KEYWORDS: Neuroinflammaiton, environmental medicine, Pollution, Toxic chemicals, Autoimmunity/Leaky gut, Estrogen, Cannabis, Sleep, microbiome, Mediterranean Diet, Glutathione

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Environmental Health Symposium: The Elephant in The Waiting Room – Neuroinflammation

By Jim Cross, ND

This is an overview of the second annual Environmental Health Symposium, a collaboration of the Annual Updates in Environmental Medicine and the Seeds of Doubt Conferences held in San Diego, California, on March 3-5, 2017. Their goal was to choose the topic of neuroinflammation, study it thoroughly, and then seek out the best speakers on the topic so that attendees could fully learn the causes, presentations, and treatment of this pervasive problem. They also wanted the attendee to leave there feeling that they were fully capable of recognizing this condition in their patient population and would be able to help those individuals in their clinics on Monday.

I do not have enough space to cover every presenter, and I will be synopsizing the various presentations I feel spoke to me most powerfully. Hopefully, I don’t offend any of the speakers I don’t include or any attendees who can’t believe I didn’t write about their favorite lecture.

Walter Crinnion, ND, and Lyn Patrick, ND, are the driving forces behind this wonderful constellation of stellar presenters and topics apropos of the present neuroinflammatory epidemic that exists in the United States. Unfortunately, truth is no match for belief, and we are facing an administration whose Environmental Protection Agency head thinks there are no problems with astronomical levels of CO2 in the atmosphere and thousands of chemicals in our food, water, and air. Shades of James Watt!

Walter started out the pre-conference on Thursday with a wonderful statement: It is never a question of if someone is burdened with toxicants. It is a question of whether their toxicant burden is a causative factor in their illness or an obstacle to their cure. I am going to add a slight addendum to his prescient statement: or is it both a causative factor and an obstacle? I think in many of our current patients this is the case. Now, if we could only convince most of our patients of this statement (more importantly our politicians), maybe we could also begin the arduous task of ridding our environment of noxious chemicals and heavy metals!

Walter presented again on Thursday and gave three really useful resources:

1. A website that showed an air pollution map of the world: http://aqicn.org/map/world/.

2. A website that listed fracking sites around the United States: http://earthjustice.org/features/campaigns/fracking-across-the-united-states.

3. Finally, he gave us an all-inclusive questionnaire for determining an environmental patient’s biotransformation ability, their current exposure history, their residential and job history, and their heavy metal exposures. What a wonderful armamentarium of information that left you feeling locked and loaded in terms of determining what the causative and aggravating factors are for each patient.

On Friday, the official first day of the conference, Walter’s talk focused on what I think is a very useful metaphor, “the elephant in the room.” You know, the one sitting in the corner, invisible, while everyone’s brain is being bombarded by environmental pollutants. Here is his list of documented neuroinflammatory agents:

• Urban air pollution (esp. diesel exhaust),

• Organophosphate pesticides,

• Chlorinated pesticides (dieldrin),

• Mercury and Lead,

• Solvents (alcohol is the classic one),

• Formaldehyde,

• Bisphenol A (no articles yet on phthalates), and

• Rotenone and paraquat.

All are pro-oxidants, all deplete GSH, and all suppress antioxidant enzymes. Tough to avoid this rogue’s gallery of corporate greed. Fortunately, we integrative medicine practitioners have the means with which to help the few among the many who arrive at our door with the various modern maladies plaguing our society.

The next speaker to really catch my eye was Aristo Vodjani, PhD in microbiology and clinical immunology. I have heard Dr. Vodjani speak at several conferences and am always amazed at what test or tidbit he comes up with next. I don’t think he believes in the status quo. He also admitted to being chemically sensitive, which might be a driving force in his continued push to expand his immunological knowledge.

His talk revolved around autoimmune destruction of the tight junction proteins in the gastrointestinal epithelial layer. This destruction leads to leaky gut and then destruction of the blood brain barrier from leaked compounds of the GI tract traveling upwards and compromising the blood brain barrier, basically leaky brain. This is the initiating process for neuroinflammation. He has a wonderful slide demonstrating this process and then a research report showing that brain-reactive autoantibodies are nearly ubiquitous in human serum and linked to various brain pathologies. Cyrex Labs now has an antibody test specifically for this: Blood Brain Barrier Permeability. For my money, correcting leaky gut and the subsequent leaky brain that accompanies it are the basis of any treatment I use for chronic diseases.

The next interesting presenter for me was Kenneth Proefrock, ND. I could list his accomplishments, which are prolific, but I loved this little statement at the end of his written introduction: “In his spare time, when such a thing really exists, he is in the desert with his kids, honing his skills in primitive archery, gardening, home brewing, wildcrafting, reading and writing poetry, and studying obscure and old texts on spiritual matters, healing, and philosophy.” Fortunately, he also gave a slam-bam talk on botanical agents, about which he appears to have a very eclectic knowledge.

