GPL-TOX: Health Concerns and Exposure of Common Markers

By JASMYNE BROWN, ND, MS

The Great Plains Laboratory, for a while now, has offered a non-metal toxin profile, the GPL-TOX. This profile has garnered much attention for its extensive range of environmental toxins assessed. As a consultant for GPL it is my goal to shed some light on the most common toxins I get questions about.

In the assessment of this profile, we must realize that we, unfortunately, live in a toxic world. Whether we know it or not the world we live in is composed of various toxins that we are exposed to daily. The routes of exposure include inhalation, ingestion, and direct dermal contact. Because these toxins can be in the air, there are a myriad of unforeseen issues that cannot always be accounted for when assessing one’s exposures.

The first marker on this profile is the metabolite 2-Hydroxyisobutyric Acid (2HIB). This is the urinary metabolite of methyl tertiary butyl ether/ ethyl tertiary butyl ether (MTBE/ETBE) after it is processed in the human body. These chemicals are important to human health as acute and chronic exposure can lead to a range of health concerns. Acute exposure symptoms include nausea, headaches, dizziness, ocular irritation, and feelings of confusion. Chronic symptoms can include central and peripheral neurologic changes, liver and kidney damage, leaks from the gallbladder into other areas of the body, sleepiness, low white blood cell count, and has been shown to be carcinogenic in animals.

In the production of gasoline lead was the additive of choice to improve octane levels. When lead was discovered to be harmful to human health, the common gasoline additive was changed to MTBE/ETBE. After its incorporation into the gasoline used across the United States, these chemicals were found to cause harm to human health as well. Due to this fact MTBE/ETBE have been phased out as gasoline additives. The rest of the MTBE/ETBE gasoline had been phased out of use in the U.S. by the late 2000’s but it is still in the soil. This leads to common exposure in water supplies. The groundwater that is contaminated could be feeding wells and potentially city water supplies that could be exposing someone through ingestion and dermal contact.

Styrene is the next marker on the profile I commonly get questions about. On the profile it is measured by its urinary metabolite, Phenyl glyoxylic acid (PGO). This is a manmade chemical most used to manufacture plastics, rubbers, and resins. Styrene goes by other names like vinylbenzene, ethynylbenzene, cinnamene, or phenylethylene. Commonly those who work with styrene are going to have the highest risk of exposure. Occupations that involve the manufacturing of boats, tubs, and showers have rather high risks of exposure. Other exposure sources include the use of plastics as food containers or vessels for beverages. Also consider how much Styrofoam is used. Styrofoam cups and food containers have had an uptick in use due to increased carryout during the new normal the pandemic has brought us. Also heating these containers whether by leaving them in a sun exposed area or heating in a microwave can cause a migration of styrene into the food or beverage consumed out of said container. Factors that are not so easy to pinpoint from other sources due to their presence in the air include car exhaust fumes and cigarette smoke. We are additionally exposed from some photocopier toners that are made with styrene and potential groundwater contamination.

Acute symptoms of a large styrene exposure are feeling of intoxication, mucous membrane irritation, gastrointestinal effects, and respiratory effects. Chronic ongoing exposure can lead to neurologic symptoms like fatigue, weakness, depression, CNS dysfunction (reaction time, memory, visuomotor speed and accuracy, intellectual function), and hearing loss, peripheral neuropathy, minor effects on some kidney enzyme functions and on the blood. All sources of exposure should be considered when this marker populates as elevated.

Also commonly elevated is the marker for perchlorate. Perchlorate is a chemical that, when the body is exposed, is passed unchanged and is excreted as perchlorate itself. It can be taken up in large amounts in a few organs such as the thyroid, breast tissue, and salivary glands. Acute large dose exposure can lead to hypoactivity. Long term or consistent exposure typically is associated with impaired thyroid function. Due to its effect on the thyroid’s uptake of iodine prolonged exposure can lead to hypo-functioning of the thyroid gland. Symptoms of hypothyroidism can manifest because of contamination.

Sources of perchlorate are commonly occupational. It is used in the production of solid rocket propellants, munitions, fireworks, airbag initiators of vehicles, matches, and signal flares. For those that do not work with the chemical as a part of their job or hobby of choice, perchlorate can be a contaminant of groundwater. Bleach is also a common source of exposure of perchlorate that tends to be overlooked. We can also be exposed through food sources. If the water irrigation for crops, like leafy greens, is contaminated with perchlorate we can become exposed from eating these foods. Cows that are fed grass that has been contaminated can produce milk that is contaminated with perchlorate. Finding the source is necessary especially in childbearing aged women as perchlorate can pass the placenta and breast milk. This contamination in the fetus or breast-feeding child can lead to decreased iodine uptake in the child and development of cretinism.

The next common toxin is the metabolite diphenyl phosphate (DPP). This is the urinary metabolite for Triphenyl phosphate (TPHP). TPHP is an organophosphate flame retardant. It is used in manufacturing industries and can commonly contaminate water supplies.  It is also a common ingredient in nail polish. Many times, I have encountered women and girls with hormonal changes associated with elevated DPP. It turned out it was their routine nail polishes that they were being continually exposed. Children are often elevated for this marker as well. Flame retardants may be used in children's products like toys, nap mats, and pajamas for their safety. In recent years, in some states, the use of TPHP has been banned in children’s products. Common health effects of TPHP contamination include neurologic changes like pins and needles, hepatic and renal complications, reproductive challenges due to the estrogenic properties, and it is potentially carcinogenic.

N-acetyl(propyl)cysteine (NAPR) marker is the urinary metabolite for 1-bromopropane exposure. This chemical exposure is one of the most difficult to pinpoint, especially if the person exposed does not work with this chemical. Most common symptoms of 1 bromopropane include neurologic changes like  headaches, dysarthria, dizziness, loss of consciousness, confusion, difficulty walking, ataxia, loss of feeling in arms and legs, arthralgia (non-arthritis joint pain),  and also infertility. The most common sources of exposure include solvents used for the cleaning of metal, plastics, and electronics. Additionally, the dry-cleaning process uses this chemical and it is used in the application of asphalt. 1-bromopropane is used in the furniture making process. The solvent is used as a foam glue in the cushions of furniture and as an adhesive spray. Another source of exposure is carpet and carpet cleaning. The adhesives used to keep carpeting secure and cleaners used to rid carpets of stains can have this chemical in the list of ingredients. These sources should be assessed when this marker is elevated.

Propylene oxide is another common elevation. The urinary metabolite is N-acetyl(2-hydroxypropyl) cysteine (NAHP). This chemical is often found in those who use it in their occupational duties. Propylene oxide is used in the production of polyether’s which are used for polyurethane foam production and propylene glycol. Propylene glycol is a common ingredient in cosmetic products. Other uses for this chemical include herbicides, solvents for preparation of lubricants, surfactants, and oil demulsifiers and the fumigation of medical instruments and foodstuffs. A common food propylene oxide is used to fumigate are almonds. Often the ingestion of almonds and almond based products soars when we take on gluten free, dairy free, or peanut free diets.  Many people who embark on these diet changes may not be eating the organic variety of these almond based products. Oftentimes switching patients to organic almond products will reduce their exposure to this toxin. Common symptoms of toxicity are in the central nervous system. Propylene oxide is a mild CNS depressant and can lead to symptoms including fatigue, lack of concentration, drowsiness, etc.

The last marker that gets a lot of attention is acrylamide. Acrylamide is an organic compound that can be created from high heat cooking of high carb and high protein foods. The process of roasting, deep frying, and baking causes the production of acrylamide. Acrylamide is also a solvent used in the creation of polyacrylamide used in water treatment plants, making water contamination a common source of exposure source. Tobacco smoke and cosmetic products like lotions and makeup can be sources of acrylamide toxicity.

Symptoms of acrylamide toxicity include nervous system dysfunction, it is carcinogenic, and infertility. Oftentimes I find that individuals are eating a good amount of processed foods. This should be ruled out. Also due to its water-soluble nature, acrylamide is easily processed in the body and quickly excreted. If someone admits to a dietary change even temporarily prior to sample collection, this could be the cause of the elevation seen on the report.

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All-in-all, the world we live in is not non-toxic. No matter what we do or where we go the opportunity for toxin exposure is upon us. In times of disease and dysfunction, ruling out elevated toxin exposure could be the cause of the symptomology presented. Assessing every aspect of life is crucial to pinpointing where these exposures could be stimming from.

Ketones and Fatty Acid Oxidation

By Jasmyne Brown, ND, MS

Hello all! Welcome back to the GPL blog. Today's installment will focus on some of the more confounding markers of the Organic Acid Test (OAT). The ketone and fatty acid oxidation markers seem to cause some uncertainty. Here we aim to understand the biochemistry behind this set of markers and what causes them to be elevated.

