I received a frantic call from a nurse/colleague, Liz, who just came back from her pediatrcian’s office with a long list of questions concerning recent abnormal laboratory results for her five-year-old daughter, Sarah. Her physician had reviewed the lab results with her, but she wasn’t satisfied with his answers. Sarah was being evaluated for obesity. Her height was calculated at the 50th percentile and her weight was above the 97th percentile on the growth chart, with a BMI of 27.1 (placing the BMI-for-age at greater than 99th percentile consistent with the diagnosis of obesity). Her lab results were remarkable for an elevated fasting blood glucose, concerning hemoglobin A1C of 6.1 and a lipid profile noted to have an elevated triglyceride level of 160. I was also concerned when the mom told me her ALT (liver function test) was 40 and her physician told her to “…Stop being a nervous Nelly!” and that it was “fine.” (Clearly, he wasn’t familiar with lab value recommendations for kids!)¹ Her MD’s advice was to increase Sarah’s exercise and put her on a Weight Watcher’s diet along with Mom who was also overweight and trying to manage her Type II diabetes. Oy vey!

It was disheartening to learn that some of my colleagues had not moved out of the dated 1970s medical mantra that obese patients (even kids) overate and were lazy. I’ve been out of the mainstream medicine world so long that I forgot that pediatricians are undernourished with nutritional knowledge and overfed with drug information. Not to mention, there is a global lack of awareness of the myriad number of other factors that can contribute to obesity in kids. In the age of technology-driven learning/play and fast-food delivery services, indeed, getting kids to move and eat well are a big part of the conversation. However, let’s talk about the elephant in the room.

The ABCs of EDCs

Substantial evidence has emerged over the last decades that exposure to endocrine-disrupting chemicals (EDCs) is connected to obesity and obesity-related metabolic diseases.² EDCs act as hormones, even in nano doses (which can cause larger or different effects than higher doses called nonmonotonic dose responses). Childhood obesity is now epidemic reported to affect 20% of US kids aged 2-19 years.² According to the Global Burden of Disease Obesity Collaborators, in 2015, a total of 107.7 million children and 603.7 million adults worldwide were obese.³ Indeed, there is much written about the contribution of industrialized food and their associated pesticides as well as decreased nutrients in the food supply to account for this issue. However, environmental toxicity is playing an ever increasing and overlooked role in this obesity pandemic.

Going to the Source

One of the largest sources for EDCs are the effluents from sewage treatment plants (biosludge). (Want to watch a Friday night horror film? https://www.biosludged.com.) In 1986, when the US decided that the “solution to pollution was dilution” (ocean dumping) was no longer an option, we turned to using our wastewater filled with toxic chemicals as fertilizer. In addition, children can be exposed to EDCs via the placenta/breast milk, air pollution, toxic dust, personal care products, contaminated food (i.e., processed food container liners), cookware/household items, and environmental ingestions simply from hand-to-mouth behaviors when playing. Two classes of the biggest obesogens (a term now applied to certain EDCs) that are ubiquitous are bisphenols and phthalates, but there are many toxic endocrine mimics.

The chemical soup of EDCs, to which many of us are already familiar, includes the following:

• Polychlorinated and polybrominated biphenyls (PCBs and PBBs)
• Bisphenols (BPA from plastics, Bisphenol S [BPA substitute], BPF and BPAF)
• Phthalates (DEHP, DINP, DOP, DIDP, DINCH)
• Perfluorooctanoic acid (PFAS/Teflon: ‘Forever Chemicals’ found in 99% of Americans)
• Parabens (preservatives; look for words ending with -parabens)
• Triclosan/Triclocarban (Hand sanitizers)
• Dioxin (high in animal products)
• Dichlorodiphenyltrichloroethane (DDT)
• Pesticides (organophosphates, atrazine)
• Vinclozolin (Fungicides)
• Perchlorate (found in baby formula!)
• Polybrominated diphenyl ethers (PBDEs: Fire retardants – 100% of people are positive in the state of California)
• Pharmaceutical chemicals
• Heavy metals (lead, mercury, arsenic)
• Solvents
• Fragrances – complex combinations of EDC chemicals (phthalates in 100% of tested fragrances)

The intent of this article is not an academic review of EDCs, but to raise awareness regarding these ubiquitous chemicals that have been invading children’s bodies for decades and offer evaluation and treatment solutions. For an in-depth review of the subject, I refer you to an excellent medical toxicology text, Clinical Environmental Medicine (Crinnion/Pizzorno, 2018). This is also a great segue into a pitch to join the National Association of Environmental Medicine (NAEM) which has abundant resources on EDCs and other toxicants.⁴

Are EDCs Causative for Sarah’s Obesity and Obesity-Related Issues?

As reported in so many ‘Pearls’ prior, the first place I start is the history. I had Sarah and Liz come into the office for a second opinion and sought out our usual root cause assessment for obesity/metabolic dysregulation, Type II diabetes, hypertriglyceridemia and mild hepatitis. The list of potential obesogens and triggers were long, including a stressed-out single mom who ate a lot of junk food (no organics) during pregnancy, had regular manicures, used a vast number of personal care products, including hair dyes and make-up and worked in a hospital setting with significant exposures to hand sanitizers and plastics, guzzling down iced decaf coffee sweetened with Splenda®. Sarah was bottle-fed with non-organic formula, ate a lot of microwaved frozen pizza, drank tap water, lived in an apartment where Mom used fragrant candles and roach sprays and attended a newly remodeled primary school: An unfortunate portrait of the modern American family.

