podcasts

Kalea Wattles:
Well, we know that environmental toxicants are all around us. It is unavoidable, unfortunately. And as you’ve told us in our APMs [Advanced Practice Modules], we’ve heard you, say over the years, exposures are really problematic. And it’s not just what we accumulate but what we then cannot eliminate that’s at the root of the dysfunction, right? 

Kalea Wattles:
What are some of the most common routes of exposure that you’re seeing in modern life? 

Bob Rountree:
Well, food, air, water, skin, things we rub on us, things that we buy and then rub on our bodies, things that we massage into our scalp. It really depends on the individual. In the last few years, we’ve really put a new emphasis on social determinants of health. And I think the reason for that is we’ve realized that people that live in certain areas, in industrial areas, for example, seem to have the highest exposure. So we’re all exposed to cosmetics and foods and water and all that kind of stuff, but people that live in industrialized areas, people that live near certain factories, I think they have the highest exposures, followed by occupational exposures. So I’m bringing that up because that’s really where the data is going. It’s saying, hey, there’s certain neighborhoods where kids really seem to have the highest levels of toxins. We’re all exposed, but certain people are at higher risk, and the social determinants seem to play a big role in that. 

Kalea Wattles:
You and I worked together earlier this year developing some of our Environmental Health curriculum, and we talked a lot about personalized medicine and individual susceptibility, and there are certain factors that seem to make some people more susceptible to the effects of toxic exposures. Will you talk to us a little bit about what are some of the factors that might make someone more at risk for becoming symptomatic, for developing chronic disease after they’ve been exposed? 

Bob Rountree:
Well, the first thing is just the overall level of exposure. There was a study that we talked about in the APM that was done at Stanford a few years ago. I think Dr. Schneider was behind that. Dr. Schneider talked at our Annual International Conference. They had people wear all kinds of monitors that would pick up exposure to air pollutants, et cetera. They measured their microbiome, and they were astounded at the exposures people get on a day-to-day basis. Now, as I said, depending on where a person lives, some people are going to have higher exposure. So starting out with a total level of exposure actually has an impact on what you’re talking about because once your total body burden of these exogenous toxins of metals and chemicals, et cetera, once your burden reaches a certain level, then the enzymes in our body can’t deal with them anymore. 

So, the typical example is somebody who goes out and sprays pesticides in their yard, herbicides in their yard, and doesn’t feel well afterwards and says, “Oh, it’s that chemical,” as opposed to realizing it’s my exposure all along. What’s been going on for years, these things are accumulating. So I know you thought where I was going to go with that leading question was it’s all about genetics, and that’s true that genetics play a big role in that. But the enzymes that we talk about, the phase one, phase two enzymes that are in the gastrointestinal border, in the liver, in the blood-brain barrier, in the lungs, yeah, they play a huge role, but those enzymes tend to slow down when they get overwhelmed. So the number one factor that determines whether somebody is going to start getting sick from all this exposure is the total toxic load. 

And it’s a concept that environmental scientists are really wrapping around. And of course, the companies that make the chemicals, they would rather not talk about this total toxic load concept to the point that I’ve actually seen interviews with some of these chemical societies where they say, oh, there’s no such thing as a total toxic load, which is nonsense because it’s all over the medical literature. Just an example, you could be exposed to mercury in a lot of different ways. Maybe you’ve got amalgams in your teeth, maybe you live near a factory that’s belching out air pollutants with mercury, and maybe do a lot of fishing, and you like to eat fish from lakes that you thought were pristine, but the fish are eating the algae that have the mercury. So you put all those things together, and it’s a problem. But at some point, you have a little too much sushi, one extra bite of sushi, and your mercury level goes from being right below the threshold of detectability, and it goes below that threshold of detectability to toxicity. 

Kalea Wattles:
Right. 

Bob Rountree:
So that’s the first thing is just the total load. And then the second thing is the genetic polymorphisms in the phase one and phase two enzymes; they do make a difference. And it’s pretty clear that we’re all individual in our susceptibility to things. I mean, caffeine is the example we always use, that somebody like me, I can get up and have four shots of espresso in the morning and that makes my day. And other people have a teaspoon of green tea, and they can’t sleep for three days. So we already know that. We know that some people can take codeine and it’s a good pain reliever or cough suppressant, and other people take codeine, it doesn’t do anything beneficial, but it makes them nauseated. And for years we would say, oh, that is just because they’re psychosomatic. They’re a little bit weird. And now we know we can measure that enzyme, the CYP2D6, and look at whether it’s even there or not. Some people don’t even have that enzyme. 

