The Crunchy Allergist 0:03
Sick of the fatigue and fog? Fed up with the unpredictable flares? Hangry from the super restrictive diets?
The Crunchy Allergist 0:12
Hello, and welcome to the Crunchy Allergists Podcast, a podcast empowering those who like me appreciate both a naturally minded and scientifically grounded approach to health and healing.
The Crunchy Allergist 0:24
Hi, I'm your host Dr. Kara Wada, quadrupel board certified pediatric and adult allergy immunology and lifestyle medicine physician sjogrens patient and life coach. My recipe for success combined the anti-inflammatory lifestyle, trusting therapeutic relationships, modern medicine and mindset to harness our body's ability to heal. Now, although I might be a physician, I'm not your physician, and this podcast is for educational purposes only.
The Crunchy Allergist 0:53
Welcome, everyone. Thank you for joining us today and a huge welcome and thank you to our guest today Dr. Leo Trasand. Trasande is an internationally renowned leader in children's environmental health. His research focuses on identifying the role of environmental exposures in childhood obesity and cardiovascular risks, and documenting the economic costs for policymakers of failing to prevent diseases of environmental origin, and children proactively.
The Crunchy Allergist 1:24
After completing his undergraduate public policy and medical degrees at Harvard, he completed the Boston Combined Residency in pediatrics and a legislative fellowship in the office of then Senator Hillary Rodham Clinton, and additional training in environmental health as well. He holds appointments at the Wagner School of Public Service and NYU College of Global Public Health. And he's perhaps best known for a series of studies published that document costs of that we see due to endocrine disrupting chemicals in the US and Europe.
The Crunchy Allergist 1:59
Dr. Trasande leads one of 35 centers across the country as part of the National Institutes of Health, environmental influences on child health outcomes program. And He's author of the book, "Sicker, Fatter, Poorer: the urgent threat of hormone disrupting chemicals in our health and future, and what can we do about it?"
The Crunchy Allergist 2:19
Thank you so much for joining us today, Dr. Trasande. And it's a pleasure to meet you.
Dr. Leo Trasande 2:24
Likewise, thank you for such a warm welcome. Really appreciate it.
The Crunchy Allergist 2:29
So we have been talking a little bit on the podcast about some of the influences of our everyday lifestyle decisions on our health. That maybe you could explain to us to start, what are endocrine disrupting chemicals?
Dr. Leo Trasande 2:45
So endocrine refers to hormones in our bodies, and just boiling it down, they're signaling molecules. The more we understand human biology, the more we appreciate that. That actually is a very big tent. We used to think of endocrine as testosterone, estrogen, and thyroid, so the sex hormones and thyroid hormone for body temperature. But now we appreciate there 1000 Or so signaling molecules out there that have all sorts of bodily functions. They're basically the telecom system for the human body. And when we're talking about those molecules, those are natural molecules. When we're talking about endocrine disrupting chemicals, we're talking about synthetic chemicals. So foreign chemicals not designed with the human body in mind. And these chemicals. Some, we used to think this was the only way you could do it. But this is one way now many look like the hormones themselves and mimic it and do things that are different than the hormone was intended to do they produce different effects. Now we realize that, in this complicated world routines are regulated by other signaling to produce DNA, and then proteins, if you will, in the human body, that you don't actually have to mimic a hormone to hack a hormone. You can actually hack a hormone, and all sorts of different other ways as well. So the universe of chemicals, and we're still scratching the surface that can hack hormones are on the order of at least 1000. And that's just based on what we've tested. When you look at the broader universe that we haven't tested, there are so many probable endocrine disruptors that we haven't even scratched the surface. So that could keep us gainfully employed for a long time, which is not a good thing. Really the ideal world is that we would test chemicals before they're used and make sure they're hormone safe, before introducing them into the big Bad world.
The Crunchy Allergist 5:01
But from my understanding how our system is set up now, it's innocent until proven guilty, correct?