Markers 43 and 44, acetoacetic acid and 3-hydroxybutyric acid respectively, are ketones. Ketones in themselves are breakdown products of fatty acid metabolism. When fat is used as an energy source it is converted into ketones in the liver by a process called ketogenesis. First, free fatty acids are released and converted into acetyl CoA, via beta oxidation in the liver’s mitochondria. Two of these acetyl-CoA molecules are then combined to make ketone bodies. These ketones then leave the liver and make their way to extrahepatic tissues via the bloodstream. In the cell, ketones are broken down back into acetyl CoA, via beta oxidation, for entrance into the Citric Acid Cycle. This process is always occurring on some level in the body. 

In times of elevated urinary ketones this means that beta oxidation has been upregulated, as it is our primary pathway for fatty acid metabolism.  In times of increased ketogenesis, more ketones are being formed and the turnover into acetyl CoA is not keeping up with ketone production. This is due to more ketones being produced than energy needed by the body, so ketones will build up and be excreted into the urine, leading to an increase in markers 43 and 44. 

There are many biologic processes that lead to this phenomenon. Some common, more purposeful, processes are mainly common dietary changes. Ketogenic diets, low carb inspired diets, and also 12-18 hour fasting are all purposeful reasons for elevated ketones. Due to the surge in low carb eating and intermittent fasting, elevations in markers 43 and 44 are common. These markers can come in handy when monitoring someone on a keto or low carb eating plan. Whenever elevations are present it is a good idea to rule out dietary changes that could impact these values. 

Other, more concerning reasons for these elevations in ketones include a myriad of processes.  A common reason in those with G.I. upset is vomiting and diarrhea. The purging associated with these processes leads to an increase in ketogenesis as all sources of energy are being purged and fat must be used to continue biological processes. B12 deficiency is another cause of increased ketones. Due to the requirement of B12 as a cofactor for the enzyme methylmalonyl CoA reductase needed for beta oxidation of odd chain fatty acids, B12 deficiency can cause a buildup of urinary ketones. This enzyme converts methylmalonyl CoA to succinyl CoA for the incorporation into the CAC or gluconeogenesis for ATP production. Due to a buildup of methylmalonyl CoA and a decrease in succinyl CoA, the body upregulates ketogenesis to meet our energy needs. To determine B12 deficiency is a possible cause be sure to review marker 50, methylmalonic acid. 

Another possibility is an eating disorder. This could be due to diagnosed or undiagnosed anorexia or bulimia. When the system is malnourished or going through a prolonged fast or purging, the body will upregulate fatty acid metabolism and ketogenesis for adequate energy production. Situations where the body cannot utilize carbohydrates for energy production will also lead to increased ketones. One common cause is insulin resistance. In times of blood sugar dysregulation, due to a lack of insulin production or insulin resistance, the body must rely on fat metabolism to make ATP. This leads to an increase in ketones in the urine. Potentially this leads to a life-threatening state of ketoacidosis. In an individual consuming carbs in their diet, but also has ketones elevated, insulin resistance should be ruled out. This phenomenon can happen in relation to diabetes type 1 and type 2.  An additional culprit for urinary ketones is fungal overgrowth. Fungus can readily absorb and metabolize carbohydrates. When in our intestinal tract, these organisms come into contact with the carbs we eat. In an overgrowth, more fungus is present and can potentially absorb and metabolize enough of the carbs eaten to switch the body into glycogenolysis and eventually ketogenesis. In absence of a low carb diet, all possible causes of elevation should be assessed.

The rest of the markers in this section are Fatty Acid Oxidation Markers. 45-49, ethylmalonic, methylsuccinic, adipic, suberic, and sebacic respectively, are known as dicarboxylic acids. These are the breakdown products of a secondary process for fatty acid metabolism called omega fatty acid oxidation. This process differs from beta oxidation in many ways. Omega oxidation is completed in the smooth ER of the liver and kidneys instead of the mitochondria as beta oxidation. Fats that are long and medium chain, having 10-12 carbons, undergo omega fatty acid oxidation and dicarboxylic acids are the end product. This process is an added support to our primary beta oxidation. In addition to dicarboxylic acids being produced, succinyl CoA is also produced for incorporation into the CAC and gluconeogenesis. 

Omega Oxidation is upregulated in times of overwhelmed beta oxidation, increased fatty acids outside of the mitochondria, and certain dietary changes. In times of slight elevations in these markers, check the dietary intake of the client. In times of increased long chain and medium chain fat intake from omega rich fats, fish or cod liver oil supplements, and coconut oil or MCT oil, we can see noticeable increases in these markers. This is due to upregulation of beta oxidation for medium chain fats and the need for omega oxidation to upregulate to process the fats in the diet. Other dietary changes that can cause expected elevations include increased intake of “junk” foods and gelatin. These foods can have adipic acid as an additive that can be expressed in this marker's elevation. In a state of fasting, the body will use both primary and secondary metabolism processes for ATP production and suberic acid is commonly produced. 

Additional factors that lead to elevations here will include any reason that upregulates ketogenesis or blocks beta oxidation as mentioned above. These factors upregulate the body's use of fats and this secondary pathway has to kick in to support the state of metabolism. Furthermore, certain nutritional deficiencies will block beta oxidation. As mentioned, B12 deficiency will block the production of succinyl CoA from odd chain fatty acids leading to increased ketones production and omega fatty acid oxidation to support energy needs.

Riboflavin Deficiency is another possibility. Vitamin B2 is a required cofactor for beta oxidation. It is required for a key process of acyl CoA dehydrogenation that begins each cycle of beta oxidation. In a deficient state, beta oxidation cannot begin and fatty acids have to be metabolized through our secondary process. There are also genetic factors that could increase these markers. Increases would be extremely significant and often found in infancy. These causes are known as Multiple acyl-CoA dehydrogenase deficiency (MADD) also known as glutaric aciduria type 2 and Medium chain acyl-CoA dehydrogenase deficiency (MCAD). In MADD, the person doesn't have the adequate amounts of various acyl-CoA dehydrogenase enzymes. While MCAD is a deficiency of just the one enzyme. These are defects in fatty acid metabolism disorders. In both conditions, high dose riboflavin is warranted for support along with l-carnitine supplementation coupled with a low fat high, carb diet. 

L-Carnitine is a common amino acid described regarding fatty acid metabolism. Due to the process of beta oxidation being in the mitochondria of the cell, the fatty acids have to get to the mitochondria to be processed. Short chain and medium chain fatty acids can pass the mitochondrial membrane, but it is impermeable to long chain fatty acids. Due to the impermeability, the Carnitine Shuttle is used to shuttle long chain fatty acids into the mitochondria for beta oxidation. In times of protein malnutrition or maldigestion, there is less carnitine, lysine, and methionine. Lysine and methionine are amino acids that our system can biologically synthesized into carnitine. When carnitine is deficient due to diet, genetic carnitine deficiency, times of stress, or maldigestion, long fatty acids cannot get into the mitochondria. This will upregulate omega fatty acid oxidation happening outside of the mitochondria. In any case of upregulated dicarboxylic acids, l-carnitine is an appropriate support. 

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In the understanding of the ketone and fatty acid oxidation section of the OAT, there are many possibilities as to why these markers are elevated. We must evaluate if it is due to nutritional deficiencies, dietary changes, overgrowths, or genetic alterations. These are the questions we as practitioners must ask ourselves

Dopamine Beta Hydroxylase Enzyme: Its Function and Dysfunction

By Jasmyne Brown, ND, MS

Dopamine beta hydroxylase (DBH) is an enzyme crucial to the balance of dopamine and norepinephrine in the body.  It is required for the conversion of dopamine into norepinephrine.  DBH is like a lock associated with tyrosine and tyrosine derivatives fit like keys in the lock.  Dopamine, a derivative of tyrosine, fits on the DBH enzyme just as a key fits into a lock.  DBH then transforms it into norepinephrine when it is functioning adequately, leaving us with proper levels of both dopamine and norepinephrine in the system.  When DBH is functioning properly, we experience balanced moods and adequate energy levels.  When DBH dysfunction occurs, a wide range of abnormalities can develop.

The Effects of DBH Dysfunction

During times of DBH dysfunction, no matter the cause, there will be a decreased conversion of dopamine to norepinephrine.  This causes a subsequent rise in dopamine levels and decrease in norepinephrine.  Symptoms associated with elevated dopamine include anxiety, depression, fatigue, low blood pressure, sluggish deep tendon reflexes, ptosis, hypotonic muscles, hyperflexible reflexes, weakened facial muscles, and increased stress. Conditions associated with DBH dysfunction are wide ranging.  Mental health disorders such as depression, anxiety, bipolar disorder, and schizophrenia have been documented to be associated with dysfunction in the DBH enzyme.  Other conditions include postural orthostatic hypotension (POTS), exercise intolerance, fainting, autism spectrum disorder, ADHD, seizures, neurologic conditions, and alcoholism.