So that’s true for a wide range of phase one enzyme’s like 2D6 and phase two enzymes as well. We know that people with Gilbert’s syndrome, which we’ve been told for years and years is a benign condition. This person fasts overnight, their eyes turn yellow, they do a standard blood test, their bilirubin is high. Well, Jeffrey Bland told us, I think 25 years ago, this is not a good thing. And it took years before the research came along to really support what Jeff had pointed out, the research showing that people that have Gilbert’s polymorphism are actually more susceptible to the toxic effects of acetaminophen. 

So it’s a total toxic load and the individual’s ability to detoxify and their overall health status. Is that person eating a lot of antioxidants, for example? So a person that’s eating junk food all the time, white bread all the time, french fries, cheese puffs, if that’s their diet, and that’s the diet of a lot of people in this country, a lot of people around the world, if somebody’s eating a lot of ultra-processed foods, then they have less of an ability to neutralize the toxins that are coming in. So that’s a third factor. So it’s genetics that’s kind of interplaying with the overall nutritional status of the person. 

Kalea Wattles:
When we think about the genetic component, are there ways that we can predict that someone might have some polymorphisms that impair their detoxification pathways without doing any testing? Are there signs? Are there symptoms? Is there a way that we could predict this just with our intake and our history collection? 

Bob Rountree:
Yeah. I mean, the typical person that has significant polymorphisms, and we all have polymorphisms, right? So that’s not that unusual, but having the more significant polymorphisms, that’s the person who gets easily sickened when they’re exposed to smells. When they go to the gas station and they pump gas in their car and they go, I just feel terrible afterwards. The person who had to have surgery for one reason or another and got the anesthetics and felt terrible with the anesthetics. So drug reactions, excessive reactions to smells in the environment. The person that is working in the garage, maybe they get a solvent on their hands and they feel headachey and brain fog and that sort of thing. So these kinds of reactions are pretty telling when it comes to these polymorphisms. 

Kalea Wattles:
I’m imagining that someone might have some polymorphisms that affect their detox pathways, but their lifestyle is really good. They’re sleeping, they’re sweating, their nutrition is really stable, but then they get a new job or they go on vacation or something happens and the lifestyle factors start to slip up and then they would become symptomatic. Is that what you see in the real world? 

Bob Rountree:
Yeah, that’s the point I’m talking about. With this total toxic load, we don’t have any easy way to measure that other than looking at the person’s lifestyle, but we all have a total toxic load, and that toxic load is going to wax and wane, and this is the concept I talk to patients about. Yeah, you change your job, you get into a new environment, maybe you’re not eating as well, you’re not sleeping as much. You’re under a lot of stress, and all those factors are going to determine what the total load’s going to be. 

Kalea Wattles:
You teach about the relationship between toxic exposures or an accumulation of toxic exposures over time and the increased risk for chronic disease. And when I started learning about this for the first time, this was not always intuitive to me. Things like osteoporosis, that was very hard for me at first to make that connection. Will you talk to us about some of the chronic diseases that might actually have an underlying driver of toxic exposures? 

Bob Rountree:
Well, one that comes to mind immediately is the change in fertility. I think it’s a subject you know about. There’s actually a website you probably know about, I think it’s called Million Marker. 

Kalea Wattles:
Yes. 

Bob Rountree:
And this is an excellent website that basically does an environmental assessment in women that are trying to get pregnant and are having trouble getting pregnant, and a lot of women are having trouble getting pregnant. Is that right? Am I correct about that? 

Kalea Wattles:
That is right. In their mid-twenties, in their late twenties, because of all of these environmental factors. 

Bob Rountree:
Because of environmental factors. So, a book came out in, boy, when was it? 1997 or 8 by Sandra Steingraber that’s called Living Downstream. And the reason she wrote the book is because she noticed that there was something going on with developmental abnormalities in little baby boys, right? That they were having undescended testicles or they were having a condition called hypospadias, and she got really curious about why this was happening. She was able to access data on toxic release and was able to actually do a mapping of which areas, which I think it might’ve been Illinois, someplace in the Midwest, where she was actually able to get data on what’s being released in the environment and match that to the incidence of these developmental abnormalities and started to see these really strong positive correlations. 

