Environmental Exposures: Overview

Caveat: This is knowledge and a lifestyle I have developed from what I have read and experienced with my family and patients. This is generalization, and since I do not know you personally, there is no way for me to give you personalized advise. This is meant to open up minds and start conversations within families and medical homes to improve knowledge and lifestyle.

There is an increase in chronic disease in children: ADHD, asthma, eczema, allergies, autism, obesity, etc. And the rate is too quick to be some kind of genetic shift, so it is most likely environmental contribution. I was taught most chronic illnesses are caused by 2 “hits” (or insults) to the body (first coined Knudson hypothesis and applied to cancer, now we are learning it can apply to many illnesses that are termed “multifactorial”). The 1st “hit” is genetic predisposition to an illness, and then a 2nd environmental insult puts the body over the edge into illness.
The current generation of children live in a different environment than past generations. As a child I said I would never say this, but “When I was a kid”, not only did I walk through snow uphill both ways to school, but we carried around books instead of electronic tablets, we used plain unscented soap, my mom made our food and we rarely went out to eat, our pantry had ingredients like rice/flour/beans and less packaged processed food, used Pyrex instead of plastic, people bought less “stuff” so less “stuff” was manufactured and wasted into the environment, had a garden we picked the bugs off the leaves, the weather was more stable, etc, etc. There are so many things different that today’s kids are exposed to that maybe causing the “2nd hit” of chronic diseases, that it is very hard for us to determine what are the biggest things that are causing the “2nd hit”, so that we can reduce those things to decrease the risk and improve health of children. It is also hard to research and generalize environmental factors because there are so many factors to filter through; you are not just comparing apples and oranges, you are sifting through and comparing every fruit to every other fruit. Plus every body is different, and what is toxic to one person may not be for another person who is able to detoxify that chemical or react differently to the environmental insult, etc.
As more research is done hopefully we will be able to know more about this, and hopefully be able to control parts of the environment that maybe contributing to chronic diseases. The American Academy of Pediatrics, as usual, has been on the forefront of interpreting the evidence to give guidance to pediatricians and families. They are the first organization to come out about concerns on environmental exposures that are negatively affecting children such as plastics and food additives (reference 1, AAP Food Additives and Child Health).

In this article my purpose is to give background and overview on this emerging area of concerns over children’s health and environmental exposures. I will then write separate articles on specific topics: food and drink, household supplies, climate change, functional medicine, etc.

I have a personal story about how I learned how much environment plays a role in wellness and illness. My daughter has a chronic skin disorder, at one point she was on strong topical and oral medications and still not improving. So I seeked the expertise of my friend, Dr. Anna Esparham, who is an integrative medicine pediatrician (see reference 2, the AAP clinical report that she helped write AAP Pediatric Integrative Medicine) She suggested environmental modifications to make my daughter’s environment “cleaner”, to try to reduce oxidative stress from environmental toxins and optimize nutrition to help her immune system “calm down”, which will help reduce inflammation and improve her body’s ability to heal. One step at a time, we slowly modified her environment and nutrition on a journey that ultimately helped our whole family. I like to say my daughter’s illness and skin was a “barometer for harmful chemicals and poor nutrition”, and I will be ever grateful to her skin for showing us we needed to improve! I started being mindful of everything that touched her skin and body: we changed bath and body products to simpler forms, like coconut oil for “lotion” and bars of natural soap instead of scented body wash. I used vinegar for laundry soap and wool balls instead of dryer sheets. My pantry changed from boxes of processed foods to glass jars of whole grains, lentils and other whole food “ingredients” as I replaced processed foods with real food. Our family changed dairy milk to plant based milk (Interestingly, my husband had suffered from chronic congestion and sinusitis which resolved when he stopped drinking dairy milk!). On top of her multivitamin we added extra vitamin D and magnesium to help her skin. Today she rarely has symptoms without any of the medications she was on before. And yes, our family’s experience is anecdotal and may not apply to all illnesses, and families may not be able to do all the modifications we did. But there is increasing evidence that environmental exposures and pro-inflammatory/nutrient lacking standard American diet (ironically the acronym is SAD) is contributing to pediatric problems. Therefore it is important to educate ourselves and make whatever improvements in children’s environment and lifestyle we can.

