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Abstract
Did you know that high levels of toxins in the human body can be linked to common conditions such as infertility, obesity, rheumatoid arthritis, heart disease, and diabetes? With therapeutic guidance designed for clinicians, Clinical Environmental Medicine focuses on how toxins such as arsenic, lead, mercury and organophosphates have become one of the leading causes of chronic disease in the industrial world. The first edition of this text describes how to treat these undesirable elements and molecules that can poison enzyme systems, damage DNA, increase inflammation and oxidative stress, and damage cell membranes. Expert authors Walter Crinnion and Joseph E. Pizzorno offer practical guidance for assessing both total body load as well as specific toxins. In addition, evidence-based treatment procedures provide recommendations for decreasing toxin exposure and supporting the body’s biotransformation and excretion processes.
- NEW! Unique! Practical diagnostic and therapeutic guidance designed for clinicians.
- NEW! Unique! Coverage of the most common diseases for which toxins are a primary cause.
- NEW! Description of how each toxin causes damage provides insights into sources, body load, and interventions for each toxin.
- NEW! Unique! Entirely evidence-based content focuses on the most common conditions from which patients suffer.
- NEW! Unique! Coverage of environmental toxicants, endogenous toxicants, and "toxins of choice" focuses on non-industrially-exposed populations.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Clinical Environmental Medicine | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Contributors | vi | ||
| Acknowledgements | vi | ||
| Preface | vii | ||
| Organization of the Text | vii | ||
| Foreword | viii | ||
| Understanding How to Practice Environmental Medicine | viii | ||
| Coherence Phenomenon | viii | ||
| Sensitization and Spreading Phenomena | viii | ||
| Biochemical Individuality | ix | ||
| Table Of Contents | x | ||
| I Introduction to Environmental Medicine | 1 | ||
| 1 The Science of Environmental Medicine | 1 | ||
| Environmental Health Professions | 2 | ||
| Industrial and Occupational Medicine | 2 | ||
| Public Health | 3 | ||
| Environmental Medicine | 3 | ||
| Total Toxicant Body Burden | 3 | ||
| Other Factors Important in Environmental Medicine | 6 | ||
| References | 7 | ||
| 2 Oxidative Damage and Inflammation | 8 | ||
| Summary | 8 | ||
| Description | 8 | ||
| Mechanisms | 8 | ||
| Sources | 9 | ||
| Physiological | 9 | ||
| Toxic Metals | 9 | ||
| Persistent Organic Pollutants | 9 | ||
| Air Pollution | 10 | ||
| Prescription and Over-the-Counter Drugs | 10 | ||
| Radiation | 10 | ||
| Solvents | 10 | ||
| Toxins of Choice | 10 | ||
| Alcohol. | 10 | ||
| Tobacco. | 10 | ||
| Assessment | 11 | ||
| Biotransformation and Oxidative Stress | 11 | ||
| Clinical Significance | 12 | ||
| Carcinogenesis | 12 | ||
| Cardiovascular Disease | 12 | ||
| Diabetes and Hyperglycemia | 13 | ||
| Musculoskeletal | 13 | ||
| Neurological | 13 | ||
| Intervention | 13 | ||
| Antioxidants—Vitamin C and E | 13 | ||
| Glutathione | 13 | ||
| Resveratrol | 14 | ||
| Curcumin | 14 | ||
| Mediterranean Diet | 14 | ||
| Quercetin | 14 | ||
| Melatonin | 14 | ||
| Ginger | 15 | ||
| Lycopene, Olive Leaf Extract, and Other Factors | 15 | ||
| References | 15 | ||
| 3 Food Pollution | 25 | ||
| Summary | 25 | ||
| Introduction | 25 | ||
| Persistent Organic Pollutants | 27 | ||
| Polychlorinated Biphenyls and Organochlorine Pesticides | 27 | ||
| Brominated Flame Retardants | 28 | ||
| Coffee and Tea | 29 | ||
| Nonpersistent Pollutants | 29 | ||
| Glyphosate | 30 | ||
| Solvents | 30 | ||
| Plasticizers | 31 | ||
| Bisphenol A | 31 | ||
| Metals | 32 | ||
| Aluminum | 32 | ||
| Arsenic | 32 | ||
| Cadmium | 33 | ||
| Mercury | 33 | ||
| Intervention | 34 | ||
| Organic Foods | 36 | ||
| References | 36 | ||
| 4 Water Pollution | 41 | ||
| Summary | 41 | ||
| Introduction | 41 | ||
| Major Pollutants and Adverse Health Effects | 41 | ||
| Microorganisms | 41 | ||