Dr. Leo Trasande 5:09
Yes, generally speaking, there's been some progress. I would say at the end of the Obama administration, there was an update to the Toxic Substances Control Act. This is the EPA regulatory permission to see over chemical safety. But if you go, for example, to the Food and Drug Administration side, there are some huge holes when it comes to chemicals unintentionally intentionally added to food. And then when you get into the cosmetic and personal care product space, there's an entire loophole called the fragrance loophole, you could practically drive a truck through it, because if it's a fragrance, you don't have to even admit what's in it. You just say it's a fragrance trade secrets. See you later. And that does that means we have to do a lot of detective work to figure out what's in the fragrance to just get started. Often it's chemicals we know about that's good. But it's often equally often new chemicals that are coming on the scene. The reality is we live in a world of 80 to 140,000 chemicals, one to 3000 new chemicals coming on the market each year. So this pot is becoming more and more of a witch's brew.
The Crunchy Allergist 6:29
How did you get involved into this work or get interested in in this area?
Dr. Leo Trasande 6:33
So when I applied to medical school, I was more interested in health care policy. And that was because I kept getting all these annoying interview questions about the Clinton Health Care Plan. This is before Obamacare, mind you. So I said okay, I'm going to take a year I'd gone straight from college to medical school. So I was a little young and I could take a little extra time. And so I decided to get a master's in public policy from the Kennedy School of Government. So that really transformed my mindset. And I was hooked, if you will, I had I had Capitol fever. I decided to get a year in of additional training after my pediatric residency and had the privilege of working for then Senator Hillary Rodham Clinton. And I was told to work on children's and environmental health. When I when I thought about that, I said, Okay, I've got the child health part down, but the environmental health part I'll figure it out, and the environmental health product kind of figure out, boy was I in for surprise, the average medical student gets like one to three hours of environmental health in his or her training. So do to assume that I knew everything coming in was crazy. And then to realize how big a threat environmental factors are, and human health was transformative. And the policy impacts you can that you can have on environmental exposures are profound. So for me, this was a perfect opportunity to bring my public policy interest, my medical training, and then I decided to get some additional training in environmental health. And that started me on this career where I'm studying populations of mostly kids and moms, but I'm starting to look more. Safety and protect us all.
The Crunchy Allergist 8:50
Sorry, we had a little bit of a internet issue, so I moved. No problem. Good. Hopefully, if not, we will edit.
Dr. Leo Trasande 9:04
Yes.
The Crunchy Allergist 9:07
It's interesting. You mentioned the lack of education in medical school. I have joked so my dad is retired public health. He worked for the Illinois Department of Public Health his entire career. And I joked with him in conversation when they were visiting recently that I think I learned more growing up at the dinner table with him about water safety and lead poisoning and all these different things than I ever encountered in in my education and you know, had a similar training pathway. I did med peds so kind of had that peds background, and even an allergy immunology. Um, we're talking with patients about eczema about you know, these different conditions that have a lot of an asthma as well with air pollution and so forth, but very little time is spent on the actual environmental trigger triggers the Yep, the different chemicals and all of those sorts of exposures. So why should we be? That is a natural segue? Why should we be concerned about these things?