What I found fascinating was his description of endocannabinoids as central nervous system regulators of many processes, including neuroinflammation. One slide showed the various brain areas that have CB-1 receptors. Another slide demonstrated the multiple areas around the body where CB-2 receptors occur in association with immune tissues. Finally, he showed a slide that demonstrated blending various cannabis strains often works the best. It appears that the various endocannabinoids will give us fantastic results in our treatment of neuroinflammation and brain trauma.

The next premier batter up was Michael Irwin, MD. Dr. Irwin is one of the world’s foremost experts on the psychoneuroimmunological pathways by which psychosocial and behavioral factors influence health and disease. Much of his talk centered on sleep and the negative bodily effects less sleep has on the body.

He connected sleep, fatigue, and depression quite effectively. He also showed that decreased sleep is a gateway to neuroinflammation by activating cellular inflammatory signaling through adrenergic activation of nuclear factor kappa beta, which then leads to activation of pro-inflammatory cytokines (IL-1, IL-6, TNF-alpha). If you’re a biochemical geek like me, real juicy science!

He also showed that cancer survivors, especially breast cancer, have 50% increased incidence of insomnia, which would dampen their immune systems and possibly lead to a reoccurrence of their cancers or other downwind diseases of stress like cardiovascular disease, autoimmune diseases, or major neurological diseases. Finally, he said there is a huge variability in the effects of stress on each individual, and we need to be able to more precisely evaluate the specific effects of stress for each individual.

Next came Felice Gersh, MD. Dr. Gersh is one of only a small number of fellowship-trained integrative gynecologists in the nation. Wow, does she understand the female reproductive system, and did I ever discover female reproductive tibbits! She felt that estrogen is one of the major conductors of our endocrine system and that our world of increasingly larger numbers and amounts of endocrine disruptors are negatively impacting the positive effects of estrogen on our bodies. She also had a wonderful slide that demonstrated the multiple areas of the body, outside of the reproductive tract, with estrogen receptors and thus affected by estrogen.

A few quick hitters from Dr. Gersh:

• Estrogen is neuroprotective and crosses the blood brain barrier/BBB.

• Estriol only activates the beta estrogen receptors and downregulates the alpha estrogen receptors. Why not give the body bioidentical estradiol and let it decide which form it needs?

• Astrocytes produce estradiol, which inhibits microglia and decreases neuroinflammation.

• We need to start bioidentical hormone replacement therapy/BHRT earlier because estrogen receptors will then start to degenerate as the woman ages, which means older women who have not started BHRT may need larger doses initially because of receptor resistance.

• Too little estradiol may elicit no effect whereas too much could lead to cognitive dysfunction. You need to ascertain the sweet spot.

• Use variable dosing during a month’s prescription of hormones to attempt to mimic a “normal menstrual cycle.”

: If you wish to practice integrative gynecology, study with this woman or entice her to start giving regular seminars!

We now find ourselves with Walter Crinnion again on the topic of the microbiome and neuroinflammation. Here again, an awesome amount of useful, clinical information. I will focus, though, on one line that he reframed from Kevin Costner’s epic movie about baseball and life, Field of Dreams: If you feed them, they will come! I think it is possibly the simplest, most useful line I could ever use with patients.

My college basketball coach taught me that you could only get one point across in a time-out in the middle of a game. I think a similar attitude exists with our patients. We can’t fill their heads with endless studies and information that either they don’t care about or don’t understand, but we can use one liners to get our points across that they will never forget and at the same time make Johnny Carson nod his head in approval!

Probiotic bacteria require food to thrive and survive. That food is cellulose, commonly called fiber. Where do we find it? Vegetables, fruits, nuts, beans, seeds, whole grain. I think we have our concept of superfoods mixed up. Locally grown, whole foods in their natural state are our real superfoods for numerous reasons but, here, they nurture and nourish the bacterial flora that will positively impact our health in multiple ways. Thanks, Walter, for giving me a line that I’ll use with my patients until my dying day and hopefully into my next life!

Next up, Walter and Lyn brought in a heavy hitter from Greece, Artemis P. Simopoulos, MD. Her topic was “Intervention for Neuroinflammation: The Greek Mediterranean Diet.” Dr. Simopoulos throws the whole idea of a “Mediterranean Diet” for a bit of a loop. First off, she had a wonderful picture of the 20 or so countries that actually line the Mediterranean Sea. Her point was that there are similarities between the diets of these various cultures but also significant differences that probably preclude one from scientifically pontificating on the value of the Mediterranean diet.

Being Greek, she focused on the extremely positive choices that Greeks, in particular, seem to be making dietarily, specifically on the Greek island of Crete. One was the omega-3:omega-6 ratio in the diet of various countries. Greece has the ratio closest to Paleolithic times (0.79), 1.00 – 2.00. Japan’s ratio is 4.0 and, currently, the USA’s is 16.74. She then had multiple slides touting the health effects of omega-3 fats to back up her superior Greek ratio.

