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Guest Bio:

Joseph Pizzorno, ND, is a transformational leader in medicine. As founding president of Bastyr University in 1978, he coined the term “science-based natural medicine,” which set the foundation for Bastyr to become the first accredited institution in this field anywhere in the world and validated that medicine that promotes health rather than just treats disease could be credibly taught, researched, and practiced. A naturopathic physician, educator, researcher, and expert spokesman, Dr. Pizzorno is editor-in-chief of PubMed-indexed IMCJ, founding board member of IFM, founding board member of American Herbal Pharmacopoeia, and a member of the science boards of the Hecht Foundation, Gateway for Cancer Research, and Bioclinic Naturals. He leads multiphase research studies that aim to assess the efficacy of detoxification for the reversal of the diabetes epidemic. If successful, they will change the standard of care not just for diabetes but for the many other chronic diseases where toxins are major contributors.

Transcript

Kalea Wattles, ND, IFMCP:
In the modern world, everyone is exposed to a mixture of chemical compounds daily, from household toxicants to ambient air pollution to food-based toxicant exposures. Trace metallic compounds in seafood, pesticide residues in fruits and vegetables, and hormones found in dairy products may all contribute to the accumulation of toxins in the gut microbiome. And they may have downstream implications for a patient’s overall health. Toxic exposures and total toxic burden are vital considerations during the clinical assessment for chronic disease.

Joseph Pizzorno
So we’re looking at the diet as a source of toxins. What we’ve done is not only have we put toxins into the diet, we’ve removed from the diet nutrients we need to protect ourselves from the toxins. So is it any wonder we have the highest burden of chronic disease in every age group ever in human history?

Kalea Wattles
On this episode of Pathways to Well-Being, we welcome renowned clinician, researcher, and thought leader Dr. Joseph Pizzorno to discuss the impact of toxins on gut health and how to identify clinical indicators of toxic overload. Welcome to the show, Dr. Pizzorno.

Joseph Pizzorno
Well, thank you. I’m very much looking forward to chatting with you today.

Kalea Wattles
Well, as a fellow naturopathic doctor and at one time a naturopathic student, I’ve had the privilege of learning from you for over 15 years. And you’ve taught so many of us the importance of assessing exposures to environmental toxicants. We know that those cumulative exposures can contribute to systemic inflammation and immune dysfunction and endocrine disruption. But I think as a clinician, that’s why it’s so challenging because this could pop up anywhere. So taking a macro view of this issue, will you describe to us some of the hallmark symptoms that you’re looking for that would prompt a clinician to say, wow, I really need to dig a little deeper here?