Now, correlation is not causation; you can’t prove anything. But when you see that kind of association over and over and over again, you just really begin to wonder. So reproductive abnormalities, developmental abnormalities, problems with fertility, all these things start to add up. And when you begin to question what the mechanism is, you start to realize, well, something must be messing with hormones. And the term that we’ve used to describe that is endocrine disruption. So that’s the area where there’s actually the most research on environmental chemicals is the relationship between these endocrine-disrupting chemicals and all kinds of reproductive abnormalities like the ones that we’ve talked about. But what about simple things like PMS? What about endometriosis? 

Kalea Wattles:
Yes. 

Bob Rountree:
What about the fact that little girls are going through puberty at a much earlier age? Is it because they’re eating more? Are they healthier and that’s why they’re doing that? Well, some of the association data suggests it’s because of things that little girls are putting in their hair, cosmetics, et cetera, that are actually causing their ovaries to, shall we say, ripen at an earlier age. I don’t think that’s a good thing, right? 

So this endocrine disruption, this is very well accepted, the American Pediatric Association has written about it, the Endocrine Society has written about it. It’s in all the medical journals, there’s no question that this is going on. So that’s one of the big focuses for toxicology. And the important thing to understand about this is we’re talking about really low doses. So the conventional toxicologists will say the doses are too low to cause a problem. Well, have you ever measured estrogen levels in a patient? Have you ever measured testosterone levels in a patient? We’re talking nanograms. We’re talking picograms, right? These tiny amounts, our body is used to distinguishing variations of very, very tiny amounts of these toxins. And the endocrine-disrupting chemicals that we’re talking about are right along those same lines.  

So what’s an example of that? Bisphenol A. We know that workers in factories that are handling bisphenol a lot tend to have more infertility problems. You can measure it in their urine. There’s more infertility, there’s low sperm counts, and a whole other issue that may not have come up initially is obesity. There tends to be higher body weight in people that are exposed to bisphenol A, and they’ve shown that in kids, kids with higher levels of BPA tend to have more body fat. That’s a form of endocrine disruption. We have this huge obesity cardiometabolic epidemic going on with metabolic syndrome, et cetera. Is that because people are eating too much or they’re eating too much junk food and not exercising? Well, that’s part of the story, but I’ve got a lot of patients who tell me they eat impeccably, they exercise regularly, and they can’t get the weight off. And you go, well, why is that? Not my fault, it’s the toxin’s fault. 

And years ago, I heard Jeffrey Bland say something very interesting. “The solution to pollution is dilution.” So why do we have that body fat? Because their body is trying to dilute the total toxic load. So if the local concentration of these toxicants is lower, they’re less likely to have harmful effects on our cells. So we put on more fat tissue to dilute it. But what happens when you lose that fat and all those toxins come out into your bloodstream, and that can make you feel terrible? Or we’re talking about osteoporosis a minute ago, what happens when a woman hits menopause and her bones start to thin out, well, what’s in those bones? Lead, well, that lead starts coming out in the bloodstream, and then the woman’s moods go crazy. And she says, well, I’m going through menopause, I expect my moods to be a little crazy. Well, maybe that’s because of the lead. 

 Kalea Wattles:
I think this point that you’re making about the low-dose exposures being really significant, it reminds me here in the Seattle area, the University of Washington just did this study because their public transportation drivers, they had concerns about methamphetamine in the air and in the surfaces of the buses, and being worried that it was impairing their cognitive function because they had exposure all day. And so the University of Washington came in and took all these air samples and samples from the seats and from the poles that people hang onto, and they found methamphetamine on 99% of surfaces in all of the air samples that they took. But the conclusion was, oh, well, the dose is so small that we don’t think it will affect the drivers, but we’ve never looked at what it means to sit in that air quality and be on those surfaces for eight to ten hours a day.  

Bob Rountree:
All day, all day.  

Kalea Wattles:
Right. So it is a very interesting question about maybe that exposure one time is fine, but day after day for years, who knows what those lasting effects would be? 

Bob Rountree:
Well, since you brought up the Puget Sound, I mean, we know the orca population is dropping, and at least part of the reason is that these orcas are accumulating all kinds of environmental toxins. I think they’ve put some attention on bisphenol A, but that’s not the only one. And then the orca has a baby, and all the breast milk from the orca is just full of these toxins, and the babies are actually dying from that. Then you go, well, wait a minute, what if you eat fish from the Puget Sound? What if you eat oysters from the Puget Sound? Is that a problem? Are they accumulating these things? Well, if we don’t study it, how are we going to know? We focus on the orcas, but we go, wait a minute. What about humans? 