Trying to reeducate parents that are entrenched in Western medical thinking can present a real challenge. Treating children with obesity from whatever causes can be difficult since you are not only treating the child, but the parents’ deeply held beliefs regarding food. There is no quick fix! When I explained that the environmental factors were the likely culprits for Sarah’s issues, Mom was not only dubious but wanted to know why she’s never heard this before. Sigh. That could have taken a few days to explain. I decided to show her some of the chemicals bathing Sarah’s body and ordered an environmental pollutants panel. Funds were limited, so I only ordered one test from US Biotek (and urine samples are a great way to go in kids).⁵ Since there are many testing challenges, such as short half-lives and incomplete testing of some of the toxicants, I utilize it more as a tool for nay-sayers to overcome mental hurdles (in particular, mainstream medical professionals). Some individuals also are not good excreters of toxicants, so ‘normal’ results may not mean that there aren’t significant exposures. For Sarah’s sake, I was hoping it would show what I thought it would in order to persuade Mom to make some needed changes.

Of the 14 metabolites reported, Sarah was off the charts for all but three of the reported chemicals. She had significant benzene, trimethylbenzene, styrene, phthalate and paraben exposures. I recommended to Liz that she read the classic book Our Stolen Future (Colborn, et al.,1996) and gave her references (www.madesafe.org) to assist her understanding in the health:toxicology interface. Eventually, most of our patients will know more about toxicology than their primary care physicians once they get on board. While many people are aware of the adverse role of plastics on health, other chemical toxicants do not have the same celebrity status. I explained that there are reports in the literature dating back to 1997 that showed solvents (which were very high in Sarah), were also EDCs, so there were many chemical groups causing metabolic disruption to consider.⁶ And we know very little about the health effects of the many-ingredient toxicant soup to which we are all exposed.

What really convinced Mom to trust a different approach was she really didn’t want Sarah to follow in her diabetic footsteps. This graph below showing correlation between organic pollutants and diabetes was helpful in our discussion; and since parents don’t necessarily come with PhDs in environmental health, I use a lot of diagrams, graphs, and summaries to go home with (see example chart).⁷

Sarah was a hot, toxic mess.

A Treatable Condition

I begin treatment with my favorite cliché, “This is a marathon, not a sprint.” My treatment protocol, which occurred over two years, is enumerated below. This was developed with the knowledge that Mom had a limited budget and time, so we worked together within those parameters.

Phase I consisted of reducing the toxic load in order to give her detox pathways a little breathing room to do their job:

1. Organic diet – no take-out
2. Eliminate all processed foods – no cans, packaged foods
3. Filtered water only
4. Eliminate plastics in food preparation
5. Toss the microwave
6. Ban the Teflon
7. No fragrances!
8. Make friends with insects
9. Regular activity daily with Mom
10. Limit screen time, especially before bedtime
11. Shut the wifi at night
12. Switch to non-toxic cleaning products and hand sanitizer

Phase II consisted of healing intestinal permeability/dysbiosis since the majority of kids I see with chronic diseases have both. I test when feasible.

1. German Biologic Medicine for gut healing
2. Removal of inflammatory foods (dairy and gluten)
3. Introduction of fermented foods/probiotics
4. Bolster antioxidants (Vitamins C, D, A and E which also protective against solvent exposures)
5. Omega 3s – I like algae omegas in kids

Phase III consisted of detoxification strategies. (Homeopathics are the core of my go-tos):

1. Homeopathic detox focused on liver, kidney, and lymph drainage
2. N-Acetyl cysteine (NAC)
3. Alkalization with lemon water and increased greens/herbs in smoothies
4. Sauna three times/week
5. Curcumin (for everything)!

Sarah did not lose any weight, nor did she gain any more weight over the next two years. I met with her monthly to check in and give Mom support. However, all of her abnormal lab values returned to better than normal over six months. What was most interesting is that Sarah’s body habitus changed. Prior to our treatment, she was very rounded in her chest and had evidence of early puberty. Her torso elongated, puberty arrested, and she grew in height. Mom lost 40 lbs. following the same protocol, and her Type II diabetes was history.

Recognizing, diagnosing, and treating children for environmental toxicity should be the focus of pediatric education; and it behooves any practitioner that works with families to include environmental health analyses in their child encounters.

References

(For an excellent review for patients, download the PDF at Environmental Working Group: https://static.ewg.org/pdf/kab_dirty_dozen_endocrine_disruptors.pdf?_ga=2.53040298.305740248.1611525098-709861240.1611525086)

1. Schwimmer JB, et al. SAFETY Study: Alanine aminotransferase cutoff values are set too high for reliable detection of pediatric chronic liver disease. Gastroenterology; 2010 Apr; 138(4):1357-1364.
2. https://www.cdc.gov/obesity/childhood/index.html
3. GBD 2015 collaborators. Health Effects of Overweight and Obesity in 195 Countries over 25 Years; NEJM; 2017; 377:13-27; DOI:10.1056/NEJMoa1614362
4. https://envmedicine.com
5. https://www.usbiotek.com/tests/environmental-pollutant-profile
6. Merrill EA, et al. Endocrine Disruptors: An Evaluation of Solvents, Deicers and Jet Fuels: USAF Research Laboratory; 1997; AL/OE-TR-1997014
7. https://envmedicine.com/wp-content/uploads/2020/11/Screen-Shot-2020-11-03-at-2.57.39-PM-1024×799.png