We have always known things can “run in families”. And we have known for obvious things that DNA and genes play a direct role in: for instance, cystic fibrosis is caused by a gene that codes for a protein that regulates salt in cells. But we are starting to piece together why certain families are predisposed to things that environment plays a role in the 2nd hit, what we call things that have “multi-factorial” causes. For instance, there are gut, liver, cellular and kidney enzymes filter and detoxify the body from substances we ingest, breath, or come in through our skin. There are different amounts and types of proteins/enzymes that are inherited. This may explain why people react to different things different ways. There are new studies showing that people with autism have certain enzymes that may not detoxify as well as others. So it maybe the enzymes that is inherited and the reason why families with autism have higher risk of having other children with autism, not necessarily the brain problem itself that is inherited, but the inability to detoxify may make the individual more sensitive to toxins that may cause the brain development problem. This is any interesting area that has a lot of ongoing research, as it is always important to find the real root of the problem before we can find the solution.

Because we are learning how much environment and nutrition impact our body, and if optimized can help be more well, there is new fields of medicine that follow this. Functional medicine focuses on interactions between the environment and the gastrointestinal, endocrine, and immune systems to optimize the function and natural healing of the body. It focuses on finding the root cause of symptoms as a sign that the body is unwell and solving that instead of just covering up the symptoms. Integrative medicine integrates traditional medicine with functional medicine. For instance: treats the asthma symptoms with albuterol, but also optimizes environment, nutrition and supplements to decrease the inflammation in the airway to decrease the symptoms that way. This is how I try to approach common medical problems in children: use medications and modern medicine to help the child be functional and symptom free, but also optimize the body’s ability to heal and become well. I will write more about this in another post, but for now here is big picture of 3 basic areas:
1. Heal Gut through diet and probiotics
2. Improve nutrition and replace nutrients that are deficient in standard American diet: Vitamin D, magnesium and omega 3 is most common that is hard to get in diet but important to keep body well
3. Detoxify, reduce oxidative stress to help the body be in anti-inflammatory state. This is what this article is giving an overview about

Right now we cannot control the 1st hit of genetics. But what we can control is environment: what we breath, eat, drink, put on our skin, etc. Again, we are just starting to tease out factors that are high yield in causing unwell bodies, so right now we don’t know all the factors that are playing a role. So for now, with my family I have tried to take a “simplify as much as possible” approach. Below I will give an overview of each area. In future articles I will give more specific evidence and risks for each area. For now, I have families who are asking me about ways they can start improving, so I included a logistics part of each section I include hints and things our family has done. When I name a product or a store/website, I am NOT getting any benefits for naming them. I also name things that I have found beneficial, I am not saying it is perfect or I know everything, just a general suggestion that you may want to consider.
As another caveat, we are living in an industrialized country, so it’s hard to eliminate all environmental exposures, so don’t get overwhelmed. Stressing about things will be counterproductive! And when I mention one factor increases risk for something, it doesn’t mean if you use that you’re going to get the illness. But what it means is we should recognize that risk and try to improve our environment as best we can. For instance, we know we can get injured in a car accident, but we still have to drive in today’s society, but we reduce the risk by wearing seatbelt and driving as safe as possible. Same thing with environmental exposures, unless we move to secluded island (which sounds great!). So every family’s lifestyle is variable based on the ability of that family and the illnesses and needs of the bodies. To find a balance, our family does what we call 80/20 “rule”: about 80% of time eat well and live “clean”, but we don’t live on a secluded self-sustainable farm and we have kids who go to school with friends and birthday parties, etc. So we have the weekend sleepovers with birthday cake and scented face mask “facials”, but most days it’s homemade food and coconut oil for lotion;). Also, with children, go slow with change, and pick the battles that are more impactful and important.