| Disinfectants and Disinfection By-products | 49 | ||
| Inorganic Chemicals, Metals, Organic Chemicals, and Radionuclides | 50 | ||
| Lead. | 51 | ||
| Arsenic. | 51 | ||
| Hexavalent Chromium. | 53 | ||
| Pesticides and Herbicides. | 55 | ||
| Unregulated Contaminants | 55 | ||
| Iodinated or Nitrogenated DBPs. | 55 | ||
| Perchlorate. | 57 | ||
| Perfluorinated Compounds. | 57 | ||
| Other Contaminants. | 57 | ||
| Intervention | 57 | ||
| References | 58 | ||
| 5 Indoor Air Pollution | 61 | ||
| Summary | 61 | ||
| Overview | 61 | ||
| Solvents | 61 | ||
| Air Fresheners | 62 | ||
| Semivolatile Organic Compounds | 62 | ||
| Biologicals | 64 | ||
| Construction and Furnishing | 65 | ||
| Sick Buildings | 66 | ||
| Green Buildings. | 67 | ||
| Intervention | 67 | ||
| References | 69 | ||
| 6 Outdoor Air Pollution | 72 | ||
| Summary | 72 | ||
| Overview | 72 | ||
| Major Pollutants | 72 | ||
| Urban Air Pollution | 72 | ||
| EPA’s Six Criteria Air Pollutants | 73 | ||
| Particulate matter. | 73 | ||
| Ozone. | 74 | ||
| Carbon monoxide. | 75 | ||
| Sulfur oxides. | 75 | ||
| Nitrogen oxides. | 75 | ||
| Lead. | 75 | ||
| Mercury. | 75 | ||
| Sources | 75 | ||
| Comparing Emissions from Diesel and Biodiesel. | 75 | ||
| Industrial- and Vehicle-Generated Volatile Organic Compounds. | 78 | ||
| Industrial Pollution. | 79 | ||
| Fracking. | 79 | ||
| Agricultural Chemicals. | 80 | ||
| Adverse Health Effects | 80 | ||
| Mortality | 80 | ||
| Cardiovascular | 81 | ||
| Neoplasia | 82 | ||
| Respiratory | 82 | ||
| Immunological | 85 | ||
| Pollutants Acting as Allergic Adjuvants. | 85 | ||
| Neurological | 85 | ||
| Reproductive and Other Health Effects | 85 | ||
| References | 86 | ||
| 7 Health and Beauty Products | 92 | ||
| Summary | 92 | ||
| Description | 92 | ||
| Sources | 92 | ||
| Parabens | 93 | ||
| Phthalates | 93 | ||
| Triclosan | 94 | ||
| Ultraviolet Filters | 95 | ||
| Toxic Metals | 95 | ||
| Aluminum. | 95 | ||
| Mercury. | 96 | ||
| Body Burden | 97 | ||
| Detoxification/Excretion Processes | 97 | ||
| II The Toxicants | 120 | ||
| Metals | 120 | ||
| 9 Arsenic | 120 | ||
| Summary | 120 | ||
| Description and Toxicity | 120 | ||
| Sources | 121 | ||
| Groundwater | 121 | ||
| Food | 121 | ||
| Other Sources | 122 | ||
| Body Burden | 123 | ||
| Clinical Significance | 124 | ||
| Cancer. | 124 | ||
| Respiratory and Cardiovascular Disease. | 125 | ||
| Diabetes and Prediabetes Risk. | 125 | ||
| Other Health Risks. | 126 | ||
| Intervention | 127 | ||
| Testing | 127 | ||
| Assessments | 127 | ||
| Treatment | 127 | ||
| References | 128 | ||
| 10 Cadmium | 132 | ||
| Summary | 132 | ||
| Description | 132 | ||
| Sources | 132 | ||
| Body Burden | 133 | ||
| Clinical Significance | 134 | ||
| Cardiovascular Mortality Risk. | 134 | ||
| Cancer Risk. | 134 | ||
| Renal Disorders. | 135 | ||
| Bone Disorders. | 135 | ||
| Endocrine (Diabetes and Reproduction). | 136 | ||
| Neurological Functioning. | 136 | ||
| Intervention | 137 | ||
| Reducing Cadmium Burden | 137 | ||
| Ameliorating Cadmium Toxicity | 138 | ||
| Assessment | 138 | ||
| Treatment | 139 | ||
| References | 139 | ||
| 11 Hexavalent Chromium | 144 | ||
| Summary | 144 | ||
| Description | 144 | ||
| Toxicity | 144 | ||
| Sources | 145 | ||
| Body Burden | 146 | ||
| Detoxification/Excretion Processes | 146 | ||
| Clinical Significance | 146 | ||
| Neoplasia. | 146 | ||
| Renal. | 146 | ||
| Reproduction. | 146 | ||
| Intervention | 146 | ||
| Laboratory Testing | 146 | ||
| Chelation | 147 | ||
| Avoidance | 147 | ||
| Antioxidant Support | 147 | ||
| References | 147 | ||
| 12 Cobalt | 150 | ||
| Summary | 150 | ||
| Description | 150 | ||
| Toxicity | 150 | ||
| Sources | 151 | ||
| Body Load | 151 | ||
| Detoxification/Excretion Processes | 151 | ||
| Clinical Significance | 152 | ||
| Allergic Dermatitis | 152 | ||
| Cardiomyopathy | 152 | ||
| Hypothyroidism | 152 | ||
| Pseudotumors | 152 | ||
| Respiratory Effects | 153 | ||
| Vision Loss | 153 | ||
| Intervention | 153 | ||
| Surgery | 153 | ||
| Chelation Therapy | 153 | ||
| References | 156 | ||