Kalea Wattles:
What about humans? And we want to eat the fish here. It’s so good, but we have to be careful. 

Bob Rountree:
It’s so good. The salmon is so good. 

Kalea Wattles:
It’s so good, but we don’t want all these endocrine-disrupting chemicals because like you’re mentioning, the way that it can impact, it’s the reproductive axis, it’s thyroid function. It increases our risk for diabetes and all kinds of issues. So when you are thinking, I’m even going to bring in the whole thing about microplastics and how we saw microplastics in the brain tissue for the first time recently, right? 

Bob Rountree:
Crossing the blood brain, it’s crossing the barriers, including the blood-brain barrier. So if these plastics are small enough, it’s not just a problem for turtles. 

Kalea Wattles:
It’s not back when we just used to cut our pop can liners, and that was our biggest issue with plastic, now they’re in our blood and our brain tissue. What are some of the other organs that are most susceptible to the effects of toxic exposures? 

Bob Rountree:
It is hard to really interpret what the data is. But is breast cancer still going up? Seems to be. Prostate cancer still seems to be going up. Well, I’ll give you an example the other day. I mean, it’s speculative, but I think it’s good speculation as I saw a woman in her fifties who was diagnosed with breast cancer, and she said, I don’t understand, I’ve eaten the healthiest diet you can imagine. I’ve done all the right things. Well, where did you grow up? Well, she grew up on a small bay in Massachusetts, south of Boston. And I said, did you live near any chemical factories, et cetera? She said, no, but I remember that there was a problem when I was younger of an old factory, it had been decommissioned, but it had dumped a lot of PCBs into the bay, and they were having to clean up the bay because it was in all the shellfish, which we ate a lot of. 

And so I looked it up out of curiosity, this is 30 years later, and immediately found a news story about that particular bay and how they were still dredging PCBs, organochlorines, from that bay. So you’re going to go, wait a minute, organochlorines, that’s DDT, dioxin, PCBs, I thought those are all gone from our environment, right? The DDT thing, we identified it’s a problem, we don’t use it anymore, but what about women that were exposed during puberty or right before puberty? The effects don’t show up for 20, 30 years. 20, 30 years. So that’s what makes this whole thing a little bit scary, because it’s not a simple matter of me going to this woman and saying, I’m going to measure your PCBs now. 

She may still have them, but the important thing was the exposure that was decades before that. And that really illustrates the whole problem we have with environmental toxins is this, the low dose and the delayed effect. So that’s what the chemical companies use as a way around it. Well, I got sprayed with DDT, and I felt fine. You may not feel bad initially, but what about these delayed effects? 

Kalea Wattles:
The clinician in me is begging you to tell me, what do I do with that information if I can’t avoid the exposure, it’s already happened. Is it a band aid now to just help with the symptoms? What do we do? 

Bob Rountree:
No, I think with this woman in particular, I’m not saying that we specifically have to get the PCBs out of her system, although I suggested that we could measure PCBs. It might still be helpful, but you can assume that there’s toxins in her body fat, and she’s getting the treatment. She got the lumpectomy, she gets some radiation, and then the oncologist says, bye-bye, we’re done. We got rid of the cancer. Why don’t you come back in two years and we’ll see if it came back? And I think that’s where functional medicine comes in because we say, well, wait a minute, the one thing we don’t want to do is recreate the scenario that perhaps caused this problem in the first place. So that’s where we get away from the helplessness of it, of hey, you were exposed to something that was not your fault. 

It’s not quite like cigarettes, well, you shouldn’t have smoked. Yeah, well, what’s done is done. The past is past. But I do think there’s things that we can do now. And so when I talk to women with breast cancer or men with prostate cancer, I say, well, the very least you can do is try to lower your total toxic load so that that environment is not conducive to the growth of more cancer. And it helps to try to identify what the initial sources of that toxic load might’ve been, right? So if that might’ve been from eating seafood in an area contaminated with PCBs, well, we can assume that those toxins went into body fat, so you want to lower your body fat. I mean, we all want to lower our body fat, but maybe in that woman, it’s more important.  