Joseph Pizzorno
And that’s the key question. I obviously have been studying this for a long time, and not only have I been looking at what these toxins do to the body to cause disease, but how do you recognize them as early as possible? I think that’s the key factor. So when I think about that, it turns out there’s kind of three different ways for clinicians to look at toxins because our population varies quite a lot in terms of their susceptibility to toxins. So one group I talk about are what I call the yellow canaries. So this is a small portion of the population, maybe 5%, who are way more susceptible to environmental toxins than everybody else. So in many ways, the environmental medicine community has focused on those people because they’re so seriously damaged, and for good reason. So as I was working with the environmental medicine community, I started realizing, well, wait a minute. Well, we have these people who are clearly highly damaged by the toxins. There’s a lot more people being damaged by toxins. As a matter of fact, we now suffer the highest burden of chronic disease in every age group ever in human history. We now suffer from diabetes. When I was in naturopathic medical school half a century ago, diabetes affected about 1% of the population. I remember being so excited when I saw my first diabetic patient in my practice after six months. I was a really busy doctor, so it wasn’t like I didn’t have many patients. It just wasn’t much diabetes. Now, the latest numbers is that 15% of adults in the United States have diabetes already, and one half of people are projected to get diabetes because one half of people are already insulin insensitive. So that was the first disease I looked at because it increased so much. Why is that happening? So I looked at, well, people are consuming too much sugar, and obviously, diabetes is loss of sugar control. But when you look at the research on sugar consumption, it peaked about 50 years before the diabetes epidemic. So while sugar may be contributing to it, it does not explain it. And then you look at the research on obesity. And obese people are way more, by the way, I’ll get to your question in a second, okay, but I want to kind of lay out the foundation. So anyway, obese people, way more diabetes. But then I remember in a lecture I heard from Jeff [Bland] when he was still doing his monthly functional medicine updates, and I wish he still was, but not anymore. He interviewed a researcher out of South Korea by the name of Duk-Hee Lee, and she showed that obese people at the bottom 20% of the bioload of environmental toxins have no increased incidence of diabetes. So everybody who’s obese gets diabetes unless their body’s not full of chemicals. And what are the researchers calling these chemicals? The ‘diabetogens’ and ‘obesogens.’ So then when I started looking at the research on environmental toxins and diabetes, all these toxins, as toxins go up, the diabetes, toxin after toxin after toxin induces diabetes. So that really gets to, well, what’s a clinician going to do? So number one, you’ve got those people who are the yellow canaries, that people have chronic diseases that are associated with environmental toxins like diabetes. And then you got the third category where the disease hasn’t shown up yet, but early symptoms are starting to show up. And the problem with so many of these environmental toxins is that when you look at the research, and you look at the correlation between the dosage and the disease, up until about the age of 45, there are very few correlations. Because up to about the age of 45, our body is able to adapt to the toxins. But the problem is, we are still getting damage to our DNA. And while we’re able to get rid of many of the toxins, there’s two kinds of toxins. You got the toxins, which you think by metals, chemicals, but better way of looking at is persistent versus non-persistent. So non-persistent toxins, the body is actually able to get rid of, and they get rid of the body within a few days, get out of the body within a few days. But the persistent toxins, some of these take months to years, even decades to get out of the body. So what happens, even though they’re not being highly symptomatic, although there’s some symptoms that we’ll talk about in a moment, the damage is accumulating, and the bioload of the toxins is accumulating, and by age 45, now it all blows up, and I start seeing all this disease. So the question is, what are the earliest symptoms of toxicity? So the moment I say to people, why wait for symptoms, why wait for disease? Stop the toxins, stop being exposed to the toxins. But we’re looking at the symptoms in general. The first ones that are affected is the immune system. Not surprising because as you know, the immune system cells turn over very, very fast. So if there’s a nutritional deficiency or a toxin in the body, they’re damaged first. We start seeing increased susceptibility to infections, and inexplicably, or not inexplicably, but you might say illogically, increase autoimmune disease as well. So what’s happened is not only is the immune system not working as well as it should, it starts making a lot more mistakes. That’s the early signs. Second early sign is neurological. So there are a number of tests you can run online that will test for neurological function. One of the first things that goes down is you start losing some neurological function without realizing it because we have a lot of reserve capacity. But that reserve capacity is going down. And the third area that is most common is endocrine disruption. And so you have a woman who’s normally a 28-day cycle, just like it’s normal for centuries. All of a sudden the cycles vary a bunch. What’s going on here? And along with that endocrine dysfunction, you then start seeing fatigue as well. But again, realize you don’t start seeing those things until there’s enough damage to start, the body starts showing symptoms. Now there’s one final one I’m going to bring up. And so with a little bit of trepidation, because I just dug it up. Now when I’m lecturing to doctors literally all over the world about environmental toxins, the worst toxin by far is arsenic, without question. And it turns out there’s an early sign of arsenic toxicity and that is slight hyperkeratosis. So if have people rub their hands together, if they’re at all rough, people think, I need more oil or I need lotion. Actually, it’s one of the very first signs of arsenic toxicity. Okay, so long answer to your short question.

Kalea Wattles
It’s very helpful though. My clinician brain is latching on to all of this. I want to zone in on the autoimmunity piece because I think a lot of us, I’m in primary care, a lot of primary care docs listening will see quite a lot of autoimmunity. So let me give you an example. Let’s say we have someone who we do their work up and they have thyroid antibodies. We do some investigation. We find there’s environmental exposures. We work to reduce those exposures, work to help them with their biotransformation. Are we going to see a reversal and see those antibodies lower? I mean, is this something we can unwind once we get rid of the exposure?

Joseph Pizzorno
Absolutely. Here’s something that’s really important. They showed in the laboratory that with people having autoimmune disease, and by the way, I’ve always thought to myself, why would our smart bodies start becoming autoimmune and start fighting themselves? I mean, if we had that function in our body, we’d have ceased to exist as a species a long time ago. Why do all of a sudden we see all this autoimmune disease? Because as you know, diseases which were rare 50 years ago are now really common around autoimmune disease. They show in the laboratory, the body having autoimmune disease is not reacting to normal tissues. It’s reacting to normal tissues that have become abnormal because metals and chemicals from the environment have bound to the normal tissues, to the enzymes and such, and they’re now abnormal and not working properly. So our smart body just said, okay, let’s get rid of that stuff. But the problem is since we’re not stopping the toxic exposure, the body can’t get rid of it. We just keep producing more and more of these abnormal tissues in the body. So the body keeps on trying to get rid of them. Now at some point, the self-regulating mechanisms start to break down. Now we start getting broader autoimmune reactions where even normal tissues are starting to get affected, but it’s not because the body made a mistake and started to alter normal tissue because the normal tissues got wrecked with all the environmental toxins.

Kalea Wattles
Indeed. I would love your advice on discovering the sources of exposure because I find this to be really challenging to pinpoint where the exposures are coming from. Do we have to know where it’s coming from in order to treat it? Or sometimes is it really like, no one can figure this out, but let’s do our best to support your body regardless?