| 13 Lead | 161 | ||
| Summary | 161 | ||
| Description | 161 | ||
| Toxicity/Metabolism | 161 | ||
| Sources | 162 | ||
| Body Burden | 163 | ||
| Clinical Significance | 165 | ||
| Neurological Disorders. | 165 | ||
| Cardiovascular Disorders. | 166 | ||
| Renal Disorders. | 166 | ||
| Respiratory Disorders. | 167 | ||
| Reproductive Disorders. | 167 | ||
| Intervention | 167 | ||
| Avoidance | 167 | ||
| Chelation to Reduce Body Lead Burden | 167 | ||
| Amelioration of Lead-Induced Damage | 168 | ||
| Assessment | 169 | ||
| Treatment | 169 | ||
| References | 170 | ||
| 14 Mercury | 177 | ||
| Summary | 177 | ||
| Description | 177 | ||
| Toxicity | 178 | ||
| Sources | 178 | ||
| Fish | 178 | ||
| Industrial and Natural Sources | 179 | ||
| Amalgams | 179 | ||
| Other Mercury Exposure Sources | 180 | ||
| Body Burden | 181 | ||
| Detoxification/Excretion Processes | 183 | ||
| Clinical Significance | 183 | ||
| General Presentation. | 183 | ||
| Cardiac Effects | 184 | ||
| Endocrine Effects | 185 | ||
| Immune Effects | 185 | ||
| Neurological Effects | 186 | ||
| Hepatic Effects | 187 | ||
| Assessing Biomarkers | 187 | ||
| Mercury Levels | 187 | ||
| Biomarkers of Biochemical and Physiological Damage | 188 | ||
| 8-Hydroxy-2′-Deoxyquanosine. | 188 | ||
| Porphyrins. | 188 | ||
| Ferritin and Alanine Aminotransferase. | 189 | ||
| Neurobehavioral Function. | 189 | ||
| Treatment | 189 | ||
| Avoidance | 189 | ||
| Reduction of Mercury Body Burden | 189 | ||
| Enhancing Normal Excretion. | 189 | ||
| Utilizing Mercury-Mobilizing Agents. | 190 | ||
| Reversing Mercury-Induced Damage. | 190 | ||
| References | 192 | ||
| 15 Other Metals | 202 | ||
| Summary | 202 | ||
| Description | 202 | ||
| Gadolinium | 202 | ||
| Manganese | 202 | ||
| III Systemic Effects of Toxins and Toxicants | 425 | ||
| 42 Neurotoxicity | 425 | ||
| Summary | 425 | ||
| Introduction | 425 | ||
| Neurological Cell Types | 425 | ||
| Basic Mechanisms of Neurotoxicity | 426 | ||
| Direct Neurotoxicity | 426 | ||
| Indirect Neurotoxicity: Oxidative Damage and Neuroinflammation | 427 | ||
| Disease Manifestation | 429 | ||
| Cognition and Executive Function Decline | 429 | ||
| Prenatal Exposures | 430 | ||
| Postnatal Exposures | 431 | ||
| Mood | 433 | ||
| Diseases | 434 | ||
| Attention Deficit Hyperactive Disorder | 434 | ||
| Prenatal Exposures | 435 | ||
| Postnatal Exposures | 435 | ||
| Autism Spectrum Disorder | 436 | ||
| Prenatal Exposures | 437 | ||
| Postnatal Exposures | 438 | ||
| Alzheimer’s Disease | 438 | ||
| Parkinson’s Disease | 439 | ||
| Assessment | 440 | ||
| Specific Assessment of Neurotoxicity | 440 | ||
| Neuropsychological Testing. | 440 | ||
| Balance Testing. | 441 | ||
| SPECT Scans. | 442 | ||
| General Assessment of Neurological Defects | 442 | ||
| Intervention | 442 | ||
| Avoidance | 442 | ||
| Diet | 442 | ||
| Supplementation | 443 | ||
| References | 443 | ||
| 43 Immunotoxicity | 456 | ||
| Summary | 456 | ||
| Overview/Introduction | 456 | ||
| Basic Mechanisms | 456 | ||
| Summary of Th Cell Functions | 457 | ||
| Th1. | 457 | ||
| Th2. | 457 | ||
| Th3 (Regulatory T-cells). | 457 | ||
| Th17. | 457 | ||
| Glutathione, T-cell Homeostasis, and Immunotoxicity | 457 | ||
| Immunotoxicity | 459 | ||
| Disease Manifestation | 460 | ||
| Allergies | 460 | ||
| Outdoor Air Pollutants | 460 | ||
| Vehicular exhaust. | 460 | ||
| Diesel exhaust particles. | 461 | ||
| Indoor Air Pollutants | 462 | ||
| Mold. | 462 | ||
| Tobacco smoke. | 462 | ||
| Building and yard chemicals. | 462 | ||
| Solvents. | 463 | ||
| Perfluorocarbons. | 463 | ||
| Phthalates. | 463 | ||
| Trichloroethylene. | 463 | ||
| Autoimmunity From Toxicant Exposures | 463 | ||
| Particulate Matter, Diesel Exhaust, BPA, Trichlorloethylene, Cigarette Smoke, PCBs, and Paraquat. | 463 | ||
| Mercury. | 464 | ||
| Chlordane. | 465 | ||
| Chlorpyrifos. | 465 | ||
| Formaldehyde. | 465 | ||
| Systemic Lupus Erythematosus | 465 | ||
| Oil Field Waste, Solvents, and Others. | 465 | ||
| Mercury. | 465 | ||
| Hair Dye. | 465 | ||
| Trichloroethylene. | 465 | ||