And what I always like to do is measure estrogen metabolites, because as Eleanor Rogan has told us, and I think in functional medicine, we all really appreciate Eleanor Rogan’s work on estrogen metabolites. She has shown that a particular metabolite of estrogen, the 4-hydroxy estrogen, damages DNA, and she believes that might be one of the major causes of breast cancer and prostate cancer, is that those genotoxic estrogen metabolites, well, you could say, okay, well, I’m having more of those metabolites because I’ve got a polymorphism in my CYP1B1 enzyme. Okay, fine. But what does that mean? Well, the CYP1B1 is exquisitely sensitive to certain environmental toxins, right? Polycyclic aromatic hydrocarbons, things that you get from burnt organic material, cigarette smoke, charbroiled beef, automotive exhaust, all of those things stimulate that enzyme to make more toxic estrogens.  

So that means don’t go jogging at the side of a highway. And if you do smoke, then you want to stop. And if you live in a place where there’s a lot of air pollution, if you’ve got an apartment on the side of a highway, you’ve got to decide, is that a place you want to continue living? Some people don’t have a choice, in which case they should get an air purifier. But minimize exposure. So, yeah, we should all do that. But if a person has this enhanced susceptibility and it’s already created a disease like prostate cancer or breast cancer, then they need to take extra precautions. They need to take the extra steps necessary to keep that total toxic load low. So I really think that’s what functional medicine has to bring to this scenario. We’re not saying you’ve got a person with metastatic cancer, and if you detoxify, there’s going to be a magic cure. But I do think it’s somewhat obvious to say the lower your total load, the less likely you are to have the same conditions that created the problem in the first place.  

Kalea Wattles:
Right. It’s risk reduction. It’s a risk reduction. 

Bob Rountree:
Risk reduction. I mean, it’s the same thing as that cardiologists do all the time, it’s just that the principles haven’t been applied to toxicology. So the cardiologist would say, hey, you’ve had a heart attack and you need to lower your cholesterol and you need to exercise and get your body fat down and get your blood sugar down. Why don’t we do that for people with cancer? Think about it, we don’t do that for people with cancer. So the cardiologists are way ahead in terms of secondary prevention, but the oncologists focus strictly on removing identifiable tumors. And once that’s been done, well, my job is over. And I don’t buy it. 

And sometimes, oddly enough, the only bit of dietary advice that I’ve heard from oncologists is, well, you’ve had breast cancer, we treated it. Don’t eat soy. Whatever you do, don’t eat soy because that’s got estrogen in it. I’m like, well, so do all kinds of legumes. So does flaxseed. So you’re going to tell people avoid phytoestrogens. Well, that’s a huge percentage of plant foods. So it’s based on a total misunderstanding and a lack of recognition of xenoestrogens, which is the abnormal synthetic estrogens, the endocrine disruptors that are in all of our food. So we’ve got this misguided focus on phytoestrogens as being problematic, and that takes us away from focusing on the real elephant in the room, which is all these other environmental endocrine-disrupting chemicals, et cetera. 

Kalea Wattles:
Yeah, these phytoestrogens that are also super fiber rich and nutrient rich and probably help to some extent to detoxify some of these metabolites. Dr. Rountree, you talked about there might be some advantages to some therapeutic weight loss at times, but we know that once you start losing fat, burning fat, that we can release some of these persistent organic pollutants from our fat cells, right? So how do you counsel patients? Do we expect when they start losing weight that we may see them become more symptomatic as they release and mobilize these toxicants into their bloodstream? 

Bob Rountree:
Well, I have to credit Dr. Kristi Hughes for bringing this up. She helped us when we first started putting our Environmental APM together, and her whole idea was you have to prepare somebody for a detox. 

Kalea Wattles:
Yeah.  

Bob Rountree:
And that was a learning for me because when I first started doing this practice years ago, people come to see me and I would say, “Oh, well, you need to detox. I’m going to have you fast for three days, water only fast or lemonade, cayenne pepper. I’m going to really be pushy about this because you got to detox, you got to get that toxic load down.” Now following Dr. Hughes’ advice, I’m more likely to say, okay, let’s get you stronger before we do that, let’s make sure your nutrition is optimal. Let’s make sure you got plenty of the plant-based antioxidants in your diet, you’re eating a whole foods diet, and that you’re feeling stronger. And then we might do a three-day cleanse, or we might use a functional food powder or even a fast. And one easy way to do that, speaking of fasting, is just having people ease into intermittent fasting. 