Joseph Pizzorno
Excellent question. So that’s one of the arguments that Dr. Walter Crinnion and I had when we were co-authoring our textbook, Clinical Environmental Medicine. He said very clearly, well, an elevated toxin doesn’t mean anything unless you know where it’s coming from and know what toxin is happening in the body. My thought was, I don’t care where it’s coming from other than to get rid of it. And I don’t care whether it shows symptoms yet or not. If it’s in the body, it’s going to cause damage, period. I mean, that’s what they do. They’re poisons. So I’ve recognized that testing for every environmental toxin, while it’s a really good idea, tends to be somewhat difficult to do and expensive. So there’s some simple things we can do to see, is my patient toxic? I want to be clear: this works for about 90% of people. But for people who are yellow canaries, this strategy does not work. And that is, I’m testing for a simple compound in the blood. It’s an enzyme called GGTP. So in the past, GGTP, also known as GGT, was measured to determine if a person had hepatitis. Because it’s an enzyme in the liver and when the liver is inflamed, it leaks into the blood. You measure in the blood cell, and the person has hepatitis. Now it’s been replaced with other enzymes that are more accurate because GGT was reacting to other things as well than just hepatitis. What was it reacting to? Well, you might ask yourself, well, what does GGT do in the liver? It recycles glutathione. Glutathione is our main way of protection against these environmental toxins, both by protection from oxidative damage, virtually every environmental toxin increases oxidative damage. So you’ve got to use glutathione to get rid of the oxidative damage and, of course, by the environment and everything else. But our smart bodies, exposed to toxins, let’s get more glutathione, increased GGTP. So it increases in proportion to the toxic load. So I find when I’m trying to assess patients for the toxic load and the response to my interventions, I monitor the GGTP. And if I’m going in the right direction, it’s going down. And if it’s not going in the right direction, if they’re not getting rid of the toxins or new toxins have come in or they say, well, I’m not going to use this health and beauty product anymore because it’s toxic, I’m going to use this one instead. Sometimes it’s more toxic. My wife just had that experience. So I monitor it, make sure it goes down. Anyway, as it goes down, patients respond, report feeling better. Another test you can run, and this one looks like it works for everybody, including the yellow canaries, is to look at urinary A2HTG. So A2HTG is basically a DNA breakdown product that shows up in the urine. So when our DNA gets damaged from toxins like arsenic, for example, our smart bodies repair the DNA as best they can. It’s not perfect, but it’s really good, okay? And then those damaged DNA pieces end up in the urine. So another way to monitor how well your patient is doing is measure their A2HTG, and by the way, Doctor’s Data runs it, a number of labs do as well. Doctor’s Data is running them because I asked them to. And so you’ll see, A2H2G goes down as the toxic load goes down. So that’s kind of the least expensive way to do it. The disadvantage is, well, it tells you the person’s toxic, it doesn’t tell what the toxin is. So we want to find what toxin people have. The best method we have, of course, is a tissue biopsy. So I want to know if my patient is suffering from mercury toxicity, because brain dysfunction, the first thing you see with mercury toxicity, well, the best thing to do is put a needle in a person’s head and get some brain matter and see where mercury is there. Patients don’t want to do that, okay, for good reason. So we have to use indirect measures. So the next best measure is going to be blood. Blood turns out to be pretty inconvenient. So most measures are done in urine. The problem with the urine is you’re measuring what the body is getting rid of, and many times, you’re actually measuring the breakdown products, not the actual toxin itself. Nonetheless, it’s what’s most readily available and most cost effective. So I work with Doctor’s Data to look at urinary metals, including arsenic. Arsenic is not technically metal, but with arsenic, I go to them for the toxins in the urine. And then I work with Mosaic Laboratory for the chemical toxins. And the reason I work with Mosaic is number one, I did a consulting relationship with them about a year ago. I told them what tests to run. So I run a bunch of the tests I want them to run. That’s why I recommend them. So then you get what’s in the urine. And you’re going to be surprised, you’ll be surprised how much toxicity you find in your patients even before they show symptoms.

Kalea Wattles
So many follow-up questions I have. So let’s say you do the testing. You couldn’t figure out where the exposure was coming from, but you did some testing. And let’s say you did a panel looking at all these different chemicals and you saw what they were exposed to. Can you do reverse investigation and say, okay, now we see your shampoo had all these chemicals. Let’s remove that.