Dr. Leo Trasande 10:16
Well, just didn't dwell on that. I think one of the things we have in common here is that, you know, we're really focused about prevention. And we are trained in the context where you are paid, if you will, for treatment. And the financial model is misaligned, in some ways, with the model that actually improves overall health. So, you know, we used to think that prevention wasn't that important. And you know, so I have empathy for for the fact that the model needs some changing, but we can't blame the messenger of that model the medical schools necessarily, we just have to try to transform it. And that's because science has taught us that these synthetic chemicals, for example, that hacker hormones, contribute to a host of consequences. So the first populations that these effects were identified were in kids, kids were our sentinels, for with implications for us with protecting us. You know, we found that thyroid hormone was crucial for a baby's brain development much before. That's why we check heel stick sticks in newborns, make them cry, get a little blood, and we make sure they don't have congenital hypothyroidism because you could treat that and prevent a lifetime of intellectual disability and other consequences. The newborn screening program is one of the crowning achievements of public health of the century. When you take a deeper look, though, it's not just gross Miss function of the thyroid hormone system. It's subtle effects on thyroid hormone, particularly not just in infancy in the newborn period, but in pregnancy, where you're relying on mom's thyroid hormone to supply a baby's brain with that growth factor. And ultimately, if you have subtle disruptions of thyroid hormone, clinically normal levels, but levels that shift, and those consequences include autism, attention deficit hyperactivity disorder and cognitive deficits. I mean, you dig deeper, flame retardants and pesticides. So flame retardants used in electronics and furniture pesticides used in agriculture, are hackers of thyroid hormone. And when you look deeper, you see effects on cognitive potential. But even images in the brain show the story. There's parts that are just not as well developed, and it matches the neuropsychological effects. So that was really the first marker that these chemicals were bad, if you will, as a category, the more we dig, the more we realize the consequences run the entire body. So we now have 50 or so chemical obesogens out there. So Bisphenol A or BPA, using aluminum can linings and thermal paper receipts, is the prototype chemical that makes us fatter, makes fat cells bigger directly disrupts the function of protein that protects the heart called adiponectin. And it's a synthetic estrogen so it can have sex specific effects on body mass. So you have all the molecular hallmarks of something that makes you fatter. These nonstick chemicals that we are used to using in pans and in oil and water resistant clothing called P FOSS. perfluoroalkyl substances, the long term. These are chemicals profiled in dark waters, this movie by Mark Ruffalo.
Dr. Leo Trasande 14:09
And, you know, there was a massive as you're alluding to a massive contamination episode, you know, industrial contamination of the water supply for many years. Large lawsuit rolled up in the end. And that, again, brings me in a way to another point about these chemicals. We used to assume only the dose makes the thing of poison. And you know, in that West Virginia episode, everyone's like, well, these are high scale exposures. But we all have P FOSS in our body. And these P FOSS are hacking our hormones at levels way below what you saw in West Virginia, West Virginia was just a good example of how things can get really pear shaped quickly. And, you know, I'm sad. It's sad to say we have to use that as your starting point. But the deeper we dig, we identify effects. And when it comes to metabolism, P FOSS literally rewire the body's thermostat the wrong way. So the metabolic rate is reduced. And in a population of adults who lost weight through healthy diet and good physical activity, regain their weight more, if their P FOSS levels were higher at the time that they stopped the diet and physical activity changes in the study. And so, you know, we're literally talking about nothing that disrupts the paradigm that diet and physical activity are important for obesity and diabetes. But there's three legs to the stool not to and environmental exposures, particularly synthetic chemicals, that hack, our hormones are just that. And so we've covered the brain, we've covered metabolism. But when you get in deeper, it's the human reproductive system that may actually be the most exquisitely sensitive of it all. And we're not just talking about decreases in sperm count in men. We're not just talking about potency issues. We're talking about things that actually kill people, we're talking about heart disease. In adults, we did a study very recently looking at Fat weights. These are chemicals that make plastic softer, used in personal care products and cosmetics to its fragrances most typically, but the levels of Dalits and adults urine were associated with earlier death. And when you add up the potential consequences in the US population, we're talking about 100,000 deaths a year as a result, and that's a big economic cost 40 to $47 billion. Because if you dive a teenager to 55, and 64, you're right at the peak earning years, and that those dollars add up, ultimately, you know, the broader consequences here for our economy of endocrine disrupting chemicals in the US are $340 billion a year 2.3% of the gross domestic product that's without that 40 additional that I just talked about before. So we're talking about, we haven't talked about birth defects, about cancers about allergies, but they're all on the list. And that wasn't even counted. In the $340 billion estimate. We looked at fewer than 5% of EDCs. A subset diseases due to the few chemicals we studied in a subset of costs due to the few diseases due to the few chemicals we studied. I'm not suggesting as 100% of anything. But that's an underestimate of an underestimate of an underestimate full stop.