Plastics
The invention of plastic helped humans in many ways, such in healthcare. But like most things, humans have taken it too far and abusing the convenience of plastic. The use of plastic is something that has definitely increased. We are now learning some adverse effects on the body. For instance, some plastic chemicals mimic hormones in our body, they have been termed endocrine disruptors. This maybe one of the factors causing an increase in infertility, obesity, premature puberty, cancer risk, among other things. It’s hard to avoid plastic all together, but minimize our use of plastic as “convenience”
Logistics: A big thing we did was replace kitchenware with glass, metal and silicone. A website, mightynest.com is great resource. Try to limit food/drink that’s been “sitting” in plastic on shelf. Little things like I started cutting up carrot sticks instead of buying the bag of precut carrots (bonus: they actually taste better too!). Plastic is also in a lot of clothing, so switching to cotton and natural materials when able. Micro plastic particles (from clothing, pollution, microbeads, etc) are not filtered out in water processing plants, so we use a water purifier called “Berkey”, looks like a water cooler (no electricity, minimal maintenance, long lasting). I would say purifying water is one of most high yield things we do. Yes, the water out of faucet does not have large levels of toxic things like lead (ugh except that poor town of Flint) or bacteria. And filters help by getting more of the large contaminants out. But if you want the micro plastic particles and pesticides out, then a purifier like the Berkey will help.

Food additives
This will be my next article to write since there is important new information (see reference 1AAP Food Additives and Child Health ) on potential toxins that are directly added to food (colorings, flavorings, preservatives) and in contact with food (adhesives, dyes, coatings, plastic and other polymers).
Logistics: Kind of simple, we try to eat real food that doesn’t have a package or ingredient list: produce, nuts, oatmeal, rice, meat. Food should rot, if it doesn’t then it has additives. If we buy processed foods, we try to choose minimal ingredients that we can read and understand. Whole Foods and Natural grocers have standards for their food without certain additives. Aldi’s brand food has standards to limit additives (not the pop tarts in Aldi’s, though;) Otherwise buy food without labels or read the labels!

Industrial agriculture and livestock
My dad likes to say, “you know what we used to call organic food: food”. And he’s right, our food supply is not the same, and we used to know where our food came from and trusted that local farmer or supplier. Produce used to be grown in home gardens or local farms, now they are mass produced in faraway agricultural fields, and with this mass production comes more chemicals to help increase the production. Animal products were from a local farm with a small number of animals roaming in pasture and barns, now the animals are in huge livestock facilities (called CAFOs: confined animal feeding operations), which have ethical, environmental, and nutritive issues. Not only is there possible toxins and harmful things like drug resistant bacteria, but there can be less nutrients (mass production of a single crop can deplete the soil, animals are fed corn instead of grass and natural diet, animals don’t have access to sun for vitamin D, etc)
These are the things we know have changed in our food supply, and we are learning more about the effects of this changing food supply, and how we can improve, more to come in next article…
Logistics: Again more to come in next article! But basically we try to be mindful of our food: how it was grown or raised, what was used, etc.