Joseph Pizzorno
Yeah, so if you didn’t look at the particular toxin, you say, okay, well, here’s where they come from. You just work your way through the list. So for example, somebody’s high in mercury. First thing you check is, well, how much fish are you eating? How many silver fillings do you have in your mouth? Now, younger people like yourself, they’re not using mercury fillings anymore. But most people don’t realize that the so-called silver fillings are actually 55% mercury. And for every filling, it leaks into the body one microgram per day. I say, one microgram is not very much. Well, if you have 10 fillings, that’s 10 micrograms per day. And guess what? That’s where you get the threshold for all this disease. So anyway, so okay, mercury, fish, fillings, those are your first ones for sure. Arsenic. Well, first you got to check for water. Most people don’t realize that 10% of the public water supplies in the United States have arsenic levels above the WHO-identified threshold for increased disease. And by way, the WHO threshold is too high, as far as I’m concerned, but that’s the threshold. And half the public water supplies in the United States have not reported their arsenic levels. It’s a $50 test. Why haven’t they reported their arsenic? You can get paranoid if you want. Now, you might say, well, I’m on a private well. Folks, if you’re on a private well, you’ve got to test your arsenic levels because many private wells in the United States have arsenic levels higher than what is found in India and Bangladesh. Everybody knows arsenic toxicity is huge in India and Bangladesh. Well, guess what? Look in Maine, and here in Washington State where I live, there are some areas in Washington State that are just as bad as the worst places in Bangladesh. So you got to check water. And then when looking at arsenic, next area is chicken. Now I thought that when the FDA, USDA said, “Okay, you can’t do this anymore, you can’t keep giving arsenic compounds to chickens” that the arsenic levels in chicken would go down. Interestingly enough, they’ve not gone down very much at all. Chicken starts to be a significant source of arsenic. And the next major one is going to be rice. With rice, basically, if there’s arsenic in the water where the rice is being grown, the rice very efficiently picks up the arsenic. Toxin by toxin, you can start to look at them. For example, it’s cadmium. It’s almost always a smoker. My Corporate Wellness Program in Canada where I assessed toxic load in 4,500 oil field workers, I could immediately determine which ones were the smokers because their levels were twice as high as the non-smokers. It was so very, very obvious.

Kalea Wattles
Wow. So if we do some labs on our patient, maybe they have multi-system dysfunction and we’re thinking that there’s an environmental exposure component. What if it comes back, their GGTP is normal, their AST and ALT look good? Can we reasonably assume that they are handling their environmental exposures well or we should still go looking even though those labs were normal?

Joseph Pizzorno
Yeah, unfortunately, I don’t have a good handle on this, so I can’t give enough advice. But I think between 5 and 10% of people, they’re in the yellow canary category. They don’t have the genetics to operate GGT when they’re exposed to toxins. So exposed to toxins, rather than glutathione going up to protect them, it doesn’t and they get more damage. So if you get somebody where you’ve got an exposure and you think there’s some symptoms, I don’t care what the GGT says, get rid of the toxins. But check the urinary A2HDG. That’s going to show up.

Kalea Wattles
Okay, that’ll show up reasonably. All right, so you mentioned that different people have different levels of sensitivity and susceptibility. And I want to bring this conversation into the health of the gut because of course we love to talk about what’s going on in the gut. And I’m wondering if the health and the diversity and the resiliency of our gut microbiome plays into our susceptibility to environmental exposures. And to say this another way, if someone has a really strong microbiome, are they less likely to be affected by these exposures that are inevitable, or is that just wishful thinking on my end?

Joseph Pizzorno
Okay, so this is a common question I get. Well, how do the toxins damage the gut microbiome? And so I started looking. Every toxin I looked at changed the microbiome in unhealthy ways. After I saw enough studies, I said, I don’t care about that anymore. It’s the toxin. Now having said that, though, it turns out a healthy gut is better at protection from arsenic. And the one area I looked at turned out to be arsenic. And it’s probably not surprising since as a species, we’re exposed to arsenic. The half-life of arsenic in a human who’s able to produce aqueous methylation, and we’ll talk about that in a second, the half-life is only two to four days. So stop exposure, arsenic all goes away. As we’re evolving as a species, we drink water and add arsenic in it. We eat fish, add arsenic in it. Okay, we’ve got to get rid of it. So as I was looking at the gut microbiome, I found that there are some species in the gut, particularly Lactobacillus and Bifidobacteria, that detox the arsenic in the gut. Okay, I want to say, that’s interesting. The all-time naturopathic adage, I hope you were taught this as a student, disease begins in the gut. I was taught that as a student 50 years ago. And it turns out that’s true. Something like arsenic, if you’ve been taking a bunch of antibiotics and you’ve lost all your good healthy Lactobacillus and Bifidobacteria, guess what, you can’t detoxify arsenic as well. So I have not got any further with any other toxins, just when I saw that I said, okay, very clear you’ve got to improve [the gut] and get rid of toxins. But you know something, we naturopaths have learned so much about: you got to restore healthy gut.

Kalea Wattles
Gotta restore healthy gut. Well, if it comforts you, I’ll have you know I did learn that in school. So the tradition still persists. You mentioned a methylation component, and I don’t want to forget to loop back to that. I think a lot of our listeners will be really interested to hear what you have.

Joseph Pizzorno
Very important. So it turns out the way we get rid of arsenic is through a two-step methylation process. In some ways, similar to what we do in the liver with phase one and phase two. So we basically methylate the arsenic. And we produce, in the first stage, called MMA, which is monomethylarsonic acid, but MMA for short. Monomethylarsonic is easier to say. Interestingly enough, it’s eight times as toxic as elemental arsenic. We then do a second methylation to produce something called DMA for dimethylarsinic acid. I probably have it backwards. Dimethylarsinic for short, which is 400 times less toxic than elemental arsenic. So as long as a person has adequate methylation, that system is running. But how about a person with high levels of homocysteine? They don’t have the methylation groups. And you look at the arsenic toxicity, and they have more arsenic toxicity. But there’s another factor, which is pretty significant. It turns out that there are some genetic variations in how fast people do the first step and how fast people do the second step. And some people do the first step really fast, about 20% of the population. And some people do the second stage very slow, about 5% of the population. So it turns out that about 1% of the population has both the fast version for phase one first methylation, slow version for the second methylation, and guess what? They get way more toxic from arsenic. So another example why these foundational things about health are maintaining a healthy homocysteine level; where you may think about it for cardiovascular disease, but it also helps so much of the arsenic toxicity. What disease do you get when people have elevated arsenic? Cancer, heart disease, stroke, diabetes. Well, homocysteine, elevated homocysteine increases all those as well. Could it be that the mechanism is not so much the methylation problem, but it’s actually that more damage from the arsenic? One third of Americans have arsenic levels high enough that are known to induce disease in humans. One third of people. So you add the number of people with elevated homocysteine, and guess what? More disease from arsenic.