Causes of DBH Dysfunction

There are various reasons why DBH function can be altered.  These include elevations in clostridia toxins, cofactor deficiency, and genetic single nucleotide polymorphisms (SNPS).  When clostridia toxins are elevated, dysfunction of DBH ensues.  The toxins produced by this species of bacteria are tyrosine derivatives.  Clostridia, when given the opportunity to overgrow, takes tyrosine to produce its toxic metabolites.  The most common of these toxins are 4-cresol and HPHPA.  These toxins are the tightest binding toxins clostridia produces, although the other tyrosine metabolites of clostridia cause dysfunction too.  Since these toxins are produced using tyrosine, they look very similar to dopamine and take its place on the DBH enzyme.  This is an irreversible binding that occurs and inhibits DBH function.  An Organic Acids Test (OAT) will assess whether a patient has elevated clostridia metabolites and will also assess neurotransmitter status.

When DBH cofactors are deficient, the enzyme does not have the necessary nutrients to efficiently do its job.  Cofactors for the DBH enzyme are vitamin C and copper. It has been shown that vitamin C and copper levels can be decreased in patients with neurological disorders.  In some populations, individuals may be at a high risk of not getting an adequate amount of these nutrients, like in those with eating disorders or patients that do not have adequate micronutrient nutrition.  Also, there are those that have arsenic toxicity.  This has been correlated with decreased vitamin C and copper.  A heavy metals test should be conducted to rule out this possibility.  Supplementation with vitamin C should commence but keep in mind if the person also has elevated oxalates, high doses of vitamin C can potentiate their production.  For copper, check their levels using the Copper + Zinc Profile. This information will guide you on dosing copper in respect to zinc.

If clostridia toxins are not elevated, and cofactors are at normal levels, there is always the possibility of someone having a genetic predisposition to decreased enzyme function. There are various SNPs that can impact the function of this enzyme.  In these individuals, the symptoms of fatigue, low blood pressure, exercise intolerance, bed wetting, etc. would be expected to be present most of their life or a family history of these symptoms.  Genetic testing would give you clues into which SNPs may be playing a role here.  Unfortunately, this does not give insight to the functionality of the enzyme.  GPL’s Dopamine Beta Hydroxylase Test assesses the functionality of the DBH enzyme via a serum sample.  It allows the practitioner to understand how the patient’s genetics is phenotypically affecting them biochemically.  The beauty of this test is that even if a person has an inhibition via clostridia toxin, there is no interference and it can be done with accuracy.  Practitioners can get a clear understanding of the enzyme’s function and the patient’s ability to adequately convert dopamine to norepinephrine.

Treatment for DBH Dysfunction

Finding out whether the patient has elevated clostridia metabolites should be done first via Organic Acids Test (OAT) or Microbial Organic Acids Test (MOAT).  If they do have elevated clostridia toxins (4-cresol or HPHPA), those should be treated, then re-evaluated for treatment efficacy.  This may improve or resolve DBH function and thus any symptoms they have been experiencing due to the clostridia toxins’ inhibition of DBH. 

In individuals with decreased DBH functionality found with the Dopamine Beta Hydroxylase Test, there is treatment available.  Currently on the market there is a prescription medication, called Droxidopa.  Droxidopa is a synthetic amino acid that is converted to norepinephrine by dopamine decarboxylase.  This takes the place of the norepinephrine that would have been made via DBH.

In summary, if a patient is having the aforementioned symptoms of DBH dysfunction, various GPL tests are warranted:  The first test to screen for DBH dysfunction is the Organic Acids Test (OAT).  The markers in the neurotransmitter section will give insight. The HVA, VMA, and HVA/VMA ratios are important.  In DBH dysfunction, HVA will be elevated, VMA will be proportionally decreased, and the HVA/VMA ratio will be elevated.  This is showing that dopamine is not adequately being converted and there is something blocking the DBH enzyme.  Also on the OAT, the clostridia markers (4-cresol and HPHPA) should be assessed to rule in or out its involvement.  From here, consider running the Dopamine Beta Hydroxylase Test, a heavy metals test,  and the Copper + Zinc Profile for further understanding of a patient’s DBH functionality.

References

1. Beuger, M., van Kammen, D. P., Kelley, M. E., & Yao, J. (1996, July). Dopamine turnover in schizophrenia before and after haloperidol withdrawal. CSF, plasma, and urine studies. Retrieved 4AD, from https://www.ncbi.nlm.nih.gov/pubmed/8797194

2. Cross, A. J., Crow, T. J., Perry, E. K., Perry, R. H., Blessed, G., & Tomlinson, B. E. (1981). Reduced dopamine-beta-hydroxylase activity in Alzheimers disease. Bmj, 282(6258), 93–94. doi: 10.1136/bmj.282.6258.93

3. Garland, E. M. (2019, April 25). Dopamine Beta-Hydroxylase Deficiency. Retrieved April 30, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK1474/

4. Kaufmann, H., Norcliffe-Kaufmann, L., & Palma, J.-A. (2015). Droxidopa in neurogenic orthostatic hypotension. Retrieved April 30, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4509799/

5. Rahman, M. K., Rahman, F., Rahman, T., & Kato, T. (2009, December). Dopamine-β-Hydroxylase (DBH), Its Cofactors and Other Biochemical Parameters in the Serum of Neurological Patients in Bangladesh. Retrieved 28, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3614808/

6. Shaw, W. (2010, June). Increased urinary excretion of a 3-(3-hydroxyphenyl)-3-hydroxypropionic acid (HPHPA), an abnormal phenylalanine metabolite of Clostridia spp. in the gastrointestinal tract, in urine samples from patients with autism and schizophrenia. Retrieved April 28, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/20423563

Mold Testing for Your Body and Your Home

By Jasmyne Brown, ND, MS

Do you ever walk into a room in your home or office building and notice a faint odor?  Or have you or someone you love had the unfortunate experience of a chronic condition that isn’t easily explained after consulting with various doctors?  Well, mold toxicity could be a major factor in your clinical picture.  So how do you know if you have mold toxicity?  Testing with GPL’s MycoTOX Profile along with the Organic Acids Test, via a urine sample, will help you understand your body’s mycotoxin load.  The MycoTOX Profile looks at 11 mycotoxins from 40 different mold species.  These toxins have been shown to be immune dysregulating, neurotoxic, reproductive toxic, amongst other effects.  The OAT can help you understand if there is intestinal overgrowth (colonization) of Aspergillus mold that requires antifungal treatment.  The highly qualified consultants at GPL can help you and your clients understand the values reported and the extent of their toxic load.  But after testing your body for mold and mycotoxins, there still lies the question of whereIt came from.  Mold inspection of your home or office may seems like an insurmountable feat since most of us don’t even know where to start.  Since there is currently no gold standard for mold testing, the following is information outlining the basics of some common mold testing companies:

Home Mold Testing – Do-It-Yourself Kits

The Environmental Relative Moldiness Index (ERMI) is a common choice for mold testing.  This method of testing was developed by the US EPA Office of Research and Development but is currently not endorsed by the EPA for mold testing.  It is available from many mold testing companies – just do a web search for “ERMI test”.  The ERMI was developed during a 2006 HUD American Healthy Home Survey based off 1,096 homes to research the moldiness of American homes.  The ERMI uses a mold specific quantitative PCR to test a single sample of dust.  From there, the sample’s potential mold is analyzed and the results are compared to water-damaged related molds (group 1) and other common indoor molds (group 2).  Using an algorithm, the ERMI score is then calculated.  The range for the score is -10 to 20, -10 being the lowest moldiness level and 20 being the highest.  Your home’s score is measured comparatively to the water damaged homes studied and a score is populated to rate the moldiness of your environment, compared to the reference or non-moldy homes tested from the research data.  The score identifies your home’s relative moldiness.  Only one sample is needed and can be completed by the average person.  Carpet dust is used and is seen as beneficial to use, as it seems to hold on to mold spores and it may give a better representation of long-term mold exposure as opposed to air testing.  The ERMI is a good test for understanding how moldy your environment is compared to other homes in the U.S.  Sampling for the ERMI is outlined on the Eurofins EMLab P&K Laboratories’ web site.  To conduct the test, you purchase a filter for your vacuum cleaner.  This allows for the dust with the mold spores to be collected during the timed vacuum cleaning session.  After collection, labeling the sample and overnight shipping are required for analysis. Once analyzed, you receive a detection and quantitation of mold from group 1, water damage associated molds from water-damaged homes used in development of the ERMI, and group 2, molds from reference homes or homes without water damage, from your sample.  With this you get a relative score that is the difference of group 2 from group 1, which is your ERMI score.  Price wise, this testing can cost around $300 plus the cost of the sample filter needed for collection which is about $7.  This is a viable option for anyone looking to understand where their environment lies in comparison to other moldy homes.