| Smoking, PCBs, and Pesticides. | 466 | ||
| Particulate Matter. | 466 | ||
| Rheumatoid Arthritis | 466 | ||
| Type 1 Diabetes | 466 | ||
| Antithyroid Antibodies | 466 | ||
| Neurological Autoimmune Disorders | 466 | ||
| Infections | 467 | ||
| Herpes Zoster. | 467 | ||
| Childhood Infections. | 467 | ||
| Chemical Sensitivity | 467 | ||
| Pesticides and Solvents. | 468 | ||
| Assessment | 468 | ||
| Intervention | 468 | ||
| Avoidance | 468 | ||
| Depuration (Cleansing) | 469 | ||
| Dietary Intervention | 470 | ||
| Mediterranean Diet. | 470 | ||
| Brassica Family. | 470 | ||
| Curcumin. | 470 | ||
| Green Tea. | 470 | ||
| Supplement Intervention | 470 | ||
| N-acetyl cysteine. | 470 | ||
| Vitamins A and D. | 470 | ||
| Probiotics. | 470 | ||
| References | 471 | ||
| 44 Endocrine Toxicity | 486 | ||
| Summary | 486 | ||
| Introduction | 486 | ||
| Disease Manifestation | 487 | ||
| Fertility and Reproductive Outcomes | 487 | ||
| Female Fertility and Reproductive Outcome Effects From Endocrine-Disrupting Chemicals | 487 | ||
| Chlorinated compounds. | 488 | ||
| Bisphenol A. | 489 | ||
| Herbicides and organophosphate pesticides. | 489 | ||
| Female Fertility and Reproductive Outcome Effects From Compounds Not Listed as Endocrine-Disrupting Chemicals by the Endocrine Society | 489 | ||
| Solvents. | 489 | ||
| Air pollutants. | 490 | ||
| Metals. | 490 | ||
| Trihalomethanes. | 491 | ||
| Xenobiotics and Birth Defects | 491 | ||
| Female Reproductive Health—Sexual Development, Endometriosis, Polycystic Ovary Syndrome, and Uterine Leiomyomas | 492 | ||
| Male Low Testosterone Levels | 492 | ||
| Male Impaired Reproductive Ability | 493 | ||
| Pesticides. | 493 | ||
| Metals. | 493 | ||
| Air pollutants. | 493 | ||
| Phthalates. | 493 | ||
| PCBs. | 493 | ||
| Erectile Dysfunction. | 494 | ||
| Obesity | 494 | ||
| Phthalates. | 494 | ||
| Bisphenol A. | 495 | ||
| Chlorinated Compounds. | 495 | ||
| Perfluorocarbons. | 495 | ||
| Air Pollutants. | 495 | ||
| The Diabetes Epidemic | 495 | ||
| Diabetogens: Toxicants That Disrupt Blood Sugar Control. | 497 | ||
| Persistent Organic Pollutants. | 497 | ||
| Arsenic. | 498 | ||
| Ambient Air Pollutants. | 498 | ||
| Bisphenol A and Phthalates. | 499 | ||
| Laboratory Markers. | 500 | ||
| Xenobiotic Effects on Thyroid Function | 500 | ||
| Organochlorines. | 501 | ||
| Polybrominated Flame Retardants. | 502 | ||
| Organophosphate Pesticides. | 502 | ||
| Perchlorate. | 502 | ||
| Phthalates. | 502 | ||
| Mercury. | 502 | ||
| Cadmium. | 503 | ||
| Xenobiotic Effects on Adrenal Function | 503 | ||
| Toxicity. | 503 | ||
| Alcohol. | 505 | ||
| Chlorophenols. | 505 | ||
| Cigarette smoke. | 505 | ||
| Drugs/iatrogenic. | 505 | ||
| Organochlorine pesticides. | 506 | ||
| Organophosphate pesticides. | 506 | ||
| Outdoor air pollution. | 506 | ||
| Polychlorinated biphenyls. | 507 | ||
| Pyrethroid pesticides. | 507 | ||
| Salt. | 507 | ||
| Toxic metals. | 507 | ||
| Assessment | 507 | ||
| Intervention | 507 | ||
| References | 508 | ||
| 45 Mitochondrial Toxicity | 524 | ||
| Summary | 524 | ||
| Overview | 524 | ||
| Mitochondrial Insufficiency | 524 | ||
| Drugs | 526 | ||
| Mercury | 526 | ||
| Cadmium | 527 | ||
| Lead | 527 | ||
| Arsenic and Tin | 527 | ||
| Air Pollution From Combustion | 527 | ||
| Chlorinated Compounds | 527 | ||
| Pyrethroids, Organophosphates, and Other Pesticides | 528 | ||
| Phthalates and Plasticizers | 528 | ||
| Solvents | 528 | ||
| Mycotoxins | 528 | ||
| Assessment | 528 | ||
| Intervention | 528 | ||
| Nutrients | 528 | ||
| Botanical Agents | 529 | ||
| References | 529 | ||
| 46 Respiratory Toxicity | 535 | ||
| Summary | 535 | ||
| Description | 535 | ||
| Chronic Obstructive Pulmonary Disease | 535 | ||
| Asthma. | 535 | ||
| Basic Mechanisms of Toxicity | 536 | ||
| Chronic Obstructive Pulmonary Disease | 536 | ||
| Asthma | 536 | ||
| Sources of Respiratory Toxicants | 537 | ||
| Air Pollution | 537 | ||
| Particulate Matter. | 537 | ||
| Ozone. | 537 | ||
| Sulfur Dioxide. | 537 | ||
| Nitrogen Dioxide. | 538 | ||
| Smoking (Tobacco and Marijuana). | 538 | ||