There was actually a study in Journal of American Medical Association where they looked at women who’ve been diagnosed with breast cancer, and then some of them had followed intermittent overnight fasting, 12-hour fast overnight, 14-hour overnight. They followed them for a number of years, and they found that the women who did the prolonged overnight fasting, which is really time-restricted feeding, and what they found in that study, is that as women approached 14 hours, the recurrence rate of the cancer went down. So, maybe you don’t have to do really prolonged fasting, et cetera, just simply extend the interval overnight that you’re going without food. A simple thing. Every single patient that I see with cancer, I talk to them about this. Trying to go overnight, see how long you can go without eating. Start with 12 hours, once you get used to that, see if you can go up to 14. So this is a gentler way of doing what I initially did in my practice. 

Kalea Wattles:
Right. Very approachable, making sure the conditions are right, the pathways of elimination are open. I’m sure that you’re talking to people about, let’s make sure you’re not constipated before we start doing these things. 

Bob Rountree:
Yeah, I mean, if you’re only pooping every three days, where do you think all those toxins are going that are in the colon, right? They’re just recirculating. Pooping is a good thing; I’ve really come to that. There’s a book, actually, I should probably give it to my patients, it’s called Everyone Poops. 

Kalea Wattles:
I’ve seen this book. It’s a must in everyone’s bathroom. 

Bob Rountree:
Yes. Yeah, it’s a must book, and it’s true. I mean, we really should do this every day. It’s a good idea because that’s part of the elimination process. We also eliminate through our breath, through our skin, through our urine, et cetera. But what’s coming out in the stool is really important. 

Kalea Wattles:
I want to just revisit what you said because even after going through so many training programs on supporting a detoxification strategy, I took it for granted that breathing is one method to support your detoxification. And it seems so simple that I think we forget about it. 

Bob Rountree:
Yep. Yeah, I’ve heard people talking about James Nestor’s book. I don’t remember the full title. Something like The Importance of Breathing, et cetera. So the breath is pretty important, and most people don’t breathe deeply enough. It’s something you really need to practice. When I go hiking to places like this, which is one of my favorite lakes to hike, I often end up at 11,000 feet. I do this during the summers here in beautiful Colorado, and I make it a point when I’m hiking to breathe slow and deep, slow and deep, because the high shallow breathing is not really getting deep into the lungs. It’s an important point, the lungs, because if you look at risk factors for certain autoimmune diseases like rheumatoid arthritis, the number one risk factor is cigarette smoking. Cigarettes.  

So we’ve taught for years, it’s leaky gut. The problem starts in the gut, but actually cigarette smoking is a higher risk factor than bad diet. And then you’ve got to put right next to cigarette smoking, air pollution, because we know that if you live in New Delhi or a city with really bad air, that’s equivalent to smoking a pack of cigarettes a day. Well, why is that? Because if you’re breathing in these toxins, they’re right there in the mucosa of the lungs. They start interacting with the immune system, and that sets into motion this whole cascade of events that can lead to systemic disease. So breathing in more deeply, breathing in clean air, getting a purifier if necessary, as I said, not jogging on the side of a highway, which I see people doing. All of those things are really important for maintaining overall health. And so not only are you breathing in good stuff, but if you’re breathing deeply, it allows you to eliminate through your respiratory mucosa. 

Kalea Wattles:
As we’re making all these connections between our toxic exposures and chronic disease, I can’t miss the opportunity to talk to you about inflammation because I love your lectures about inflammation. I’ve heard you say, “we’re inflammologists.” 

Bob Rountree:
Inflammologists! 

Kalea Wattles:
And I love that. Yes, we’re inflammologists. So when I’m seeing patients and they have chronic inflammation, sometimes I try to go on an inflammation hunt, but it’s hard. Is it, do they have something going on in their gut? Are they insulin resistant? Is it oxidative stress? Do they have periodontal disease? It can be really frustrating. At what point do we start to suspect that there’s a toxic exposure going on that’s driving that inflammation? 

Bob Rountree:
Well, I think it’s good to have that suspicion from the very beginning. It’s just often less easy to identify the specific trigger. So our mnemonic is the food toxins, stress, microbes. Let’s start with that. Let’s look for the obvious sources of inflammation. As you said, look at the gums, look at the gut, look at the obvious environmental sources. A lot of times you don’t find anything really obvious, and when you don’t find something obvious, that’s when you start going to the next level and saying, well, maybe this person’s got some smoldering inflammation that’s going on for no clear reason. And then you think total toxic load. Well, it’s not going to ever hurt to put attention on lowering the toxic load, not going to hurt. 

Kalea Wattles:
So, in a patient like that, if we have this healthy suspicion, do we go and do some testing or do we just say, everyone’s going to benefit from addressing your detox pathways, let’s just clean things up and see how your inflammation responds. 