ERMI Photographic representation

Another company that has been used for mold testing is ImmunoLytics.  Their testing method involves the use of plates with a specialized agar utilized to allow the mold spores to grow.  Their analyst will look at your test plates under the microscope to identify the types of molds growing.  The analysis reports on the quantity and type of mold found and assigns a health index score in accordance to what was found.  ImmunoLytics also allows you to collect several types of samples.  You can test the air in a room, the air in your car, your pets, and visible mold you will swab directly.   Their website outlines the different collection techniques in a stepwise manner for ease of sample collection.  In general, you will need to keep all windows closed in the room you are testing, have the test plat agar side up, and open two feet away from the walls, and leave it there to collect for approximately 30 minutes.  This can be done simultaneously in various rooms with different plates and you and your family can go about your lives while testing.  This allows for more rooms to be tested at the same time to ensure no part of the home is missed when investigating for mold.  Testing the car involves running the A/C for 30 minutes, then placing the plate in the car with the A/C running for 30 minutes for collection.  There is also the direct swab option. I f there is a vent, windowsill, etc. with visible mold, this is a direct way to collect said sample.  The cost of Immunolytics’ testing is dependent upon how many plates and/or swabs are requested.  Each plate or swab is about $33 each.  This includes the testing materials with labels required for testing.  With this you can then self-analyze your plates and determine your homes mold yourself.  For an additional fee, you can send in your samples and have an ImmunoLytics analyst analyze them for you and provide a consultation to review your results and help you understand next steps.  This company allows for tailor-made testing materials to be ordered for by the client to fit their needs.

EnviroHealth Consulting, Inc,  is a company dedicated to helping people limit their environmental exposure.  This company gives information regarding electromagnetic fields and how to reduce your exposure, clean air and how to make you indoor air cleaner, and mold exposure.  This company has a Certified Microbial Consultant certified through the American Indoor Air Quality Council with over 3,000 home inspections worth of experience.  As the client, you can collect your own samples at home or in your office and have them analyzed.  The website outlines how to collect the samples.  Their testing is different in that it doesn’t require a plate with agar or a dust filter.  They require a tape method for collection.  You can purchase clear tape and collect dust from multiple areas, as outlined in their collection instructions, and apply them to a plastic bag.  From here, you send in your samples and they are analyzed for a fee.  The fee ranges from approximately $25-$100.  This an affordable option for clients.  The turn-around time for results is said to be about a week with results e-mailed directly to the client.

Professional Home Inspections

For those looking for someone to come out to your home for an inspection, there is a company called Environmental Analytics (EA).  They will do an indoor environmental inspection of your home or office looking for potential off-gassing of chemicals, microbial overgrowth, and how your environment is potentially encouraging or minimizing your toxic exposure.  It is an overall assessment of your potential environmental toxic exposure.  Based off your results, a customized plan is developed to help you combat the results and follow ups are given as needed, according to the company’s website.  Not much information is given regarding what type of testing equipment is used, as it is based off their assessment of your home for what type of testing is needed.  It appears they follow Indoor Air Quality Association (IAQA), Surviving Mold, and International Society of Environmental Acquired Illness (ISEAI) guidance on best practices for their testing.  The benefit is that there is someone that will come to your space and do a visual inspection.  Even though this service isn’t offered everywhere there is the option for virtual consultations.  They will help you determine, over the phone, where you should go or look next in your environmental investigation.  Second opinions on other lab testing for environmental inspections and sample gathering assistance are also offered to those out of state and out of the country.  This may be a good follow up for those out of their service area to better understand results from another company or to get a second opinion.

Another resource for seeking out mold inspectors in your area is the National Association of Mold Remediators and Inspectors (NAMRI).  NAMRI is dedicated to ensuring professionalism in the mold inspection and remediation profession.  It is for mold professionals to have an ethical code and standard of practice befitting the mold industry to protect all.  Inspectors associated with this group are held to a minimum requirement for describing and reporting microbial overgrowth and contributing factors.  Members also must have a minimum of 90 hours of accredited mold education training.  If they do not have this training, at least 25 mold inspection or remediation jobs need to be successfully completed to apply for membership.  Their list of accredited mold educators includes Professional Mold Inspection Institute and Professional Home Inspection Institute.  There is also an exam all applicants must take and pass before membership is granted.  This organization also serves as a directory for clients looking for professional mold inspectors in their area.  For those looking for an actual person with credentials in mold inspection, this may be a good resource to explore when searching for a mold inspector.

In the journey of mold-related illness, finding the source of exposure is a crucial part of the puzzle.  When it comes to finding the right test or inspector, it can be overwhelming.  I hope this guide has outlined a few options to make it simpler to navigate the choices that are out there.  Currently there is no gold standard for how many mold spores in the air or environment are an acceptable amount.  There is also no gold standard in the testing of mold.  Continue to do your own research when looking for a mold inspector or mold testing company.  When looking for an inspector in your service area, ensure the inspector is qualified with a degree in microbiology and/or has experience in looking for mold in the home or other building environments.  Utilize resources that you trust, that are credentialed, and that provide clear and detailed information about how they sample and test for mold, their price point, and quality communication for any questions or concerns that may arise.  Before going with any home mold test or inspector, be sure you know what questions you want answered.  Are you more interested in how your home’s moldiness compares to other homes or are you curious about what is growing in your environment?  Who you decide to go with on this journey to understanding your exposures is ultimately up to you.  This will hopefully serve as a guide to help your decision-making process.

References

1. Consumer Information: National Association of Mold Remediators and Inspectors (NAMRI). (n.d.). Retrieved April 8, 2020, from https://www.namri.org/consumer.php

2. ERMI Sampling for PCR Testing. (n.d.). Retrieved April 7, 2020, from https://www.emlab.com/resources/sampling-guides/pcr-ermi-sampling/

3. ERMI Testing Lab Services. (n.d.). Retrieved April 7, 2020, from https://www.emlab.com/services/ermi-testing/

4. How to Test for Mold (n.d.). Retrieved April 8, 2020, from http://createyourhealthyhome.com/checking-for-mold/how-to-test-for-mold/

5. Services. (n.d.). Retrieved April 8, 2020, from https://environmentalanalytics.net/services/

6. Testing & Treatment - The ImmunoLytics Mold Testing Kit. (n.d.). Retrieved April 8, 2020, from https://immunolytics.com/testing-treatment/

Tips for Wellness and Immune Boosting During a Viral Pandemic

By Jasmyne Brown, ND, MS

Throughout life we all are striving for optimal health. We do our personal research and look for ways to enhance our natural immunity and overall function by maximizing our activities of daily living. Gaining a good quality of life is typically the goal. This post looks at some simple things we can do daily to support wellness and immune function, particularly during the time of the Coronavirus pandemic.

Since we all must eat to survive, let's start with diet. When shopping for food it can be overwhelming to decide what to put in our carts.  A general rule of thumb I like to use is shop the outside borders of the store. Here we typically find the fresh produce. Fruits and vegetables are key to any healthy diet. At each meal we should be striving to have half of our plate be full of fruits and veggies. These foods are full of vitamins, minerals, antioxidants, and phytochemicals that provide our body with the substances needed for human life. Many of the nutrients in these foods are cofactors for enzymatic reactions that take place daily in the human body. When shopping, fill your cart with nutrient-dense foods like apples, oranges, avocados, broccoli, cauliflower, sweet potatoes, peppers, garlic, onion, and the list goes on. A special note about leafy greens -  they are very nutrient-dense, but if you suffer from high oxalates you should limit these in the diet. Always look for vibrantly colored foods like those that are purple, red, black, and blue, as these pack a higher density of antioxidants.

High quality protein, both animal and/or plant based is important to wellness and immune function. As these proteins are broken down into amino acids they are used in the regulation of T and B lymphocytes, macrophages and natural killer cells. They are needed in the production of antibodies and cytotoxic substances, which are crucial in an active infection. When purchasing animal proteins look for grass fed, organic meats and organic vegetable proteins, like nuts, seeds, legumes, etc. Fatty fish like salmon and sardines are full of omega fatty acids like DHA and EPA. Not only are omega-3 fatty acids a constituent of cell membrane structure, allowing for cell fluidity, they are well-known for their overall anti-inflammatory nature. DHA has also been shown to regulate macrophage function in their activation, enhancing production and secretion of chemokines, and their ability to phagocytize and destroy pathogens and infected cells. Omegas have also shown great promise in the regulation of neutrophil activity and production, and in T-cell regulation and differentiation. A diet rich in quality protein and omega fats will give the body daily support for decreasing inflammation and maintaining immune function.  Whole grains should also be consumed as they are full of fiber, regulate bowel movements, and in moderation can reduce risk of blood glucose dysregulation. The key to general wellness is eating a diet high in a variety of whole foods like fruits, vegetables, quality protein, and whole grains. 

Foods that we should either limit or eliminate in our diet are all encompassing as nutrient lacking. These are foods and beverages that are high in sugar, trans fats, low quality or no protein, hydrogenated oils, artificial sweeteners, preservatives, and artificial food dyes and colors. Substances like this are what we deem as calorie dense with little to no nutritional value. This means that when we consume foods like conventionally packaged baked goods, candy, soda, fried foods, fast foods, heat-and-eat frozen foods, etc., our body gains caloric energy but very little nutrition. If we work to replace these foods in our diets with nutrient-dense foods as described, just sitting down for a meal or snack will be a great wellness boosting activity that we conduct multiple times per day without even thinking about it. 