| Occupational Agricultural Exposure | 538 | ||
| Bisphenol-A. | 538 | ||
| Toxic Metals | 539 | ||
| Arsenic. | 539 | ||
| Cadmium. | 539 | ||
| Lead. | 540 | ||
| Mold/Mycotoxins | 540 | ||
| Assessment | 540 | ||
| Intervention | 541 | ||
| Avoidance | 541 | ||
| Antioxidants | 541 | ||
| Vitamin D. | 542 | ||
| References | 542 | ||
| 47 Cardiovascular Toxicity | 549 | ||
| Summary | 549 | ||
| Overview/Introduction | 549 | ||
| Disease Manifestation | 549 | ||
| Ambient Air Pollution From Vehicular Sources | 549 | ||
| Cardiovascular Mortality. | 550 | ||
| Atherosclerosis. | 550 | ||
| ST-Segment Depression. | 551 | ||
| Oxidation of LDL. | 551 | ||
| Indoor Air Pollutants | 551 | ||
| Persistent Organic Pollutants | 552 | ||
| Bisphenol A and Phthalates | 552 | ||
| Heavy Metals | 553 | ||
| Lead—Hypertension and Cardiovascular Death. | 553 | ||
| Methylmercury—Hypertension and Atherosclerosis | 554 | ||
| Cadmium and Arsenic—Cardiovascular Illness. | 554 | ||
| Assessment | 555 | ||
| Intervention | 555 | ||
| Avoidance | 555 | ||
| Supplementation | 556 | ||
| Depuration | 556 | ||
| References | 556 | ||
| 48 Musculoskeletal Toxicity | 561 | ||
| Summary | 561 | ||
| Description | 561 | ||
| Gout | 561 | ||
| Rheumatoid Arthritis | 561 | ||
| Osteoporosis | 562 | ||
| Basic Mechanisms of Toxicity | 562 | ||
| Sources of Musculoskeletal Toxicants | 564 | ||
| Mold | 564 | ||
| Air Pollution | 564 | ||
| Persistent Organic Pollutants | 564 | ||
| Perfluorocarbons. | 565 | ||
| Metals and Metalloids | 565 | ||
| Aluminum. | 565 | ||
| Arsenic. | 565 | ||
| Cadmium. | 565 | ||
| Lead. | 566 | ||
| Silica. | 566 | ||
| Diet | 566 | ||
| Gut Microbiota | 566 | ||
| Prescription Drugs | 567 | ||
| Aromatase Inhibitors/Gonadotropin-releasing Hormone (GnRH) Analogs. | 567 | ||
| Glucocorticoids. | 567 | ||
| Heparin. | 567 | ||
| Proton Pump Inhibitors. | 567 | ||
| Selective Serotonin Reuptake Inhibitors. | 568 | ||
| Thiazolidinediones. | 568 | ||
| Thyroxine. | 568 | ||
| Assessment | 568 | ||
| Intervention | 568 | ||
| Calcium | 568 | ||
| Vitamin D | 569 | ||
| Other | 569 | ||
| References | 569 | ||
| 49 Liver Toxicity | 577 | ||
| Summary | 577 | ||
| Description | 577 | ||
| Toxicity—Mechanisms of Action | 578 | ||
| Sources | 579 | ||
| Diet and Lifestyle | 579 | ||
| High Fructose Corn Syrup. | 579 | ||
| Obesity. | 579 | ||
| Gut-Derived Endotoxins. | 580 | ||
| Air Particulate Matter | 580 | ||
| Chemicals | 580 | ||
| Chloroalkenes. | 580 | ||
| Volatile Organic Compounds (VOC). | 580 | ||
| Persistent Organic Pollutants. | 580 | ||
| Toxic Metals | 580 | ||
| Cadmium. | 580 | ||
| Mercury. | 580 | ||
| Assessment | 580 | ||
| Alkaline Phosphatase | 581 | ||
| Bilirubin | 581 | ||
| Transaminase Enzymes—ALT and AST | 581 | ||
| Gamma-Glutamyltransferase | 581 | ||
| Intervention | 581 | ||
| References | 582 | ||
| 50 Renal Toxicity | 587 | ||
| Summary | 587 | ||
| Introduction | 587 | ||
| Kidney Excretion of Toxins and Toxicants | 588 | ||
| How the Kidneys Are Damaged | 589 | ||
| Toxic Metals | 590 | ||
| Cadmium. | 590 | ||
| Mercury. | 590 | ||
| Lead. | 591 | ||
| Persistent Organic Pollutants | 591 | ||
| Fluorinated Hydrocarbons. | 591 | ||
| Glyphosate. | 591 | ||
| Smoking | 592 | ||
| Nonsteroidal Antiinflammatory Drugs | 592 | ||
| Toxins from the Gut | 592 | ||
| Excessive Salt in the Diet | 593 | ||
| Excessive Phosphates in the Diet | 593 | ||
| Protecting and Regenerating the Kidneys | 594 | ||
| Decrease Total Toxic Load | 594 | ||
| Aggressively Decrease Exposure to Nephrotoxins | 594 | ||
| Improve Microcirculation of Kidneys | 594 | ||
| Beetroot Juice. | 594 | ||
| Gotu Kola. | 595 | ||
| Chocolate. | 595 | ||
| Protect the Kidneys from Oxidative Stress | 595 | ||
| N-Acetylcysteine. | 595 | ||
| Melatonin. | 595 | ||
| Blueberries. | 595 | ||
| Quercetin. | 595 | ||
| Curcumin. | 596 | ||
| Ginkgo Biloba. | 596 | ||
| Ginger (Zingiber Officinale). | 596 | ||
| References | 597 | ||
| 51 Cancer | 602 | ||
| Summary | 602 | ||
| Description | 602 | ||
| Toxicity—Mechanisms of Action | 602 | ||
