insights

IFM Director of Medical Education Dan Lukaczer, ND, IFMCP, spoke with Lyn Patrick, ND, to discuss toxicants, inflammatory markers, and methods for toxicant elimination. Dr. Patrick is a naturopathic physician who is widely published in medical journals, is on the board of directors of the American College for Advancement in Medicine, and speaks internationally on topics including environmental medicine, endocrine disruption, and metal toxicology. In the following interview, Dr. Patrick shares her knowledge and clinical insights on toxicants, as well as on the importance of patient assessment, identifying the body burden, and considering a toxicant’s mechanism in order to implement an effective therapeutic intervention.

The following text gives a bulleted breakdown of some of the topics discussed during the interview, as well as Dr. Patrick’s observations and insights. Dr. Patrick will also be speaking at the 2020 Annual International Conference Online Experience. Learn more.

Toxicants & Inflammation

Dr. Patrick notes that insufficient information exists to prove that all toxicant exposure causes inflammation, but enough exists to infer this conclusion. She explains that “the response to all toxicant exposures, and I would include metals in this as well, is an upregulation either of the aryl-hydrocarbon receptor, which is the newest area of research, or an upregulation of the Th2, T-cell response, and the production of cytokines, particularly IL-6.”

• An inflammatory response can be seen:
  • Elevated 8-hydroxydeoxyguanosine (8-OHdG):
  • Indicator of oxidant damage to DNA.
    • Seen in elevated levels for patients exposed to mercury, air pollution, polychlorinated biphenyls (PCBs).
  • Upregulation of cytokines like IL-6.
• The problem:
  • No way to equate one immune marker to one toxicant.

Through a variety of different mechanisms, all toxicants upregulate inflammation; they induce and exacerbate inflammation.

–Dr. Patrick

Surrogate Markers

• Gamma-glutamyl transferase (GGT):
  • Correlation mostly seen between GGT and lead, mercury, pesticides, PCBs.
  • Correlation seen when GGT reference range or threshold is lowered:
    • If reference range had a reduced “high limit,” or threshold, then GGT may be a marker for increased risk of type 2 diabetes and cardiovascular disease.
    • You can’t use GGT as a diagnostic test for toxicants, but you can see correlations with a modified reference range, or lower threshold.
• High-sensitivity C-reactive protein (hsCRP):
  • Less information about hsCRP.
  • Most information related to pesticides—organochlorides and organophosphates:
    • Induce oxidant stress and elevate hsCRP.
    • Cause organ and vascular damage.

Future Biomarkers

• Aryl-hydrocarbon receptor:
  • No test for this upregulation yet.
• Paraoxonase (PON 1):
  • Strong antioxidant.

Clinical Insight – Address the Body Burden

• Intake assessment extremely important:
  • Identify the source of the exposure:
    • Test for the toxicant.
    • Stop the exposure.
    • Increase elimination from the body.
• Labs that test for inflammation are important, but labs would not identify the specific toxicant exposure.

Avoidance is the first intervention, always.

 

–Dr. Patrick

Thyroid & Association With Toxicants

Thirty toxicants have been identified as thyroid disruptors, Dr. Patrick says. She also points out that these same toxicants affect other non-thyroid, immunity-related diseases such as type 1 diabetes, celiac disease, Sjögren’s syndrome, biliary cirrhosis, pernicious anemia, and multiple sclerosis. “It’s a bigger picture in terms of toxicant exposure than just thyroid autoimmune disease,” Dr. Patrick suggests.

• Mercury:
  • Most well demonstrated toxicant to affect the thyroid pituitary axis.
  • Stored in thyroid follicular tissue.
  • Initiates autoimmune thyroid disease, as shown in animal models.
• Perchlorate:
  • Component in rocket fuel.
  • Water contaminant.
  • Blocks uptake of iodine into thyroid tissue by blocking the symporter.
  • Treatment:
    • Avoid exposure.
    • Think about the mechanism—how toxicant causes the damage.
    • Perchlorate broken down quickly in body and eliminated.

Reversing Autoimmune Thyroiditis?

When asked if a reversal of autoimmune thyroiditis would be possible if the toxicants and triggers were avoided, Dr. Patrick responds that it depends on the root cause of the autoimmune thyroiditis. More than one toxicant may be involved, or may have initiated the disorder. She discusses the following toxicant examples.

• Mercury example:
  • Half-life is multiple years.
  • Chelating agent needed to get rid of what is inciting autoimmune reaction.
  • Mercury may not be the only toxicant and may not have initiated the disorder.
• Mercury plus trichloroethylene (TCE) example:
  • If mercury is eliminated, autoimmune condition remains because TCE initiated the reaction.
  • TCE: Well demonstrated to lead to autoimmune disorder.
  • TCE: Exposure through contaminated drinking water and soil contaminants.
  • Even when TCE metabolizes and is gone from the body, the damage has been done. Other mechanisms are then used to address autoimmune disease.

Toxicant Elimination

Dr. Patrick discusses both the use of saunas to increase elimination of certain toxicants through sweat and urine and the use of brans and fiber to aid in toxicant elimination.

Saunas

• Optimal construction of medical sauna:
  • Constructed without the use of glues, solvents, toxins, or any material that would off-gas when heated up.
  • Infrared saunas constructed with metal conduit around wiring to mitigate for electromagnetic field (EMF) exposure.
  • Medical sauna needs an exhaust:
    • Patients will be eliminating toxins that they and others should not breathe back in.
• When to use medical sauna:
  • Patients who have been exposed to solvents, phthalates, BPA, cadmium (pours out in sweat), mercury (in sweat and increased elimination in urine after sauna), organochlorine pesticides, and PCBs.
• Results:
  • Infrared sauna compared to standard radiant heat sauna:
    • Equivalent results in their ability to eliminate toxicants.
  • Sauna compared to an exercise bike:
    • Heat-stimulated opening of the sweat glands using the sauna was more effective in eliminating toxicants.

Bran & soluble fiber

• Rice bran:
  • Pulls out fat-stored toxicants.
  • Negligible amounts of arsenic.
• Bran in general and soluble fiber:
  • Pulls out fat-soluble toxicants.
• Cholestyramine:
  • Best track record of all interventions for fat-soluble toxicants, especially PCBs.

Rice bran will pull fat-stored toxicants out of the body, meaning from the bile into the intestinal tract, and will prevent enterohepatic reabsorption.

–Dr. Patrick

Dr. Patrick is one of the expert speakers at IFM’s 2020 Annual International Conference (AIC).