are already being threatened by these growths of blue-green algae. So I think it’s becoming an increasing national health crisis issue, and I do think allopathic medicine is going to come around to dealing with this. It’s too important not to.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Arnold R. Eiser: I think the physician audience needs to be more aware of environmental toxins and how they might manifest in clinical illness. Certainly, the book is a reasonable starting point. In addition to the science in the book, and I have over 400 references, I also put in vignettes of the researchers, because I think it’s important to gain insight from the people who did challenge the conventional wisdom and did develop the insights, all the way from the founder of neuroscience, Ramón y Cajal, to researchers currently doing research in this area. So I do think there’s room for improvement, but I think a large number of physicians have to become aware of this, be proactive, and demand more from their medical societies.

Kevin Pho: Arnold, thank you so much for sharing your time and insight, and thanks again for being on the show.

Arnold R. Eiser: My pleasure, Kevin. Thank you.

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