Additional nutritional supplementation can be considered for wellness and overall immune function and should be considered just that, a supplement. Supplements are great in that they can help replenish what is missed in the diet, but they are not meant to replace a healthful diet. Some nutrients I find helpful as a daily addition include a multivitamin, vitamin C, vitamin D, and fish oil. During the cold/flu season I like to increase my defenses by adding zinc, colostrum, vitamin A (either by itself or via cod liver oil) and select herbs. For general maintenance, consider adding a quality multivitamin once a day and vitamin C twice a day as this vitamin allows phagocytes and T-cells to perform their immune functions. If you live a lifestyle that doesn't allow for much time in the sun you may consider adding vitamin D to your list. I suggest getting your levels checked before adding this vitamin because in high doses it is toxic. Zinc acts to regulate immune function, decrease NF-kB activity, and is anti-inflammatory. Cod liver oil is a great way to incorporate a maintenance dose of vitamins D and A during the cold/flu season. During active disease, increasing vitamin A has shown to have anti-viral activity. When deficient mucosal regeneration is impaired after damage, there's a diminished function of neutrophils, macrophages, and T-helper cells and B-cells. A diminished mucosal surface allows for increased infectivity of other pathogens that it encounters. Colostrum is useful as it is full of bioactive and immune boosting compounds like lactoferrin and lysozyme that support immune function and defend against pathogens. It is also rich in proline-rich polypeptides which helps stimulate the body to make its own immunoglobulins as a defense against invading pathogens. It also has shown many regenerative effects especially in the gut lining. Together these nutrients can support healthy immune function for preventing and supporting the body in fighting illness.  Many of these supplements can be purchased through New Beginnings Nutritionals.

Some general supportive botanicals I like include nutritive teas like dandelion and nettles. Dandelion can be enjoyed as a tea or used in salad greens. It's been shown to be hepatoprotective allowing the liver to function properly. Nettles is antiallergic and full of vitamins and minerals like carotenoids and calcium. Its anti-allergenic properties have been shown to decrease IFN-gamma, IL-6, IL-1, and TNF-alpha while improving symptoms of allergic rhinitis. It has also been shown to inhibit early stage infection of severe acute respiratory coronaviruses. By binding the virus’s glycoprotein it reduces its infectivity. Other immune supportive herbs that can be used include echinacea, elderberry, astragalus, and medicinal mushrooms like reishi, cordyceps, and turkey tail. During an active cold, typically caused by a viral infection, other herbs like scutellaria, ligusticum, and olive leaf are beneficial, as they are anti-viral. Scutellaria has been shown to inhibit the replication of the influenza A virus. I like to keep these on hand to support my system as needed. Keeping foods like garlic and onions as staples in the diet are helpful as the allicin found in these foods have been known to have anti-viral properties. Raw honey is another natural medicine I keep in my pantry. It is naturally antimicrobial and good for wound healing, plus it tastes delicious. Right before flu season I like to make a honey-based immune support with chopped garlic and onion infusion. One tablespoon a day is a great immune tonic and 2-3 tablespoons a day can be used for its anti-viral properties. 

Outside of internal supports there are many other lifestyle factors that play a role in wellness and immune support. My favorite is physical activity. It's something about getting my blood pumping and my muscles moving that is so stimulating yet relaxing to me. Engaging in regular physical activity not only helps to keep your muscles strong, regulate metabolic processes, reduce stress, and support adequate blood flow, but it works to support immune function. It improves immune defense strategies, can mediate anti-inflammatory pathways, improves immune regulation when done consistently, and can delay the onset of age-related dysfunction.

Keeping stress to a minimum is also beneficial. Not only does chronic stress lead to increasedrisk of chronic disease and fatigue, but it increases the body's pro-inflammatory cytokines. The chronicity of stress creates an environment that is suitable for the reactivation of latent viruses like EBV, CMV, etc. This re-activation is a sign of the immune system’s loss of immunologic control over the virus and leads to increased stress of the immune system. Finding ways to relax each day is crucial to keeping stress at bay. Some activities you can engage in included mediation, exercise, or an enjoyable hobby. Other options, for especially hard days, include adding relaxing essential oils to a warm bath, taking a walk outside, or spending time with others that bring joy to your life, though that may be difficult right now, since we’re all supposed to be “social distancing”.

Other aspects of life to keep in mind for general wellness and immune support are sleep and hydration. Adequate sleep allows our body to properly process the happenings of our day. Repair and recovery are conducted during sleeping hours, with the immune system releasing cytokines to fight disease while we sleep. When sleep-deprived, these processes cannot be properly completed, leading to increased stress on the body and subsequently increased susceptibility to chronic disease. 

Hydration is necessary for many reasons. Water is a major component of our body’s makeup and biochemistry. Without water, some reactions necessary for life cannot work efficiently and this adds stress to the body. It's also needed as a transporter of nutrients throughout the body. This allows for the nutrients we eat to be delivered to their proper locations to conduct their immunologic activities. 

Summary 

Overall, there are many things we can do on a daily basis to increase our wellness and boost immunity, particularly during a time when we may all be more at risk for viral infection. The biggest challenge is finding the time in the demanding world we live in. I find scheduling meditation and exercise into my days helpful in making sure I do them. Making these things a part of your lifestyle is the best way to ensure that you are living a life of wellness and supporting healthy immune function. 

References

1. Adhikari, B. M., Bajracharya, A., & Shrestha, A. K. (2015, August 7). Comparison of nutritional properties of Stinging nettle (Urtica dioica) flour with wheat and barley flours. Retrieved March 26, 2020, from https://onlinelibrary.wiley.com/doi/pdf/10.1002/fsn3.259

2. Bakhshaee, M., Mohammad Pour, A. H., Esmaeili, M., Jabbari Azad, F., Alipour Talesh, G., Salehi, M., & Noorollahian Mohajer, M. (2017). Efficacy of Supportive Therapy of Allergic Rhinitis by Stinging Nettle (Urtica dioica) root extract: a Randomized, Double-Blind, Placebo- Controlled, Clinical Trial. Retrieved March 26, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963652/

3. C.Niemana, D. (2018, November 16). The compelling link between physical activity and the body's defense system. Retrieved March 26, 2020, from https://reader.elsevier.com/reader/sd/pii/S2095254618301005?token=1DF6DA45D8CCCA6038DE1FD145E3BB340BB61EDC5D28F876B19BDEAFCADB2A757CFACD3D7BBC680F4EFB2B802DAE52BC

4. Gutiérrez, S., Svahn, S. L., & Johansson, M. E. (2019, October 11). Effects of Omega-3 Fatty Acids on Immune Cells. Retrieved March 26, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6834330/

5. Hosseini, B., Berthon, B. S., Saedisomeolia, A., Starkey, M. R., Collison, A., Wark, P. A. B., & Wood, L. G. (2018, July 1). Effects of fruit and vegetable consumption on inflammatory biomarkers and immune cell populations: a systematic literature review and meta-analysis. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29931038

6. Hour, M.-J., Huang, S.-H., Chang, C.-Y., Lin, Y.-K., Wang, C.-Y., Chang, Y.-S., & Lin, C.-W. (2013). Baicalein, Ethyl Acetate, and Chloroform Extracts of Scutellaria baicalensis Inhibit the Neuraminidase Activity of Pandemic 2009 H1N1 and Seasonal Influenza A Viruses. Retrieved March 31, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705751/

7. Kumaki, Y., Wandersee, M. K., Smith, A. J., Zhou, Y., Simmons, G., Nelson, N. M., … Barnard, D. L. (2011, April). Inhibition of severe acute respiratory syndrome coronavirus replication in a lethal SARS-CoV BALB/c mouse model by stinging nettle lectin, Urtica dioica agglutinin. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085190/

8. Li, P., Yin, Y.-L., Li, D., Kim, S. W., & Wu, G. (2007, August). Amino acids and immune function. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/17403271

9. Morey, J. N., Boggero, I. A., Scott, A. B., & Segerstrom, S. C. (2015, October 1). Current Directions in Stress and Human Immune Function. Retrieved March 26, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465119/

10. Prasad, A. S. (2008). Zinc in human health: effect of zinc on immune cells. Retrieved March 26, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2277319/

11. Stephensen, C. B. (2001). Vitamin A, infection, and immune function. Retrieved March 26, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/11375434

12. Ströhle, A., & Hahn, A. (2009, February). Vitamin C and immune function. Retrieved March 26, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/19263912

13. Uruakpa, F. O., Ismond, M. A. H., & Akobundu, E. N. T. (2002, June 4). Colostrum and its benefits: a review. Retrieved March 27, 2020, from https://www.sciencedirect.com/science/article/pii/S0271531702003731

14. Wirngo, F. E., Lambert, M. N., & Jeppesen, P. B. (2016). The Physiological Effects of Dandelion (Taraxacum Officinale) in Type 2 Diabetes. Retrieved March 26, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553762/

GPL is Pleased to Introduce Our New Consultant - Dr. Jasmyne Brown

JASMYNE BROWN, ND, MS

Jasmyne Brown is a board certified and licensed naturopathic doctor.  She earned her Bachelor of Science in chemistry with a minor in biology from Alabama Agricultural and Mechanical University in 2013.  In 2017, she earned her doctorate in Naturopathic Medicine and master’s degree in Human Nutrition from the University of Bridgeport College of Naturopathic Medicine.  Her educational background and her experience as a WIC nutritionist with the Florida Pasco County Department of Health allows her to convey complex concepts in a manner that can be grasped by anyone on multiple levels. She is thrilled to be a member of the GPL team and hopes to bring an understanding of functional medicine to all who seek it.  She will be using her professional training to interpret clinical data from GPL lab tests and further her passion for identifying the biochemical pathways within our bodies and how nutrition and lifestyle impact them.  