| Clinical Significance—Cancer Sites and Associated Toxicants | 603 | ||
| Bladder Cancer | 603 | ||
| Arsenic. | 603 | ||
| Cadmium. | 604 | ||
| Water Chlorination. | 604 | ||
| Tobacco Smoking. | 604 | ||
| Bone Cancer | 604 | ||
| Arsenic. | 604 | ||
| Fluoride. | 605 | ||
| Brain Cancer | 605 | ||
| Pesticides and Herbicides. | 605 | ||
| Tobacco Smoke Exposure. | 605 | ||
| Lead. | 605 | ||
| Vinyl Chloride. | 605 | ||
| Breast Cancer | 605 | ||
| Organochlorine Compounds. | 605 | ||
| Parabens. | 606 | ||
| Colorectal Cancer | 606 | ||
| Water Chlorination. | 606 | ||
| DDT/DDE. | 606 | ||
| Head and Neck Cancer | 606 | ||
| Aluminum. | 606 | ||
| Arsenic. | 606 | ||
| Tobacco and Alcohol. | 606 | ||
| Liver Cancer | 606 | ||
| DDT. | 606 | ||
| IV Assessment of Toxic Load | 620 | ||
| 52 Assessment | 620 | ||
| Summary | 620 | ||
| Identifying Environmental Illness | 621 | ||
| Step 1: Establish Environmental Illness and Toxicant Pictures | 621 | ||
| Step 2: Identify the Pollutant(s) Most Responsible | 621 | ||
| Neuropsychological Testing. | 623 | ||
| Step 3: Identify Exposure Type | 624 | ||
| Mapping. | 625 | ||
| Step 4: Establish Timing of Exposure | 625 | ||
| Create a Timeline. | 625 | ||
| Patient Examples | 626 | ||
| Example: Timing Is Key | 626 | ||
| Case 1. MH. | 626 | ||
| Example: Putting it All Together | 627 | ||
| Case 2: MS. | 627 | ||
| The Diagnostic Opportunity Afforded by Chemical Sensitivity | 629 | ||
| Classic Patterns | 630 | ||
| References | 630 | ||
| 53 Laboratory Assessment of Toxicant Levels | 632 | ||
| Summary | 632 | ||
| Introduction | 632 | ||
| Normalizing Results | 633 | ||
| Prevention and Preconception Care | 633 | ||
| Identification of Health-Damaging Pollutants | 633 | ||
| Serum Testing | 633 | ||
| Persistent Organic Pollutants. | 634 | ||
| Solvents. | 634 | ||
| Metals. | 635 | ||
| Urine Testing | 635 | ||
| Solvent Metabolites. | 635 | ||
| Organophosphate Pesticide Metabolites. | 636 | ||
| Glyphosate. | 636 | ||
| Plastics. | 636 | ||
| Mycotoxins. | 636 | ||
| Metals. | 637 | ||
| Metal Mobilization Testing | 638 | ||
| Ensuring an Accurate Result. | 638 | ||
| Breath Testing | 639 | ||
| Refereences | 639 | ||
| 54 Conventional Laboratory Tests to Assess Toxic Load | 642 | ||
| Summary | 642 | ||
| Assessment of Toxic Load | 642 | ||
| Direct Measures of Toxicants | 642 | ||
| Conventional Laboratory Tests | 643 | ||
| Complete Blood Count | 643 | ||
| White Blood Cell Count. | 643 | ||
| Red Blood Cell Count. | 643 | ||
| Platelets. | 644 | ||
| Basophilic Stippling. | 644 | ||
| Liver Enzymes | 644 | ||
| Gamma-Glutamyltransferase. | 644 | ||
| Alanine Transaminase. | 645 | ||
| Alkaline Phosphatase. | 647 | ||
| Inflammatory Markers | 647 | ||
| Lipids | 647 | ||
| Thyroid Hormones | 648 | ||
| Metabolites | 649 | ||
| Uric Acid. | 649 | ||
| Bilirubin. | 649 | ||
| Homocysteine. | 649 | ||
| Blood Sugar Regulation | 650 | ||
| Clinical Application | 650 | ||
| References | 653 | ||
| 55 8-Hydroxy-2’-deoxyguanosine and Other Nucleoside Metabolites | 657 | ||
| Summary | 657 | ||
| Description | 657 | ||
| Assessment of Urinary 8-OHdG | 657 | ||
| Sources | 658 | ||
| Air Pollutants | 658 | ||
| Tobacco Smoke. | 658 | ||
| Urban Air Pollution. | 658 | ||
| Perfluorinated Compounds. | 659 | ||
| Water-Damaged Buildings. | 659 | ||
| Food Pollutants | 659 | ||
| Cadmium. | 659 | ||
| Lead. | 659 | ||
| Mercury. | 659 | ||
| Organophosphate Pesticides. | 660 | ||
| Water Pollutants | 660 | ||
| Clinical Significance | 660 | ||
| Cardiovascular Disease | 660 | ||
| Neoplasia | 660 | ||
| Diabetes | 661 | ||
| Intervention | 661 | ||
| References | 661 | ||
| V Biotransformation and Excretion | 667 | ||
| 56 Biotransformation and Elimination | 667 | ||
| Summary | 667 | ||
| Functionalization (Phase 1) | 668 | ||
| Induction (Upregulation) | 670 | ||
| Inhibition (Downregulation) | 671 | ||
| Paraoxonase | 672 | ||
| Conjugation (Phase 2) | 673 | ||
| Acetylation | 673 | ||
| Amino Acid Conjugation With Glycine, Taurine, or (Less Often) Glutamine | 674 | ||
| Glucuronidation | 674 | ||