Kalea Wattles
You’re reminding me. I have this subset of patients who have, I guess what we would call histamine intolerance. They have a lot of gut dysfunctions going on, methylation problems. And with those patients, I sometimes wonder, should we really just be looking for environmental toxicants? Because there’s clearly something going on that is preventing them from doing all the things that they need to do in their gut.

Joseph Pizzorno
Yeah, another great question. So I’m not in private practice anymore. But having said that, I still do some concierge medicine because people still want my help, and family, friends, or business associates. Okay, fine. I’ll do what I can. So what I do is I say to them, okay, well, tell me what disease you’ve got you can’t fix. But I don’t care too much about the disease. I’m going to check your nutritional status. I’m going to check your toxic status. I’m going to check your genomics. And we’ll use that to get your nutrition optimal, get all the toxins out of your body and teach you a bit more about how to eat properly, and we’ll see what’s left over. And so many times these difficult diseases, what we don’t know what the cure is, is just help the body get better and allow those things to start reversing themselves without us having to address them directly because we’re supporting the health of the body.

Kalea Wattles
Right. I think many of us have had these patients where it’s clear they need some nutritional support, and we offer that. We do what we think is right. We give them the foods and the nutrition and perhaps the supplements that we think are right, and they’re not getting better. Is there a connection between toxicant exposure and nutrient absorption in the gut? I mean, is this a connection that we can make?

Joseph Pizzorno
Yes, yes, yes. There’s a huge amount of research in the plant kingdom, and there’s a huge amount of research with humans. Let me start with the plants. I remember way back, this is 1977. I just graduated two years before, and I was in private practice, and I intentionally was only practicing three days a week. Now they were long days. I was doing that for two reasons. Number one is I was doing natural childbirth. So I get called off to do a home birth. So I had to leave some flexibility for that. But the other part was so that I could read medical literature. So I read this really interesting study. They’re looking at spinach plants. And they’re asking this question. Does the mineral content of the soil affect what’s in the plants? So they did an interesting experiment. They looked at the zinc content of spinach and the cadmium content of spinach. Then they grew the spinach with normal soil with plenty of zinc in it. Then they did with soil with not enough zinc in it. They put it so with high levels of cadmium and then high levels of cadmium with not enough zinc. See what would happen. It was very clear. There’s only zinc there. It absorbed the zinc very efficiently. If there’s no zinc there, whatever cadmium is in the soil, it’s going to absorb that if it can because the zinc’s not there. But if there’s a lot of cadmium in the soil, it doesn’t matter if there’s zinc in there. It’ll absorb the cadmium. So it turns out many of the nutrients we’re looking at we look at the absorption sites in the gut, they are competed with by many of the environmental toxins. So as the metals in the environment go up, or in our food go up, our ability to absorb the nutrients, the mineral goes down as well. But there’s a bigger issue. And this is something I’m actually doing a lot of study right now around cancer, and if you’re interested, by the way, you know, I’m the editor of a journal called IMCJ or Integrative Medicine: A Clinician’s Journal, and we’re in PubMed. So I now have about 75 editorials in PubMed where I explore these various areas. So I’ve looked at toxins. I just finished my second editorial on arsenic. I’ve been looking at these things a lot. The environmental toxins being a problem. So I recommend that people look at this information. But having said that, it’s very, very clear that the one I want to, in particular I want to mention is a lecture I published maybe three years ago, tongue-in cheek, “Unimportant molecules” is the name of the article. So what I did is I looked at, so when we’re doing our nutrition research, when was most of the core nutrition research done? Done about 100 years ago. Now think back 100 years ago about our understanding of physiology, the laboratory equipment we had available to us. It was pretty limited. So pretty much all we’re able to do is look at animals and try to remove things from their diet to figure out what makes them die. Now with humans, we also have some pandemics of nutritional deficiencies that we saw some things there like berberine and the lack of vitamin C in the British sailors getting scurvy. There’s some things we recognize, but the vast majority came from animal research. So it’s based on what in food is necessary to keep animals alive. We found these vitamins, we found these minerals, fatty acids, amino acids, the atom altogether, 43. 43 molecules and elements. So we decide that’s all that’s important in food because it’s what’s necessary for life. So when we started growing foods chemically rather than organically, as long as those 43 were maintained reasonably well, and they are maintained reasonably well in chemically grown foods, we thought, well, the food is just fine. You got to start asking yourself the question, how many molecules are there in food? We decided only 43 of them were important, molecules and elements. But how many were actually in food? 50,000. So we decided that 99.9% of the molecules in food were not important. Well, let’s talk about those molecules. Have you heard about phytonutrients and this latest miracle drink from this special fruit down in South America, which has all these great molecules causing health? All these things are promoting people’s health. These molecules should have been in the food supply to begin with. It’s going back to supply. Like arsenic, for example. So that enzyme that detoxifies arsenic, guess what? Flavonoids in the diet make it work better. But the flavonoids aren’t in the diet anymore. So now we’re more toxic to arsenic because we’re eating chemical-grown foods. I’ve been looking right now at cancer, and it turns out that many of the mechanisms cancer depend upon for them to take over the mitochondria to distort the immune system, under normal circumstances, we’re protected from those functions by flavonoids and carotenoids in the diet. They’re not in the diet anymore. So we’re looking at the diet as a source of toxins. What we’ve done is not only have we put toxins into the diet, we’ve removed from the diet nutrients we need to protect ourselves from the toxins. So is it any wonder we have the highest burden of chronic disease in every age group ever in human history? One of the fun parts about the work that I do is so many times I’d look at age-old naturopathic adages about what’s necessary for people to be healthy. And time after time, they got it right. I mean, even though they didn’t have the high level of technology we have today, those forbearers of our medicine were very good clinicians that could see what was happening. And they found that people who ate real food and avoided toxins for either intentional or accidental, they’re healthier. Pure and simple.