The Crunchy Allergist 17:58
So as you think about, like, where do we go from here? What are certain things that you're doing or that you would recommend to patients or families.
Dr. Leo Trasande 18:10
So I'm always going to tell you further research is needed. But we have enough to act. So let's talk about the research first. And then we'll talk about the actions. So we're putting together cohorts of moms and kids typically, looking at environmental exposures, we have one here in New York City where we follow, we're following about 4000 mothers and kids getting urine samples and three time points of pregnancy following the kids, the oldest kids five now, putting them through a battery of tests. That's part of this NIH environmental influences on child health outcomes program. So we're collaborating in a national consortium that actually in the end will be 50,000 kids. And so we have the opportunity to look at questions that you can't look at in a single population, just because you need a very large sample for rare conditions. You know, Eczema is not that rare, but you know, certain types of allergies are relatively rare. They're getting more common. So teasing that out is really important, and hasn't been done well in previous studies. So that's the kind of flavor and we're also building out some capacity to look at effects in adults to over time these exposures and looking at newer chemical exposure. So one of the things we haven't talked about yet is regrettable substitutes. One prototype example is Bisphenol A, you know about BPA free ma bottles and sippy cups have made it in the news. It was the companies that ran to the Afghans and please bear BPA but they replaced them with artists formerly known as BPA like beef PS BPF VPP for yourself, of these regrettable substitutes, BPS is as estrogenic as persistent in the environment as toxic embryos. So basically we swapped out one problem for another, and we still haven't banned BPA in cans and aluminum cans. So, and this is true at p FOSS two, we have long chain P Foss and P FOSS are flooring carbon rich bonded atoms and the number of carbons was usually eight to 12. While the industry said wells make forward eight carbon compounds and they'll get out of the body faster because they're not so hard to excrete. Well, the P FOSS that are short chain have the same effects as P Foss and long chain for gestational diabetes. So that's gonna keep us gainfully employed for a while in studying these effects, but let's talk about what we need to do it because that's really important. There are two things are safe and simple steps we can take as individuals to reduce our exposure. And then we need to advocate for the change we believe in. So let's safe and simple steps are don't require a PhD in chemistry, they don't have to break the bank. You know waiting can food consumption straightforward way to reduce your bisphenol levels in the urine. Saying no to the thermal paper receipt, just ask for a receipt, it's a lot easier. If you if your store will do it that actually saves two people the exposure because there's the cashier as well as the person who's purchasing the product. Then eating organic, straightforward way to reduce your pesticide levels, it works in high income and low income populations. And the big box stores are starting you're starting to see conventional and organic side by side similar prices. And that's because the market share for organics had double digit percentage gains per year. And that means that there's a economy of scale that's been put into place that reduces the price. Let's talk about plastics. It's not the year of the graduate anymore. We need to renegotiate our relationship with plastics. So fundamentally, it's about reducing, it's less about recycling and recycling. Yes, we need to recycle but we have way too much plastic to begin with. And our recycling chains are not working well with 9% of plastic being recycled functionally.