| Glutathione Conjugation | 674 | ||
| Methylation | 675 | ||
| Sulfur Conjugation | 676 | ||
| Routes of Excretion (Phase 3) | 676 | ||
| Assessment | 677 | ||
| References | 678 | ||
| 57 Lung Excretion | 686 | ||
| Summary | 686 | ||
| Introduction | 686 | ||
| Function | 686 | ||
| Gas Exchange | 686 | ||
| Lung Excretion of Toxins. | 686 | ||
| Biochemical Transformation | 687 | ||
| Macrophages and the Mucociliary Escalator | 688 | ||
| Other Considerations | 688 | ||
| Analysis | 689 | ||
| Specific Toxicants | 689 | ||
| Mercury | 689 | ||
| Ethanol | 689 | ||
| Acetaldehyde | 690 | ||
| Perchloroethylene | 690 | ||
| References | 690 | ||
| 58 Hair Excretion | 692 | ||
| Summary | 692 | ||
| Introduction | 692 | ||
| Hair Mineral Analysis | 692 | ||
| Hair Growth | 693 | ||
| Hair Composition | 693 | ||
| Keratin. | 693 | ||
| Excretion of Minerals and Metals | 693 | ||
| Hair Status and Systemic Disease | 693 | ||
| Excretion of NonElemental Toxins and Toxicants | 695 | ||
| Drugs of Abuse | 695 | ||
| Pesticides | 695 | ||
| Doxycycline | 695 | ||
| Mercury | 695 | ||
| Autism: Analysis of Hair Testing Data With Pathophysiological Implications | 695 | ||
| Toxic Metals | 696 | ||
| Trace Elements | 696 | ||
| Genetics | 697 | ||
| References | 698 | ||
| 59 Breast Milk Excretion | 704 | ||
| Summary | 704 | ||
| Introduction | 704 | ||
| Synthesis and Composition of Breast Milk | 704 | ||
| Analytical Considerations | 705 | ||
| Depuration | 706 | ||
| Analysis | 706 | ||
| Toxicants Excreted in Breast Milk | 706 | ||
| Persistent Organic Pollutants. | 706 | ||
| PCBs, organochlorine compounds, and polybrominated biphenyls. | 706 | ||
| Dioxins and Furans. | 707 | ||
| Toxic Metals. | 707 | ||
| Aluminum and lead. | 707 | ||
| Mercury. | 707 | ||
| Cadmium. | 707 | ||
| Other Toxicants. | 707 | ||
| References | 707 | ||
| VI Therapeutics | 709 | ||
| 60 Avoidance | 709 | ||
| Summary | 709 | ||
| Introduction | 709 | ||
| Reducing Exposure to Air Pollutants | 710 | ||
| Construction Practices for Less-Toxic Homes and Offices | 710 | ||
| Green Buildings. | 711 | ||
| Remediation of Mold- and Water-Damaged Buildings | 711 | ||
| Reduction of Sources of Indoor Air Pollution | 712 | ||
| Removing Pollutants From the Indoor Air | 712 | ||
| HVAC filters. | 712 | ||
| Air purifiers | 713 | ||
| Masks. | 714 | ||
| Personal ionic air purifiers. | 715 | ||
| Indoor houseplants. | 715 | ||
| Reducing Exposure to Food Pollutants | 716 | ||
| Avoiding the Most Toxic Fruits and Vegetables. | 716 | ||
| Fish | 717 | ||
| Plastic Contamination | 719 | ||
| Water | 719 | ||
| Personal Care Products | 719 | ||
| References | 719 | ||
| 61 Sauna | 724 | ||
| Summary | 724 | ||
| Overview | 724 | ||
| Sauna Types | 724 | ||
| Radiant-Heat Saunas | 724 | ||
| Dry-Heat Saunas | 724 | ||
| Infrared Saunas (Infrared and Far-Infrared Saunas) | 724 | ||
| Wavelength Tissue Penetration. | 725 | ||
| Physiological Response to Sauna Therapy | 725 | ||
| Specific Benefits | 725 | ||
| Cardiovascular. | 725 | ||
| Myocardial infarction. | 725 | ||
| Hypertension. | 726 | ||
| Congestive heart failure. | 726 | ||
| Neurological | 727 | ||
| Anorexia nervosa. | 727 | ||
| Bipolar disorder. | 727 | ||
| Dementia. | 727 | ||
| Depression. | 727 | ||
| Pain. | 727 | ||
| Respiratory. | 727 | ||
| Autoimmunity. | 728 | ||
| Chronic Fatigue. | 728 | ||
| Depuration (Excretion of Toxicants) | 728 | ||
| Mercury. | 728 | ||
| Lead. | 728 | ||
| Cadmium, Nickel, and Antimony. | 728 | ||
| Bisphenol A and Phthalates. | 728 | ||
| Chlorinated Pesticides and Polychlorinated Biphenyls. | 728 | ||
| Protocols. | 729 | ||
| Hubbard Method. | 729 | ||
| Rea Protocol. | 730 | ||
| Crinnion Naturopathic Protocol. | 731 | ||
| Contraindications for Sauna Therapy | 731 | ||
| References | 732 | ||
| 62 Gastrointestinal and Renal Elimination | 737 | ||
| Summary | 737 | ||
| Overview | 737 | ||
| Reducing Hepatic and Renal Recycling (Reabsorption) | 737 | ||
| Renal Recycling | 737 | ||
| Hepatic Recycling | 738 | ||
| Microbiome. | 738 | ||
| Intestinal Binding Agents | 738 | ||