Bob Rountree:
Well, I start there. To be honest, the testing has gotten increasingly difficult. We used to have several labs that we could turn to that would measure a wide range of organic chemicals. And now there’s not many labs that are doing that testing anymore. And why? I think either they just weren’t making enough money from it, or maybe, and this is total speculation, maybe there was a little pressure from industry to say, hey, it’s better that you don’t test for this. Why do I say that? Because there was a national adipose tissue survey that was done year after year, finally stopped about 25 years ago. So the government was funding this, and they were basically doing fat biopsies to people all over the country, and they were finding that levels of organic chemicals, synthetic toxicants were going up every year. And at some point, they just said, well, we’re not doing this anymore. If you don’t look for it, you’re not going to find it. 

So, the consequence for us as practitioners is, other than measuring heavy metals, which is pretty easy, and a few labs that do testing for PFAS, which is the up and coming thing, it’s not very easy to do specific measurements, what we call markers of direct exposure. So to measure DDT levels, not very easy. To measure atrazine levels, not easy. To measure mercury, we can do that, but the heavy metals are only a small part of what’s going on. It’s like, yeah, it’s easy to do the mercury, cadmium, lead, arsenic, so I do that. But the rest of the testing, I don’t do that much any more just because it’s gotten difficult. Now, what you can do is measure biomarkers of effect. That is easy, and I do that every day. 

And by biomarkers of effect, I mean things like elevated liver enzymes, huge percentage of people with elevated liver enzymes, the ALT, AST, GGT, huge percentage of them don’t have a known cause. I saw somebody like this just two weeks ago. We did a routine lab screen, just part of her annual physical, and her liver enzymes are up. Okay, what could this be? Could it be hepatitis B or C? Let’s check for that, they’re negative. She eats organic food, clean diet, retest it, the levels are coming down. I give her some things like milk thistle, n-acetylcysteine, curcumin. Let’s support your liver. Let’s have you eat some broccoli sprouts on a regular basis. So let’s up your supplement intake because she’s already eating a healthy diet. So I think it’s a pretty fair assumption she got exposed to some kind of toxin in her environment. We may never know what it is. And I could have her spend a lot of money trying to track that down. 

There are labs that do testing for PCBs, but it’s only a fraction of what’s out there. There’s 87,000 chemicals that are registered in the United States, 87,000 chemicals. So there’s a lot of things you can look for, and it can be a wild goose chase. I’m not saying never do that, but unless you’re in a scenario where, let’s say you’re in an area where you have a lot of patients coming in with really similar, weird, serious complaints, and you think some company must be dumping chemicals into the water, that has happened. If you see that, then you’ve got a contract with a forensic lab and actually start measuring all these people to find out if there’s a connection. So with an individual patient, it’s harder to track that down. But when you’ve got groups of patients with similar collections of symptoms, then that’s a slightly different scenario. 

Kalea Wattles:
Well, on this topic of liver enzymes, I’ve had patients come to me and they’ve had an annual exam with their primary care doc, and their liver enzymes are elevated, and their doc might say, liver enzymes go up and down. I’m not really worried about this until it’s twice the reference range. What is up with that? 

Bob Rountree:
That’s because they don’t know what to do. They’ve read in the news, well, dietary supplements are worthless, they don’t do anything, which conveniently ignores tens of thousands of articles that have been written about what certain botanical medicines can do, what certain nutrients can do. So they’re going to discount the value of n-acetylcysteine or milk thistle extract or curcumin because they just don’t think that way. So there’s nothing they can do. The person doesn’t have hepatitis B or C. What else can you do? What I’ve sometimes seen docs like that do, the mainstream docs, is go, it must be the supplements. There must be… 

 Kalea Wattles:
The supplements are raising the liver enzymes. Yeah. 

 Bob Rountree:
Yeah, your enzymes are up, it was probably a supplement. I’ve seen people on multiple pharmaceuticals, three or four drugs and a couple of supplements that get elevated liver enzymes, and the doctor says, “Yeah, it’s your supplements.” One person in particular, I’m thinking, she comes in, her enzymes are up, and I go, and the doc says, just stop your supplements. And I go, why don’t you stop the venlafaxine? And she did, and her enzymes came right down. So the mainstream docs, they’re not going to think of the drugs that they prescribed as a culprit. They’re going to think, well, it might’ve been one of the vitamins they’re taking or the botanicals they’re taking. But yeah, there’s botanicals out there that are problematic, they’re usually from obscure companies that sell on the internet, et cetera, not the well-known companies that mostly work with professionals. 