Kalea Wattles
I’m just wondering, as we talk about how to help someone heal when they’ve had these environmental exposures, sometimes it’s my clinician’s brain gets a little scared to push on these detox pathways in someone who already appears ill to me. Will you talk us through, how do we look at their other organ systems, their skin, their kidneys, to help us determine who’s the right candidate to do a detox protocol?

Joseph Pizzorno
Another great question. So I wrote the textbook for doctors, Clinical Environmental Medicine. I wrote for consumers a book called The Toxin Solution. And I state right at the very front, going on a detox program before you open up the organs of elimination is really dumb. Because why stir things up if you can’t get rid of them? So I say to people, first thing you got to do is you got to clean up your gut. Because now you have to have the right bacteria to your gut to help detoxify things. But if your gut’s unhealthy, it’s producing all these chemicals that go to the liver and overloads the liver having to detoxify the stuff from the gut that it shouldn’t have to detoxify. Clean up the gut first. Then we get the liver functioning properly. And then we work on the kidneys. Now, I’ve been doing this for decades. I only started doing the kidneys for the last 10 years because up until 10 years ago, I wasn’t seeing much trouble with the kidneys. Now you’ve got kidney dialysis centers all over the place. People’s kidneys are failing because of number one, the high toxic load, but number two, the high drug load, prescription drugs. Many prescription drugs, particularly the nostril anti-inflammatory drugs, are incredibly damaging to the kidneys. So then I had to develop a protocol, well, how do you restore the kidneys? And by the way, it works. What I’ve come up with works. So once I’ve done all that, now we start doing detoxification. And the best, wait, the first two weeks I teach people how to avoid toxins. There’s no point in opening up your [detox organs] to get rid of the toxins if we keep on putting toxins in. So we learn how to avoid toxins, prepare the body for detoxification, then I do detox. And my preference is by far, so I’m sweating. Sweating is very effective and great for every toxin I’ve looked at with one exception, that’s a big one. And the interesting thing about this, not only are we able to get rid of toxins, but many toxins that are very, very hard to get out of the body, we can sweat out pretty effectively. You may be wondering what toxin is not eliminated by sweating. The perfluorinates, they’re forever chemicals, the PFASs. Turns out they’re not in the sweat. So these are another man-made chemical, new to nature, we’ve never been exposed to fluorinated compounds before. We can’t get rid of them. They have half-lives in the body from typically two to seven years. They’re really hard to get rid of. In my fallback, the one I’ve used in so many patients successfully, sweating?

Kalea Wattles
Well, this is where I think my paranoia enters of, okay, I really have to be diligent about avoiding these chemicals because we don’t have any reliable ways to remove them.

Joseph Pizzorno
So actually, there’s one more thing I’m going to add to this because I think it’s going to help handle the question we’re to have. So sometimes we see patients that are so toxic, no matter what we do to them, even giving them vitamins, they get worse. There’s a trick for these patients, okay? And it comes from how we evolved as a species. And let’s look at mercury as an example because I actually have both animal data, and I got some limited human data on this. So every day, we secrete into the gut 1% of the bioload of mercury. That’s pretty good. You know, when we ate fish as we evolved as a species and we, well, you get some mercury there as well arsenic, well, let’s be able to get rid of it. It’s not great, okay, but we can get rid it. And then we reabsorb 95% of the mercury dumped into the gut back into the body through hepatic recirculation. So why were our smart bodies with all that energy, mainly glutathione, producing glutathione to get rid of the mercury and then just reabsorb the mercury? It’s because as we evolved as a species, we consumed 150 grams of fiber a day. Now we only consume 15 to 20 grams of fiber a day. So our bodies are expecting the fiber to be there to bind to the garbage the liver is getting rid of to get out of the body. If fiber’s not there, we reabsorb the stuff. So when somebody’s really toxic, the easiest thing I can do, not easiest, but pretty much the only thing I can do for them is increase the fiber in their diet so that what mechanisms are working, we’ll have a chance to get rid of the toxins rather than keep reabsorbing them.