| Cholestyramine. | 738 | ||
| Activated charcoal. | 738 | ||
| Fibers. | 738 | ||
| Chlorophyll. | 739 | ||
| Fecal Fat Enhancement | 739 | ||
| Pancreatic Lipase Inhibitors | 739 | ||
| Bowel Cleansing | 740 | ||
| Retrograde Colonic Irrigation. | 740 | ||
| Colonic Irrigation. | 741 | ||
| References | 743 | ||
| 63 Microbiome | 748 | ||
| Summary | 748 | ||
| Overview | 748 | ||
| Health Properties of Probiotics | 748 | ||
| Endotoxemia | 749 | ||
| Factors That Alter the Microbiome | 749 | ||
| Xenobiotics. | 750 | ||
| Specific Benefits | 750 | ||
| Gastrointestinal Health | 750 | ||
| Immune Function | 750 | ||
| Allergy | 751 | ||
| Inflammation | 751 | ||
| Neuroinflammation | 753 | ||
| Traumatic Brain Injury. | 753 | ||
| Autism. | 753 | ||
| Cognition. | 753 | ||
| Mood. | 753 | ||
| Gastrointestinal Inflammation and Function | 754 | ||
| Gluten intolerance and celiac disease. | 754 | ||
| Endotoxemia. | 754 | ||
| Biotransformation and Excretion. | 754 | ||
| Support | 755 | ||
| Diet | 755 | ||
| Mediterranean Diet. | 755 | ||
| Berries. | 755 | ||
| Botanical Medicines. | 755 | ||
| Probiotics. | 755 | ||
| Prebiotics. | 755 | ||
| References | 757 | ||
| 64 Chelation (Oral and Intravenous) | 765 | ||
| Summary | 765 | ||
| Description | 765 | ||
| Chelating Agents | 766 | ||
| Desferrioxamine or Deferoxamine | 767 | ||
| 2,3-Dimercaptopropane-1-Sulfonate | 767 | ||
| 2,3-Dimercaptosuccinic Acid | 767 | ||
| 2-[2-[Bis(carboxymethyl)amino]ethyl-(carboxymethyl)amino]acetic Acid | 768 | ||
| N-Acetyl Cysteine | 769 | ||
| Other | 769 | ||
| Chelatable Toxicants | 769 | ||
| Aluminum | 769 | ||
| Lead | 770 | ||
| Mercury | 770 | ||
| Arsenic and Cadmium | 771 | ||
| References | 772 | ||
| 65 Nutritional Supplementation for Environmental Toxins and Toxicants | 777 | ||
| Summary | 777 | ||
| Overview | 777 | ||
| Most Common Natural Antitoxicant Compounds | 777 | ||
| Enhancement of Biotransformation and Excretion | 778 | ||
| Phase 1: CYP and Other Common Oxidase Enzymes | 778 | ||
| Phase 1: Paraoxonase | 778 | ||
| Phase 2: Conjugation | 778 | ||
| Amino Acid Conjugation | 778 | ||
| Glucuronidation | 778 | ||
| Glutathione | 779 | ||
| Amelioration of Specific Toxicant-Induced Damage | 779 | ||
| Metals | 779 | ||
| Arsenic. | 780 | ||
| Cadmium | 781 | ||
| Mercury | 781 | ||
| Lead | 782 | ||
| Polycyclic Aromatic Hydrocarbons | 783 | ||
| Solvents | 785 | ||
| Pesticides and Antimicrobials | 785 | ||
| Mycotoxins | 787 | ||
| References | 787 | ||
| Appendix A Dimercaptosuccinic Acid Metal Mobilization Protocol: Two Days On and Five Days Off | 798 | ||
| Appendix B Dimercaptosuccinic Acid Metal Mobilization Protocol: Five Days On and Nine Days Off | 799 | ||
| Appendix C CaEDTA/DMPS IV Metal Mobilization Protocol | 800 | ||
| Appendix D Intravenous Metal Mobilization Testing | 802 | ||
| Appendix E Oral Metal Mobilization Testing | 803 | ||
| Appendix F Environmental Exposure Questionnaire | 804 | ||
| A. Metabolism of Pollutants: | 804 | ||
| B. Toxicant-Related Health Problems: | 804 | ||
| C. Pollutant Exposure: | 805 | ||
| Air Pollution | 805 | ||
| Food Pollution | 807 | ||
| Metals | 807 | ||
| Mycotoxins | 808 | ||
| Lifestyle Pollutants | 808 | ||
| Environmental Toxic Exposure / Residence History | 809 | ||
| Environmental Toxic Exposure / Occupational History | 809 | ||
| Appendix G Environmental Exposure Questionnaire: Interpretation Guide | 810 | ||
| A. Metabolism of Pollutants: | 810 | ||
| B. Toxicant-Related Health Problems: | 810 | ||
| C. Pollutant Exposure: | 811 | ||
| Air Pollution | 811 | ||
| Food Pollution | 813 | ||
| Metals | 814 | ||
| Mycotoxins | 814 | ||
| Lifestyle Pollutants | 815 | ||
| Index | 816 | ||
| A | 816 | ||
| B | 818 | ||
| C | 819 | ||
| D | 822 | ||
| E | 823 | ||
| F | 824 | ||
| G | 825 | ||
| H | 826 | ||
| I | 827 | ||
| J | 827 | ||
| K | 827 | ||
| L | 827 | ||
| M | 828 | ||
| N | 831 | ||
| O | 832 | ||
| P | 833 | ||
| Q | 836 | ||
| R | 836 | ||
| S | 837 | ||
| T | 838 | ||
| U | 840 | ||
| V | 840 | ||
| W | 840 | ||
| X | 841 | ||
| Y | 841 | ||
| Z | 841 |