One slide showed typical foods eaten by Cretans every day in the 1960s. They included omega-3 rich foods such as snails, fish, herring, Greek eggs, Greek cheeses, and purslane. Purslane is a very interesting plant. Its omega-3 content is 8.5 mg/gram of plant material, which contains various omega-3 fats. The closest competitor to this amount is spinach at 1.6 mg/gram and mustard at 1.101 mg/gram. When I told my wife this, she said we have a purslane growing wild on our property. I think we’re going to start including it in our spring salads! I also think we need to vacation in Crete for a month every Spring to consume their purslane!

Saturday was closed out by Joe Pizzorno, ND. His topic was “Toxins Have Become the Primary Drivers Of Disease.” Dr. Pizzorno had just released his new book, The Toxin Solution: How Hidden Poisons in the Air, Water, Food, and Products We Use Are Destroying Our Health – And What We Can Do to Fix It. I highly recommend the book as I came away from the read with an immense amount of new information on what we’re exposed to and how we can help ourselves and our patients avoid and deal with the environmental loading of our bodies with material that isn’t very helpful to our various systems.

Dr. Pizzorno basically laid out, scientifically and in great graphic detail, the link between various chronic diseases, especially diabetes, and multiple environmental pollutants. He had a wonderful quote, “toxicity has become the new normal,” on the side of a slide. He then proceeded to show on the rest of the slide the toxin, in what environmental chemical it is located, its use, its threshold for disease association, its percent of US use above the threshold, and disease associations for various common pollutants like BPA and arsenic. Extremely powerful information!

Next Dr. Pizzorno makes the powerful point that there is a huge detoxification variability in our clients because of their rather large genetic variability in their liver’s ability to effectively eliminate these various pollutants in their Phase I and Phase II detoxification system. He also had a wonderful slide with various toxins’ half lives in our blood and tissues. Finally, a slide contained the CDC’s list of worst toxins. More importantly for us, he followed that slide up with a slide of the worst toxins clinically. This is real heady material, meticulously researched, and presented in an easy to understand and clinically useful format. Thanks, Joe!

The last person I will review is Tim Guilford, MD. Dr.Guilford’s study of the role that glutathione plays in the basic mechanism of many diseases led him to perform some excellent research on glutathione and its role in the treatment of various chronic diseases. Many speakers touched on the role of glutathione in the effective elimination of the various pollutants, but Dr. Guilford appears to have raised the bar to an extremely high level in his research on how to clinically incorporate glutathione into your treatment protocol.

One of his slides was extremely interesting and talked about glutamate cysteine ligase/GCL. GCL catalyzes the rate-limiting step in the formation of the cellular antioxidant glutathione (GSH). The GCL holoenzyme consists of two separately coded proteins, a catalytic subunit (GCLC) and a modifier subunit (GCLM). Both GCLC and GLCM are controlled transcriptionally by a variety of cellular stimuli, including oxidative stress. Where it became very interesting was when Dr. Guilford stated that some autistics are missing the GLCM modifier, which would most definitely decrease their ability to make glutathione. He later stated that GCLC was blocked by mycotoxins, which would also decrease a person’s ability to make glutathione when exposed to mycotoxins. This little bit of biochemical knowledge potentially sheds light on potential remedies for autism and persons beset with mycotoxins. This is potentially very useful information. Hopefully in the future, we’ll find out how to positively intervene in GCLC and GCLM production, so we can foster positive glutathione production.

Finally, allow me a clinically observational aside. I really liked Dr. Guilford’s information and sources. I found him leaving the seminar after the talk and approached him to ask a question. He had mentioned during the talk that he had been on a bit of a healing quest. He answered my question, but clinically he didn’t look very well. Dr. Guilford, you’re a tremendous asset to the profession. Hopefully, you successfully deal with whatever health issue is plaguing you!

So, to conclude, wonderful information but I think the real issue here is a slightly different elephant in the room. That elephant is corporate greed and corporate malfeasance. We, the integrative medical community, are the yin to the corporate yang. Without us, the public hears only one message of corporate innocence in the destruction of our environment and that corporate profits supersede environmental health. I feel it is our responsibility to not only treat our patients integratively but also to educate them about what is happening environmentally to our world and what they can do to help stop and reverse the negative corporate impact. Many people want to remain quiet and not rock the boat, but this strategy unfortunately allows corporate mentality unprecedented opportunities for profit without consideration of the unimagined environmental horrors that will result from their ill-considered economic adventures, as this political cartoon by Bob Mankoff so clearly illustrates.

(Personal permission by the author of the political cartoon, Bob Mankoff)

Let me end, then, with a quote from one of the original truth tellers about our environmental destruction of the environment, Rachel Carson: “The human race is challenged more than ever to demonstrate our mastery, not over nature, but of ourselves!”