Environmental Health

Our environment includes the air we breathe, the water we drink, and the food we eat. Most people grasp the idea that air and water pollution, chemicals added to our food supplies, and other toxins can have damaging effects on our bodies. In some situations, prescription medications can be included in toxic substances that can harm health. Our thoughts and emotions factor into our individual environment and can influence our personal health.

We adapt to a changing environment and this may mean that we become stronger, more capable people as in "what doesn't kill me makes me stronger". Here is the definition of evolution: "Evolve - to come forth gradually into being; develop; undergo evolution; (Biol.) to develop by a process of evolution to a different adaptive state or condition. " ( from the Random House Webster's Unabridged Dictionary) This implies that we survive by adapting to environmental influences.

What happens if we don't adapt effectively to the chemicals that are polluting our environment? We may "devolve" and our physiology becomes less capable of maintaining necessary functions for health. As a prime example, the effects of some man-made petrochemicals are responsible for damage to the thyroid hormone systems and neurotransmitters of of many people. In 2001 I began reviewing research literature and, so far, I find agreement that the neuroendocrine systems are especially susceptible to disruption.

Neuroendocrine disruption (NED) is a general term for the effects of chemicals such as polychlorinated biphenyls (PCB's), bisphenyl (bis-A) in many plastics, DDT, and dioxins on our brains, endocrine glands (such as the thyroid), and hormone receptors. These chemicals did not exist in nature before humans manufactured them and then allowed them to filter into the air, water, soil, and food. While some of them such as PCB’s and DDT have been banned, they linger in the environment from previous use.

The thyroid system, whether we’re considering central regulating mechanisms in the brain, thyroid hormone production by the gland, transport of thyroid hormone in the blood, or utilization at the receptor level, seems to be particularly affected by NED. When I did a literature search for neuroendocrine disruption (NED), most of the research articles I found discussed the damaging effects of PCB’s on the thyroid hormone system. Since adequate thyroid hormone is so important for the optimal functioning of nearly all of the tissues in the body, a multitude of symptoms can result when there’s a breakdown in that system.

The Agency for Toxic Substances and Disease Registry (ATSDR) issued a report in 2000 that points out that we all have some level of PCB's in our bodies. There are numerous studies showing that breast milk in women across the USA has significant levels of PCB's. If you’re breast-feeding, please don’t let this information deter you - the benefits of breast-feeding far outweigh the fears of even PCB exposure. This is just an example of how pervasive these petrochemical toxins are in the environment.

An adequate amount of thyroid hormone is critical to the normal structure and chemistry of our brains. Impaired cognitive function, depression and anxiety can be linked to poor thyroid regulation of brain tissue. The production of neurotransmitters like serotonin and dopamine are affected by thyroid regulation. How many people do you know who are taking antidepressants? Particularly disturbing were the multitude of articles discussing the damaging effects of PCB’s on the brains of developing fetuses and infants through the first two years of life. How much of the ADD, ADHD, and autism that are so common in children today can be linked to poor thyroid regulation of the brain? How many children are medicated for behaviors that may be related to NED?

Endocrine-Disrupting Chemicals: An Endocrine Society Scientific Statement

by Diamanti-Kandarakis E et al. 2009 Endocrine-Disrupting Chemicals: An Endocrine Society Scientific Statement. Endocrine Reviews 30(4)293-342.   http://www.endo-society.org/journals/scientificstatements/                                  

In June, 2009, The Endocrine Society issued this report describing the many ways that neuroendocrine disruption from pervasive environmental chemicals such as PCBs, bisphenol-A (BPA), and dioxins in the environment cause impaired thyroid regulation, cancers, abnormalities of the reproductive system, diabetes, obesity, cardiovascular disease, neurotransmitter imbalances, ADD and ADHD. (Click here for the report.)

This information is not new; research articles have been published for decades describing the damaging effects of chemicals such as PCBs on the thyroid and other systems of the body. For example, all of the "moving parts"in the production and utilization of thyroid hormone are subject to impaired function from PCBs. Nine years ago the Environmental Protection Agency issued a report stating that we all have measurable levels of PCBs.

As in other realms of life, we have to acknowledge the existence of a problem before we can solve it. I see this report is an open door for the endocrinology profession to look beyond the TSH.  It provides common ground for us integrative practitioners who adopt different ideas earlier and the endocrinology profession which seems to move in geological time. Will we all agree on how to diagnose and treat clients?  It’s doubtful – put 4 doctors in a room and you’ll wind up with 5 opinions!  This 50-page report with 485 references concludes with "Recommendations for the Future". The first recommendation is"Linking basic research to clinical practice".

While this is not a new idea either, I'm encouraged by the Endocrine Society's recognition of the need. For the past thirteen years I've been looking “beyond the TSH” to help people get well. While I use a client’s symptoms and the standard thyroid lab tests as the introduction to the diagnostic process, I also use Resting Metabolic Rate (RMR) measurements and clinical judgment to find the rest of the story.  There are many of us integrative practitioners who use functional medicine testing and treatment protocols but allow the patients’ responses to treatment guide us toward the best, common sense answers for them.

Using Resting Metabolic Rate measurements for functional assessment of thyroid hormone regulation in addition to the standard thyroid-related blood tests does link basic research to clinical practice.  There are several reasons I take this position.

• We all seem to be agreeing that neuroendocrine disruption can alter production and/or utilization of thyroid hormone. Utilization is a key concept here.
• The standard blood tests for TSH, free T4 and free T3 give us information about the supply of thyroid hormone that is available for use, but not about utilization. 
• As an example, neuroendocrine disruption can cause a thyroid hormone receptor to lose its affinity for the thyroid hormone that your thyroid gland produces quite well.
• RMR will detect utilization problems at the cellular level that the standard blood tests cannot.

I propose that measuring RMR, using our clinical management skills, and educating our clients can help us all be well in spite of the damaging effects of environmental toxins.  Hopefully Planet Earth will be cleaned up but until then we can still be well. 

What Can We Do About NED?

While I sincerely hope that we clean up the planet quickly, we're most likely going to be at the effect of these chemicals for the rest of my lifetime and yours. Some people seem to have the physical constitution to buffer against these contaminants and don’t seem to have any significant health impact. Others have subtle but significant problems that defy usual diagnostics. They modify their lifestyles and diets to try to be well in spite of their "mysterious illness". Some people have devastating health problems because of NED and are sidelined from full participation in their lives. How much human potential is undeveloped because of impaired thyroid regulation due to NED?

The ray of sunshine in this dismal prediction is that you can still be well, regardless of the level of impact you may currently experience. If NED has disrupted your thyroid production or utilization, metabolic rehabilitation effectively addresses the cause of the symptoms. One of the most frustrating problems for my patients has been the lack of information about thyroid disease and effective treatment by their primary care physicians and endocrinologists. My goal is to increase awareness of these problems and their solutions.