Kalea Wattles
So you increase their dietary fiber and then you just, how do know you’re ready to move on? Do you try something and see if they feel worse and then you back it down?

Joseph Pizzorno
Yeah, it’s the main way is to trial and error and just be really slow, really careful. And because a lot of my first experience with environmental toxins with this Corporate Wellness Program I did in Canada where I had 4,500 oil field workers, when I found toxicity with them, since they weren’t my patients, I would see it like every two or three months in this program, I had to develop some really safe protocols for getting toxins out of people’s bodies. So they’re relatively slow, but they don’t have adverse reactions for people. And so I found over the time, you know, what I’m going to do is stop the exposure as much as I can and very gently, slowly get them out of the body. That’s what seems to work best for me.

Kalea Wattles
Along these lines, I have to ask you this. I have a fertility practice, and I’ve taken lots of courses from you on detoxing for fertility. And I think the question that always comes up in those courses is, can you help me create a timeline? How far in advance of when someone’s actively trying to conceive can I safely detox them so I’m not mobilizing all these toxins in early pregnancy?

Joseph Pizzorno
Yes, please. Great. Good thinking. So if it’s a woman, I’d like a year. If it’s a man, I’d like six months. Okay, so I, just pure and simple, they don’t want to hear that. I mean, people come to me. They don’t want to hear that. That said, all I can tell you is the best that I know. Some toxins are really easy to get rid of, but some of those persistent toxins are very hard to get rid of. And unfortunately, the research shows that the mother concentrates toxins in the fetus. Now, when I was in school 50 years ago, we were taught that the mother does everything she can to protect the fetus, gives the fetus the best nutrition, protects from all the toxins, things like that. Now it looks to me like Mother Nature says, you know, mother’s really important. I can produce a lot of fetuses, so let’s get rid of those fetuses, get rid of those toxins as quickly as possible. So things like PCBs, example, polychlorinated biphenyls, which you know are directly correlated with breast cancer, a major factor for breast cancer. Well, we know that when women breastfeed, it’s the most effective way to get rid of PCBs. So as one breastfeeds, the PCBs goes down and the breast cancer risk goes down. Where the PCB is going? They’re going to the poor babies.

Kalea Wattles
Okay, all right, so that’s very motivating to do some detox work before we’re actively trying to conceive.

Joseph Pizzorno
Absolutely. You want a baby with a good brain and functioning properly, you’ve got to get rid of toxins. Look at organophosphate pesticides, really commonly used in food today. When you look at the IQ of children born to women, the top 10% organophosphate body load compared to children born to women, the bottom 10% organophosphate body load, they have a seven-point drop in IQ in the women with the highest levels of organophosphates. Three studies have shown it. One of the studies followed the kids for seven years, and they never got the IQ back. So baby’s brains, the fetus’s brain can’t develop properly if there’s neurotoxins in the uterus damaging the range.

Kalea Wattles
Well, I think we are all taking a hard look at our lifestyle factors. I wanted to ask you, you talk about determinants of health sometimes as active or passive. And will you give us some examples of how these factors might increase our sensitivity or susceptibility to these exposures? And what should we be most aware of as we enter into our own detox protocols?

Joseph Pizzorno
Yes, thank you. I’m really glad you brought that question up. So I served on King County Board of Health for six years. And it was a great experience because I got a chance to really understand public health measures. So we’re not talking about active versus passive. We’re talking about how much we can change people’s behavior and how much can we change the environment so that behavior doesn’t matter. Now ultimately you want both. We can, independent of people’s behavior, make them less toxic. So for example, the water supplies. Too many of the public water supplies have too much toxins in them. So simple thing is decrease toxins in the water supply, you improve the health of the community without them having to make any kind of different change. Teaching farmers how to grow food with higher nutrition in them and less toxins is a passive thing we can do because no change in the person’s behavior, the food they’re eating is now safer rather than what it is right now, which is pretty bad…low nutrients, lots of toxins. So anyway, the idea is with the passive we do everything we can to make it, the world, safer for people without having to make choices. Now having said that, the world is really toxic, so people have to be actively engaged and protected.

Kalea Wattles
I’m glad you brought this topic up because I have a lot of patients who they start to feel scared to interact with the world. And we have to have this conversation about you have to breathe the air and drink water and eat food. So we’ll do everything we can, the things that we can control to minimize those exposures. But wouldn’t it be great if we had a world that wasn’t so scary and full of toxins?