Now, let’s hear from Dr. Brown: 

Hello everyone, 

It’s my pleasure to now be working with Great Plains as a consultant and I look forward to speaking with some of you in the future.  I am particularly excited about the fact that I will also be contributing blog posts on a regular basis.  My journey to becoming an N.D. started many years ago as I struggled with my own health issues.  

Year after year of waking with random oozing scrapes on my arms and legs due to intense pruritus and the persistent urge to scratch even in my sleep, I always wondered what made me so prone to having dry itchy skin.  Since infancy I have been plagued with eczema.  Constantly fighting the urge to scratch my arms, legs, face, and hands has always been a part of my life journey.  Even through my 13-year career as a national and world class trampolinist and power tumbler, I struggled to find relief.  I had an unfortunate incident of almost falling off the trampoline due to a random intense itching sensation coming over me in the middle of my routine due to the clinginess of my leotard.  With topical and internal medications, I found relief, but with their removal I found a swift return of my pruritic rash that came back with a vengeance, as if it was angry with me for trying to get rid of it.  Never would I have thought or imagined this would be the key to me finding my path to integrative medicine. 

After I graduated Suma Cum Laude with a bachelor’s degree in Chemistry and a minor in Biology, I was on my way to the northeast for naturopathic medical school.  I set sail to learn the ways of natural healing.  For four years I immersed myself into learning the principles of integrative medicine, how the body works, and how we as practitioners can support the body’s natural function.  My focus in school was in pediatric and dermatologic medicine.  It is my mission to support parents in the health of their children and for everyone to feel good in the skin they’re in.  My path also led to me to my own healing and understanding of what was happening in my own body.  Nutrition and botanical medicine are where my passion lies, and in understanding how they work with our bodies.  Biochemistry was one of my favorite courses as it allowed me to really see all the chemical reactions happening in our bodies every day and how they can be supported in disease states.  

Once I graduated with a doctorate in naturopathic medicine and a master’s in human nutrition, life took me to Florida.  There I had the opportunity to conduct nutrition counseling with collegiate and professional football and baseball players.  It was my pleasure to support these fine athletes in their journey to and in the world of professional sports.  Supporting them through their training by assisting them and educating them on good nutrition for their professional goals was an experience I’d never thought I’d have, and one I’m grateful to have been a part of.  Through this experience I was able to get my Florida state nutrition license.  With this I accepted a government position in the WIC department as a senior public health nutritionist.  This experience was so much different from the type of counseling and client demographic I was used to.  I had to be very creative in how I gave my recommendations.  At WIC, people of a lower socioeconomic class are deemed eligible for monthly food benefits for pregnant, post-partum, and breastfeeding women.  Also, infants and children age 1-5 were screened for being under/overweight and for anemia.  Bi-yearly, and sometimes more depending on their health concerns, nutritional counseling was provided to be sure this population has proper nutrition for growth. Nutrition, breastfeeding support, and overall health were the focus.  There I got to see children every day with conditions ranging from chronic ear infections and ADHD to autism and cancer.  I had the privilege of helping families support themselves, their unborn babies, and their children nutritionally. This helped me further realize that all people, even those that cannot afford it, need functional medicine and the support of the functional medicine community.   

Later I moved back to my hometown of Kansas City, MO to be close to family again.  Not long after I had the privilege of joining the great team at The Great Plains Laboratory.  Working with Dr. Shaw was only something I had imagined in school while I learned about and utilized the Organic Acids Test (OAT), which is part of the curriculum at University of Bridgeport.  I found it to be one of my most valuable assets as a Naturopathic Doctor, especially with cases that traditional labs just couldn’t explain.  Working with the GPL team as a consultant is so rewarding.  “Doctor as teacher” is one of the naturopathic tenants I hold in the highest regard as our patients/clients and our fellow practitioners deserve to understand what we are looking at and what’s happening in the body.

It gives me great joy to be able to be a guide in the world of biochemistry as it relates to patient health and well-being.

I look forward to connecting with all of you with my future blog posts and I hope the topics I write about are of interest and benefit to you as practitioners and patients.  Until next time, stay safe and healthy. 

Jasmyne Brown, N.D., M.S. 

How to Maximize the Benefits of Sauna for Detoxification

by Jessica Bonovich RN, BSN

We have been recommending sauna therapy for detoxification to many of our patients who have high levels of various chemicals found in their GPL-TOX, Glyphosate, or Metals test results.  The fundamental principle that governs detoxification is that heat liberates toxins from fats, which then gets flushed out by the sweat and carried off by the blood to the liver, kidney, and GI tract. Many people are familiar with the Hubbard Protocol for sauna detoxification, which has been shown to be effective for those with serious toxic load issues, and was even used with success on emergency workers who were exposed to chemicals at the World Trade Center 9/11 disaster site.  The Hubbard Protocol is quite intense and requires a great deal of time spent in the sauna on a regular basis.  The sauna detoxification protocol that follows is perhaps more reasonable for the average patient and is designed to maximize detoxification without causing undue stress to the patient.  Sauna should be started after other metabolic supports have been implemented (such as those indicated by the results of the Organic Acids Test (OAT) and GPL-SNP1000 genetic test.

The Case for Sauna Therapy

The use of sauna for liberating toxins from the adipose tissue has been fairly well established as being effective for the treatment of toxicity for many years. The studies that I have read were all published before infrared technology existed.  So, it is safe to say that sauna of any sort is likely to benefit patients with toxicity. Infrared technology claims that it is able to cause a more vigorous sweat at lower temperature, which may create a more comfortable experience for the user (less time needed and at a less high temperature).  Infrared technology also claims that it can penetrate deep within the tissue for effective elimination. While visceral fat (the fat surrounding the organs) is certainly capable of housing toxins, it is the adipose tissue found in the subcutaneous layer that is viewed as the primary culprit for toxin accumulation. To reach the subcutaneous tissue, you simply need heat. Heat can be generated internally. Consequently, exercise is an excellent way to generate heat and burn the fat housing the toxin to begin with. Many patients are too sick to consider this as an option but patients who can tolerate exercise should be encouraged to do so. Better yet, do both exercise and sauna therapy.

 Here is a very thorough article about sauna detoxification, including an interview with Dr. George Yu, who has worked for many years with Gulf War veterans and 9/11 site workers to help them detox with sauna.

Niacin Flushing

Heat helps to destabilize lipophilic compounds just enough so that they can become mobilized by the fluids that are simultaneously released during heat exposure. Some compounds can be liberated directly into the sweat while others will be transported by the blood stream into the liver for metabolization and/or conjugation. The vasodilatation that is induced by heat exposure provides an increased blood flow to these organs.  Nicotinic acid (niacin or niacinamide) can induce flushing in doses above 50 mg which will subsequently increase blood flow to the liver and kidney. It is often used as a part of detoxification protocol because of what is referred to as rebound lipolysis. High dose niacin is used therapeutically to inhibit free fatty acid release, decrease LDL, and increase HDL. This effect is soon compensated for and free fatty acids return to normal and in some cases above normal. The rebound effect varies from study to study but is generally considered mild. It is the release of free fatty acids that also causes the release of toxins in the body. Practitioners are hoping to achieve a greater degree of toxin release through this rebound effect that niacin can have about two hours after administration.

In addition to the rebound lipolysis and vasodilatation, niacin also inhibits oxidation in the vasculature which is an important factor with detoxification. It is worth exercising caution with niacin in patients with diabetes, history of gout, on blood thinners, and who have MTHFR/methylation gene mutations. The rebound effect is associated with insulin resistance in many studies. Patients who are already diabetic tend to have the greatest difficulty with this.  High dose niacin can also cause elevations in uric acid, increased prothrombin time, and decreased platelet counts. It can also cause stress to the methylation pathway because this compound requires methylation to be eliminated. In fact, there are documented cases of hyperhomocysteinemia occurring in patients taking 1000 mg of niacin per day, which is the standard dose for a flush. I typically only recommend niacin as part of the detoxification protocol in patients who have demonstrated their ability to tolerate it or who have minimal risk for methylation pathway disruption.