 So the docs don’t do anything because they don’t know what to do, or their assumptions are that it’s something outside of their realm that’s causing the problem. And God forbid if you said it’s some environmental toxin, most docs are not trained in how to do a workup. Now, this patient I told you about that, if her enzymes had stayed up, that’s somebody that I might’ve started doing a more extensive search. I might’ve measured her PFAS levels. So those options are there, but they’re third tier, they’re third tier, they’re legitimate, but they’re third tier. 

 Kalea Wattles:
It’s time for functional medicine to shine in that scenario, it’s our time to shine. 

Bob Rountree:
A huge amount to offer there. 

 Kalea Wattles:
Well, as we look to the future, is there any research that could happen in the field of environmental toxicology that would help you treat your patients? Is there something you’re hoping someone will study to inform your practice? 

Bob Rountree:
I would love to see more studies on which specific strategies, and I mean precise strategies, which precise strategies lower the total toxic load, right? So for example, there’s a chemical called olestra that I’m sure you’ve heard of, right? 

 Kalea Wattles:
Yeah. 

 Bob Rountree:
It’s a fake fat. It’s like polyester sucrose or something. I don’t remember the exact chemical structure, but they put it in potato chips. I think it’s still on the market, right? 

 Kalea Wattles:
I’m not sure because of all the GI symptoms we had. 

 Bob Rountree:
Yeah, it can cause bad gas, bloating, et cetera. But they’ve done some interesting studies showing that you lower dioxin levels with olestra, so it actually pulls… Yeah. So to the company’s credit, I don’t remember who makes it. Maybe it was Procter & Gamble to one of the big food companies. I actually did I think at least three studies showing that olestra can lower the toxic load of dioxin, and presumably that means other organochlorines. I would love to see more of that kind of research. There’s research on chlorella green algae showing that you can lower dioxin levels and heavy metal levels. We need more of that kind of research. Number of years ago, there were studies done on the combination of saunas and niacin, and they did fat biopsies before and after, and sure enough, the saunas and the niacin lowered the total toxic load. So we’ve got a lot of interventions. 

 There’s all kinds of books on detoxification. There’s all kinds of ideas about how to do it, but mostly what we’re doing is based on piecing together a lot of theoretical data. So we know that if people eat broccoli sprouts every day, then it increases their urinary excretion of all kinds of toxins. It’d be nice to take that to the next level and saying, okay, what happens if we actually do some of these sophisticated tests where we measure a thousand different toxins in a person’s synthetic toxicants, heavy metals, et cetera, and just see what changes to expect. Now, I’m sure the pushback would be, well, everyone’s different. So it’s the logistics of that are complicated, but we need that. You said, looking to the future, in the future, these toxins are not going to go away. There’s a reason they call PFAS forever chemicals. They’re going to be with us forever, and they seem to be increasing. 

 So that means we’ve got one of two choices. We can either just give up and keel over and say, there’s nothing we can do, or we can get proactive and start studying this scientifically. We’re never going to get anywhere if we put our head in the sand and say, oh, this is an overwhelming problem, we can’t even deal with it. But I think what we’re proposing in functional medicine is we’re saying, let’s respond, let’s be resilient about it, let’s think about it. Let’s not give up or shrug or be overwhelmed. Let’s systematically start saying, well, what makes a difference? Does calcium-D-glucarate lower the xenoestrogen load? We have reason to think that it does that. But we need more studies. There’s preliminary studies, there’s lots of studies on all the things that we recommend in functional medicine. There’s in vitro studies, there’s animal studies. What we don’t have is larger human trials. Maybe we can’t do a trial with 10,000 people in it, but we could do a trial with a couple of dozen and see what the effect is. 

 Kalea Wattles:
Well, we know that you’ll keep your eye on the research and you’ll teach us everything that you learned. 

 Bob Rountree:
I’ll keep imploring. Especially the people that are taking our training now that still have the energy to go out there and start designing clinical trials, I implore them to go out and do that. 

 Kalea Wattles:
Right. That’s the call to action. Dr. Rountree, thank you so much for being with us today and sharing all these insights of how we can remain resilient in a world of toxic exposures. It’s always a pleasure to chat with you Thank you so much for your time. 

Bob Rountree:
You bet. My pleasure. 

Kalea Wattles:
To join the conversation on this topic, visit IFM’s pages on Facebook and Instagram. For more information about functional medicine, visit IFM.org.