Joseph Pizzorno
Yes, that’s something my wife and I are extremely conscious of. Number one is so many of our family and friends in our age group are dead, have major chronic disease, or they’re done with life. And so we say we don’t want that to happen to ourselves. And as I’ve looked at this research on toxins, we realize we’re being extremely careful about toxins. So what do we do? We only eat organic food if at all possible, and I grow as much of our own food as I can. That’s a big time commitment, but our food that we grow ourselves is so much better than what’s in the grocery store. I mean, obviously way better than the chemical grown foods, but it’s better than organic grown foods as well. And then we have a filter, and we filter all the water coming to the house. So not just drinking water, but the water we shower with or we bathe with is clean. And then we have a MERV 16 filter in our forced air heating system, and we run it 24/7, 365. So all the time we’re cleaning the air in our environment as thoroughly as we can. And when people come into our house, we have them take off their shoes. So does this work? I’ll go back to one of the fun parts about being naturopathic doctors is we apply all this health information to ourselves as well. So when I first started getting into this, when I was in the Corporate Wellness Program in Canada about 15 years ago, I’d measured my GGTP. It was 27. And normal range is 10 to 50. I thought, well, 27 is fine. I started looking at the research on diabetes, and it turns out that GGT correlates with diabetes. So when a person gets a GGT of 40 and above, they have a 20-fold increased risk for diabetes. A GGT of 30 to 60, in the normal range, 8-fold increased incidence of diabetes. So I thought by 27, well, actually I have some increased risk for diabetes. So I started getting more and more careful. I got down to 20. About three years later, I got down to 23. I tested again about three years ago. I got down to 17. I just tested a couple of months ago, down to 15. My belief is optimal is about 15 to 20. So as I found that as we decreased our toxic load, our GGT went down and our health went up as well. So now we virtually never go out to eat because there’s very few organic restaurants around. Basically, it’s all foods of commerce. So we eat. It’s been kind of a challenge for us because we just don’t trust the environment very much anymore.

Kalea Wattles
Do you think we could have a GGT that’s too low? Is that possible?

Joseph Pizzorno
Yes. Yes. So again, some people don’t upregulate GGT proportion of toxic load, but I could not find much research. I did find some research that when it gets below about 10, you definitely start seeing some problems. And I haven’t fully worked through the genetics on that. So yes, it can be too low. But everybody, get it into 15 to 20. That’s the safe, sweet spot.

Kalea Wattles
We’ve talked about a lot of things we can do in terms of lifestyle and how you have filters in your home, and you’re increasing dietary fiber and phytonutrients.

Joseph Pizzorno
And taking saunas!

Kalea Wattles
You mentioned that there’s a role of Lactobacilli. Should we be taking a probiotic to support our biotransformation?

Joseph Pizzorno
Yeah, they want as broad a spectrum probiotic with as many normal human organisms as possible. Because you have these constant challenges from the environment trying to kill off a microbiome. Even if we’re not taking antibiotics, and many of the foods have antibiotics in them, and as well as the toxins we’re being exposed to trying to change our microflora from healthy to unhealthy.

Kalea Wattles
For anyone who’s listening, as we wrap up this episode, maybe there’s clinicians who are listening or even patients, they suspect that they need to take a deeper dive into environmental toxicants but haven’t made the leap yet. What advice do you have for someone who’s just getting started in their environmental exposure investigation?

Joseph Pizzorno
Great, so if it’s a consumer, obviously my book, The Toxin Solution, and for clinicians, of course, my textbook, Clinical Environmental Medicine. I’m right now taping a lecture on environmental medicine, kind of an introduction to environmental medicine for Fullscript, and it will be available probably at the beginning of 2025. And I’m going to be using that as a stepping stone to a comprehensive environmental medicine course that I’m developing, which will be about 17 hours of lecture. And then my friends Drs. Lyn Patrick and Anne Marie Fine have an advanced environmental medicine course for people who really want to get into it. They have a very sophisticated 40 or 50-hour course with all kinds of education and tests and things for those who want to deeply get into it. And then of course in functional medicine, we now have our detox [Environmental Health] module that does more than just environmental medicine but has environmental medicine in it. And that’s a useful experience for people as well.

Kalea Wattles
It seems like no matter your specialty, primary care, fertility, neurology, cardiometabolic health, having some baseline knowledge of environmental exposures is going to serve your patients well.

Joseph Pizzorno
Absolutely. Another age-old naturopathic adage, when in doubt, detoxify the liver. That’s where the action is happening.

Kalea Wattles
That seems like a great piece of advice to walk away with. So, Dr. Pizzorno, I really appreciate spending time with you today. Thank you so much for sharing all of these insights, and we look forward to all the work that we know you’ll be sharing in the future.

Joseph Pizzorno
Well, thank you, and thank you for what you’re doing. It’s so much fun to do an interview with somebody who actually understands the field and asks good questions. It’s a lot more fun for me. Thank you.

Kalea Wattles
Such a pleasure. Thanks everyone. We’ll see you next time.

Kalea Wattles
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