Further Supporting the Detoxification Process

Heat allows toxins to become reintroduced into circulation and there is an increased potential for oxidative damage. For this reason, I recommend that patients take antioxidants before and after sauna therapy. Liposomal glutathione is an obvious choice because it is not only an antioxidant but an important substrate required for conjugation of many toxic compounds by the liver. I recommend a teaspoon before and a teaspoon after sauna treatment. This equates to approximately 400 mg twice a day. I also recommend taking plenty of vitamins E, A, C, D, and K.

The lipophilic, toxic compounds that find their way to the GI tract should ideally be flushed out through fecal elimination. To ensure the greatest possible chance for this to occur, patients should first and foremost be eliminating bowels every day. To prevent the reabsorbtion of these compounds, bile acid sequesterants and binders can be used and there is evidence to support their use. Bile acid sequesterants are just that - agents that sequester the bile, essentially making it unavailable to bind with other lipids. The prescriptive agent that is most commonly used is called cholestyramine. This agent has a very short half life (6 minutes) and is capable of binding up to 80% of bile in that short time. This short half life also means that taking cholestyramine before sauna will not interfere with the absorption of nutrients at meal time. This is an excellent choice for patients who can tolerate this prescription. Fiber is also capable of binding bile acid, but to a lesser extent. Both soluble and insoluble fibers like lignan, alfalfa, bran, and guar can bind between 10%-30% of bile acids. Cellulose does not effectively bind with bile, so it should not be considered as an option for this particular application. Binders are agents that prevent reabsorbtion by adhering to the toxin itself. Examples of binding agents are bentonite clay and activated charcoal. GI elimination is the only way for the extremely lipophilic, toxic compounds to be eliminated. When doing sauna therapy, any toxic compound in tissue has the potential to be eliminated, so taking these measures to ensure proper elimination via stool is important.

Electrolyte monitoring is an equally important consideration when detoxifying patients. To an extent, the minerals K, Na, Ca, and Mg will be lost during dieresis. Binders used to prevent the absorption of toxins will also prevent the reabsorbtion of certain minerals that are in the gut, so a good multi-vitamin/mineral supplement such as Spectrum Mate should be taken throughout the detoxification process.

Other Factors Impacting Results

The degree that a patient is likely to respond to sauna therapy depends on several things. The amount of toxin accumulated in tissue and the ability of the liver to safely mobilize toxins are two major factors. Toxic compounds that are not conjugated are either extremely hydrophilic or extremely lipophilic (to the extent that they cannot be measured in the urine). Some compounds are more toxic when they have been metabolized and others actually become more stable. The more time exposed to heat, the more toxins will be liberated, but the body can only do and handle so much of this at once. For this reason, I recommend that when patients are in crisis, they start sauna therapy very slowly and work their way up in time spent per session and how often they do sessions, as they become more tolerant.

What Types and Brands of Sauna Are Best?

As previously mentioned, infrared technology claims to have additional benefits over traditional sauna, but there doesn’t seem to be any research directly comparing the two types of saunas.  If infrared rays allow for profuse sweating at lower temperatures than a traditional sauna, then an infrared sauna might provide a more comfortable option (similar results at a lower temperature) for those sensitive to the heat.  If you’re looking for an infrared or other sauna, it is important to consider brands whose wood is not treated with toxic chemicals that will off-gas while in use or that emit large amounts of electromagnetic (EMF) radiation.  Some of the better options for booth-style, wooden saunas are Clearlight and Heavenly Heat.  There are also more portable infrared saunas available that have been shown to be effective and Relax Saunas is a good example.

 If you find purchasing a sauna to be cost-prohibitive, the portable versions are less expensive.  Another option is to find a spa or health club in your area that has a sauna you may use for a particular fee per session or as part of a membership package.  Many integrative healthcare practitioners who are invested in helping their patients detoxify also have saunas in their offices for use.

Summary

In summary, patients should be given metabolic supports and be eliminating bowels every day prior to initiating a sauna detoxification program. Heat therapy is effective at removing many toxic compounds from the body and sauna therapy is a passive form of heat therapy. Advise your patients to take antioxidants before and after the heat therapy (liposomal glutathione, if possible). Give binders and bile acid sequesterants prior to heat (sauna) therapy. Make sure that patients remove as much sweat as possible during and immediately after sauna sessions. Monitor your patients’ serum electrolytes. Finally, have patients start with sauna therapy slowly and progress toward longer and more frequent (even daily) sessions until complete elimination of the toxin is observed through testing.

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References

Evidence for sauna treatment:

PMID: 20400489, 2143911, 220089658, 7144634, 20621793, 17234251, 23844383

Evidence in support of fiber and cholestyramine for binding bile acids.

PMID: 956912, 3008573, 30273, 24499150, 17438377

Evidence in support of binders:

PMID: 16019795, 18286403, 22069658, 15781206, 11439224, 17092826, 16095665, 16782537, 17561436, 11245394, 23710148

Bioaccumulation and elimination of toxins:

11572612, 11834080, 17296488, 16924830, 15513954

Niacin flushing:

21386057, 18375237, 18047854, 17996241, 10893322, 4883477, 17368274

Detoxifying Your Body - Water Filtration 101

Jessica Bonovich, RN, BSN

Hello, and welcome back to the GPL Blog.  Today we are talking about water filtration, which is a subject a lot of clients have asked about since we introduced our GPL-TOX test.  What we have seen through our studies, and those of other labs is that many of the toxins assessed by GPL-TOX have been found in many water supplies.  Any treatment plan needs to encompass a plan to prevent re-exposure. 

I recently reached out to over 12 water filter distributors and manufacturers to learn about the best filtration system for removing volatile organic compounds (VOC’s) from water and why. I was very transparent about the needs of our patients and the company I work for. I also reviewed information provided by The Environmental Working Group, who offers this Water Filter Buying Guide.  In addition, I contacted the Industrial Wastewater Management Center, the Department of Natural Resources, NSF Public Health and Safety Organization, and the Environmental Protection Agency.  Here is what I learned:

Carbon Block Filters

Carbon block is the commercially available standard for removing VOC’s. These very small compounds adhere to a surface of carbon (a process called adsorption) but will not be removed through reverse osmosis, ceramic, deionization, ozone, or ultraviolet light filtration. Factors that affect adsorption include the concentration of the compound, surface area, and the contact time between the water and the carbon. Of these factors, filters control the latter two.

The surface area of the carbon refers to the size of the pores in the carbon filter. This is where the “block” comes in. The filtration companies pack the carbons in very tightly which creates a very small pore size. The smaller the pore size the greater the chance of catching very small molecules like the VOC’s. The pore size of carbon block filters is generally measured in microns and ranges from 0.5 up to 1 micron.  This is sometimes also called submicron filtration. These tiny pores also remove lots of other small molecules like bacteria and particulate matter. Our main concern here is the removal of VOC’s because the carbon is the only filtration that will eliminate these compounds. Many other kinds of filters are available to remove the other materials. It’s a bonus but not a big selling point.

The contact time equates to how much water can contact the filter over a given period and directly affects the gallons per minute (gpm) of filtration. Companies intentionally build in methods to restrict the water flow to increase the amount of contact time the water has with the filter. The water restriction lowers the gpm which can slow the water flow. Consumers tend to want higher gpm for greater water pressure but this can affect the removal of contaminants.  The size of the filter also influences the removal. So, if you want high water flow (gpm) you need a larger filter that will handle the larger volume. This will cost you a bit more. If budget is your main concern, low gpm is the priority. Whole house filtration systems are not as effective at removing VOC’s because they are geared toward optimizing the water flow, in other words, fast filtration. The size of the filter needed to overcome the pressure drop on whole house filters is cost prohibitive for most people. Several companies do make carbon block filters for your shower head which is a nice option for reducing the VOC contaminants in your shower water. The under-the-sink and counter top units are often called point of use (POU) filters. The industry standard for good carbon block filters is between 0.5 and 1 gpm. The filter size that is needed to accommodate the larger gpm and still remove VOC’s can be deduced by looking at the performance data sheets that companies provide. This is what people should focus on to determine how robust the filter really is.

Filter Specifications

Understanding filter specifications can be a learning curve in itself. Companies will have third parties test the amount of contaminant coming in (called influent) and the amount going out (called effluent) through a company called NSF. The data sheets do not report the actual effluent, but instead report the “maximum permissible product water concentration” established by the EPA. This number will be the same on all data sheets. This testing is an important factor because we know that the concentration of the compound influences the ability of the filter to adsorb. NSF spikes water samples with a known amount of a compound and then measures the amount that is still in the specimen after filtration. These reports vary considerably and range from very well-organized to quite confusing. Some performance data sheets list these figures as a chart, while others use graphs. The only real difference is the percent reduction. This is the amount that was eliminated during the testing. I have asked multiple companies why they do not provide the actual effluent data and even contacted NSF about this. No one has been able to tell me why they don’t provide the raw data.

Filter Housing Options

Choosing the housing for your filter is the final step. Most of the companies use stainless steel, aluminum, or polypropylene plastic housing. Polypropylene is considered nontoxic by the Environmental Working Group. However, it can be oxidized when exposed to stress like heat and UV.  On top of this, many of our patients have developed severe chemical sensitivity. Once this acute phase has established itself, it can be difficult to predict what the patient will react to. I recommend the stainless steel option to remove any concern about plastic toxicity. Once your water has been filtered, do not store water in a container for more than 24 hours. Without chlorine, the water becomes a target for microbes to take up residency. 