Household, cleaning, Bath and body products
The average American uses on average 20 bath and body products per day. And if you start to read labels you realize we don’t know what is in them. The Food and Drug Administration (FDA), allows companies to put things in products that are determined “generally recognized as safe”. This is different than other countries, such as European countries an ingredient has to be proven safe before it goes on the market. The FDA allows it until it is proven harmful.
The Environmental Working Group (www.ewg.org) is an independently funded group that is not biased towards corporations and is seeking the truth to protect humans. For instance, their research about triclosan (a chemical used as antibiotic in things like soap) showing it is carcinogenic (can induce cancer), got the FDA to ban it from future use. But it makes me wonder why the FDA allowed it in the first place, all the while people who have trusted the FDA and companies could have been put in harm.
(Caveat on EWG: most of their reducing toxin recommendations are evidence based, low risk, and helpful. They do have some misleading information on vaccines. For the record, I am all for natural, except for getting “natural” vaccine preventable diseases. Vaccines are more “clean” than most things kids are exposed to (like what I’ve mentioned about plastics, food, water, etc), and vaccines prevent disease and deaths, so benefit far outweighs anything. To me, a lot of the scary anti-vaccine propaganda is perpetuated by the industrial corporations so families blame the vaccines instead of the company’s toxins and don’t stop buying their toxic chemical containing products. But I digress!)
Logistics: Hint: most of the “new and improved” stuff on the shelf is for companies to try to sell more. The simpler it is, like plain soap worked just fine for centuries, and probably has less potentially harmful ingredients. Lots of simple natural cleaning and BB products, think the pioneers using lard soap (I’m not recommending lard soap, but you get the picture;). Most of them are cheaper and easier and less wasteful! Vinegar and baking soda are great cleaning agents, I even use white vinegar as laundry detergent. I use wool dryer balls instead of dryer sheets (the chemicals and fragrance in dryer sheets are last thing that gets put on your clothes, and gets aerosolized in the air). Coconut oil is a great makeup remover, moisturizer, shaving cream, etc (and cheap!). Cosmetics are difficult to get with low risk ingredients, but more consumers are becoming aware, so there are certain brands that have less toxic ingredients. EWG has a list on their website

Pollution and Climate change
This is a whole other article, also. But in short: Pollution from transportation, factories, agriculture, livestock waste, and other waste is putting large amounts of potential toxins in the water, air and environment. Climate change is changing the environment in many ways. Longer summer and shorter/milder winters causing increase in pollen, allergens, and pollution. Natural disasters with an array of negative effects on children like mold, release of toxins like from livestock sewage ponds, etc, etc.
Logistics: Our family tries to minimize our use, asking ourselves “do I really need this”, or is there a better alternative. We try to buy used, or most sustainable choice. Our family eats plant based as much as possible, because livestock is the biggest producer of green house gasses (more than all the transportation industry). Eating more plant foods and less animal products is better for health, earth, and animals. More to come on plant based eating in a healthy eating blog;)
Again, our family is not perfect, and we do live in this society, but we try to be as mindful consumers as possible

Conclusion:
Genetics we cannot control (yet?!), Environment we can control. Different people are sensitive to different things in different amounts. Therefore it is very hard to study and apply to the “masses”. But individualized medicine: optimize the body’s ability to heal and be well using things that have lower risk and help that individual patient. I have seen things like improving diet, increasing nutrients, and decreasing environmental exposures can really help improve numerous ailments and help people be more well. No lifestyle is perfect, but little changes on a journey to improve wellness can make a big difference!

References:
1. Trasanda L, Shaffer RM, Sathyanarayana S; AAP Council on environmental health. Food additives and child health. Pediatrics. 2018;142(2):e201814082.

2. McClafferty H, Vohra S, Bailey M, et al. Pediatric Integrative Medicine. Pediatrics. 2017;140 (3):e20171961

6 thoughts on “Environmental Exposures: Overview

  1. This was so helpful and inspiring! I’m going to look up a Berkey. We already do some of these things in our family, but your blog post motivates me to incorporate even more. Thank you! Looking forward to more!

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  2. Excellent article. Thank you for raising these important environmental health issues for parents to consider. I look forward to reading more soon! — Ned Ketyer, M.D., AAP Council on Environmental Health.

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    1. Thank you! We are all doing what we can to help children. It looks like you are doing your part in the Council on Environmental Health, I appreciate all your council’s efforts in advocacy and bringing this issue the attention it needs! This blog is a start, and I hope to do more in advocacy as my career progresses.

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