Dr. Leo Trasande 22:43
And, you know, I can talk all I want about the ecological effects. These are chemicals that are hacking our hormones, too. So if you have to use plastic, avoid the numbers three, six, and seven, three or four Thal eight six is for styrene, a known carcinogen and seven are for those bisphenolS we talked about. But it's also about avoiding microwaving, and machine dishwashing plastics, because those chemicals are not necessarily Kobe only bound to the plastic. And if you heat them, or use harsh chemicals to disrupt that layer, you're undermining and breaking down the chemical bonds that keep the chemicals in the plastic in the first place. Now stainless steel and glass are great alternatives and you're starting to see companies step up their game. Tetra pack is not as great but it's better than some of the plastics that we've talked about. And, you know, if it's obviously extra scratched, it's time to throw it away. And then for nonstick chemicals, the thing to do is to go stainless steel or cast iron. It's you know, a little extra elbow grease, maybe a little extra soap in terms of washing off those pans. I've dealt with those I get it. You know, it's all a workout, which get two for one deal. But you know the other the last thing is just simply opening the window and recirculating the air gets rid of these chemical dusts that can linger from electronics and furniture in particular, those persistent organic pollutants. So I'll stop there for a minute meals are the safe and simple steps that's probably like the three and a half minute version as opposed to the 60/62 elevator pitch that we use with our patients. I mean, I tell patients all the time. I mean, I work at the flagship of the public hospital system, Bellevue Hospital in New York City. And 10 years ago, I wouldn't talk about this because the price points were not the same. The intervention data were not as strong, but now I do. And that's because we've come such a long way in this space, and we've seen that these interventions work in low income as well as high income populations
The Crunchy Allergist 24:58
And forgive me if I'm wrong, but there's some data that would say that those are some of our low income populations are at the greatest risk.
Dr. Leo Trasande 25:11
That's right. Unfortunately, there's been, you know, call it environmental dumping, environmental racism. Sometimes products are marketed to certain individuals on the basis of the color of their skin or their background, or their income situation. And that magnifies exposures. And that means that there's a greater burden of disease and a greater cost that they bear as a result of industries benefiting. That's double racism, there's just no way around it. And that's shameful at every level.
The Crunchy Allergist 25:54
So, in thinking through kind of everything, is there anything that we missed that you love to talk about, you know, love to tell?
Dr. Leo Trasande 26:05
So, we haven't gotten hopeful yet. You know, there's a lot of hope. You know, the millennials and z's of the world, have taken onto environmental contamination with gusto. And, you know, through the lens of climate change, and petroleum based companies are the core drivers of both. Now, you can cool the planet, but if you don't deal with the contamination issue, you're not gonna be able to enjoy the planet. So I, that's why they get it. And so I have a lot of hope, for the future in that respect. The other thing is, we've seen so much change happen faster. You know, getting nonstick chemicals out of buffet style food packaging was kind of easy. A study of five packages, found these chemicals, two major supermarket chains that oh, God, get that out. And it was all over social media. You know, the BPA, storing big balls and sippy cups is not perfect. But it's a good example of quick change that can happen. And the power of the pocketbook or wallet in driving positive change. Companies do listen, they don't want to lose, and the companies are doing the right thing. And using safer alternatives are gaining market share. You know, I happen to work with some of them full disclosure, because, you know, I, I'd like to advise the folks that are doing the right thing and are willing to listen to these issues. But that's, that's the way forward mean, yes. Do we need changing regulatory policy? Agreed? Is it? Or is it the first step or the second step usually is the second step. It should be the first step. But you know, we live in a world where it's challenging to make that business case in a way that's super compelling without getting a lot of resistance. So we need to be flexible in our approach.
The Crunchy Allergist 28:24
So where can people find out more about your work?
Dr. Leo Trasande 28:29
So I have a personal website, www.leotrasande.com , or sickerfatterpoorer.com among social media, Instagram, Twitter, Leo, Trasande, T-R-A-S-A-N-D-E. And, you know, there's a way to pass emails to me and ask questions. I'm always open.
The Crunchy Allergist 28:53
Thank you so much. And I would encourage our listeners, if you haven't read "Sicker, Fatter, Poorer" yet, it is a really great read. And I really appreciated the end, just as in our conversation, you really do bring around that element of hope, because I think you do, you know, you read through, especially as, you know, mom of three and, you know, I kind of put the personal hat on, you know, with my own autoimmune issues and so forth. But that there, there is hope for the future. And there are these really sustainable steps that we can take in our everyday habits that really do make a huge difference in our exposure and in the end, will end up saving us money, which is always, you know, can be in the front of everyone's mind. So, I thank you so much for your time and appreciate your expertise. And thank you for writing the book and all the work you're doing. It's much appreciated.
Dr. Leo Trasande 29:57
It was a joy. Thanks again.