Testing Your Water

Most filtration companies recommend that you have your water tested prior to getting a filtration system so you know exactly what you need. I have focused on single stage filtration designed to remove VOC contaminants. If you have heavy metals or bacterial contamination, you will need a multistage filter that will remove all the other contaminants. To find a laboratory in your area that can test your water, the EPA suggests that you start with your local municipality. I contacted the local water department here in Johnson County, KS to test this theory and they provided me the names of three local laboratories that can test water for contaminants.  Only one of these companies responded to my request and they offered to test for 29 VOC’s for $140.

An acceptable level of contamination has not been established for every chemical compound. The VOC’s that do have a limit are listed on pages 257-533 of this document.  According to the most current information available on the EPA website, municipal water suppliers must test the water for these VOC’s four times per year. If there are no contaminants reported for three years, the municipality can test just once per year. Municipalities can go a step further and apply for a waiver that exempts them from testing any VOC’s for up to six years. If a contamination is found, quarterly monitoring is required. If the municipality does not comply with this, there are no stated penalties or further requirements, which is a bit disconcerting. If you find that your water exceeds any of these standards, you should report this contamination to your state EPA office.  

Final Thoughts

The company (and person) that was the most helpful to me by far on this journey was Ron at Water2drink.com. All of their filter performance sheets are disclosed here. Individual requirements will vary based on price and available space. If you want my personal opinion for a good filter to remove VOC contaminants, this is a great place to start.

Oxalates

Hello. Welcome back to the GPL-Blog.  My name is Jessica Bonovich, RN, BSN.  I’m the nurse consultant here at The Great Plains Laboratory.  Today I’m going to be discussing oxalates, which are one of the many things that are tested for in the Organic Acids Test (OAT). Oxalates are of particular interest to patients who have pain and in non-verbal children with behavioral issues. Frequently, these individuals are experiencing pain as the result of oxalate crystals precipitating with minerals in tissue, including the formation of kidney stones. The Organic Acid Test is well suited to determine if this is likely occurring. When determining the best course of action we look at the proportion of the oxalate, the metabolite of oxalate, and the patient’s symptoms.

As the nurse consultant at the lab, it is my primary job to review test results with people. and as a result, I see a lot of Organic Acids Tests. Doctors and patients are often surprised to learn that Candida and Aspergillus species can produce oxalates. These species have certain enzymes that allow them to use glyoxalate as a means of making energy (it is an intermediate in their TCA cycle).  Individuals with elevations in Candida or Aspergillus frequently have a subsequent elevation in oxalate metabolites. The degree of elevation may or may not be proportional to the yeast/mold overgrowth and this is an important distinction when evaluating the significance of the markers.  If the elevation is proportional, I can easily point toward yeast as the culprit. If the oxalates are disproportional, it can be related to several other factors.

To some extent, all individuals will obtain oxalates from three sources: liver cells (endogenously), yeast species (exogenously), and food (also exogenous). The reference ranges on our test show the typical accumulation of oxalate metabolites from all three sources.

In humans and in yeast, glyoxalate is the parent compound that can be converted into the three metabolites measured on the Organic Acids Test (OAT): glyceric, glycolic, and oxalic acid (Figure 1).

Figure 1

It can also be converted into glycine which is not measured on the OAT. Individuals with primary, secondary, or tertiary hyperoxaluria have genetic deficiencies in the enzymes that drive these pathways and cause the distinguishing features of the disease. People who are predisposed to stone formation may or may not have deficiencies in these enzymes. The degree to which a person will favor each pathway depends on a number of metabolic factors (including available precursor and pH of the cell). Elevations in all three metabolites can occur because of yeast and endogenous production. Food and Aspergillus on the other hand, produce oxalate in the body directly. So, when these are the source of excess, only oxalate will be elevated on the test.

Patient symptoms are a key component to all of this. It almost goes without saying that we treat the patient and not the number. Low oxalate values do not rule out an oxalate issue and extremely elevated values are not always equated with pain (though the potential certainly exists).  

Let’s get back to the disproportional oxalate scenario. If a patient has mildly elevated yeast and moderately to highly elevated oxalate, what do you think would be the most likely cause?

a.      Endogenous production

b.      Yeast

c.       Food

d.      A combination of b. and c.

The correct answer is d. Food is a direct source of oxalate and the most common cause of disproportionately elevated oxalates. Yeast is contributing to the oxalates in this scenario but is not likely to be the only cause of the elevation. Patients like these should introduce calcium and magnesium supplementation with meals to help bind up excessive oxalates in the food (so they can be eliminated in stool). Many conventional doctors falsely believe that calcium supplementation should be avoided when oxalate stones are a problem. They forget that calcium levels are maintained at precise levels in the blood no matter what the intake is. This is because without calcium, the heart will not pump. So, several mechanisms are in place to ensure adequate levels are maintained at all times. Avoiding calcium is only likely to increase osteopenia and not at all likely to reduce stone formation.

Let’s walk through another scenario. An individual presents with extreme pain in the muscles and history of stone formation. The patient has very elevated Candida and eats a high oxalate diet. All of the oxalate metabolites on the OAT are normal. What is the most likely scenario?

a.      Oxalates are not a problem

b.      Endogenous production

c.       Food and yeast are not a problem

d.      None of the above

The correct answer is d. This is a scenario that I refer to as hidden oxalate toxicity. This patient should have elevated oxalate metabolites.  Based on their history and lab results, oxalates would be expected. It is likely that oxalates are present in the body. However, they are precipitating in tissues before they ever make it into the urine. These patients are usually the most extreme cases of pain. They are also the people who do very well once all of the sources of oxalate have been eliminated. It is important to remember that when patients are in pain, removing oxalates should be done SLOWLY. Otherwise the patients are likely to experience an increase in pain as a result of “oxalate dumping”. When oxalate crystals are already in the tissues, mobilizing them can cause irritation. I recommend that patient introduce therapies one at a time, thoughtfully, over several weeks to months.

Okay, last one. This is a patient with moderately high yeast metabolites, a diet rich in fruits and veggies, and severely elevated oxalate metabolites.  To give this some perspective, the reference range for oxalates is 100 mmol/mol. This patient has close to 1000. The patient has symptoms of yeast overgrowth and fatigue as the chief complaints. What is the most likely cause of the extremely elevated oxalates?

a.      Yeast

b.      Diet

c.       Endogenous production

d.      All of the above

If your answer was d, you are correct. This patient has disproportional oxalates beyond what would be expected in diet. The patient certainly has the potential to accumulate oxalates in the tissues. However, since she is eliminating it effectively, it is not causing her pain at this time. Measures should still be taken to decrease the oxalate burden. We have much more to learn about the tendency for a person to form oxalate crystals.  Several genes (AGXT, GRPHR, and HOGA1) have been implicated (all of which are identified on the GPL SNP1000 test). Even if these genes are not mutated, some individuals still have a tendency toward oxalate stone formation. The high glyoxalate production is only one factor. 

Remediation of high oxalates is a multi-step process. Elimination of yeast is always important and not only because of excessive production. Pathogenic yeast can also cause an imbalance in beneficial bacteria that help to degrade oxalates.  Many studies have demonstrated that oxalobacter can reduce oxalate stone formation (hence the name). As of right now, testing for oxalobacter is available primarily in research settings and supplements are not widely available to the public (though I expect that they will be soon). Fortunately, there are other beneficial bacteria species shown to reduce oxalic acid. Many of these are already available probiotic form. These include Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium breve, and Bifidobacterium lactis all of which are available in Lactoprime and Ther-biotic Complete probiotic formulas.

Awareness of oxalates in food and elimination of those foods highest in oxalate (like spinach, soy, almonds, sweet potatoes, and raspberries) is important. Keep in mind that a low oxalate diet should only be done with the help of a practitioner and only when there is a clear need. The foods that contain oxalate are healthy and provide many nutrients that our bodies need to maintain healthy homeostasis. People forget that the oxalate content alone is not the only factor in oxalate absorption. The oxalate to calcium/magnesium ratio should be taken into account when we consider the potential for oxalate accumulation. If a food has equal amounts of both calcium and oxalate, it is likely that neither one will be absorbed very well. Plenty of bile acid needs to be available to prevent fats from binding with calcium. Both taurine and glycine strengthen bile acid but glycine increases oxalate. Glycine is where our endogenous production of glyoxalate starts. Keep this in mind when you are choosing supplements.

Lastly, sufficient B6 is required to help with the conversion of glyoxalate to glycine in the body. Maintaining sufficient levels of vitamin B6 will help with the endogenous production. However, the active form (P5P) is poorly absorbed.  I recommend that patients in pain start with low doses of pyridoxine hydrochloride (10 mg) and work up to higher doses as tolerated. The upper limit is 100 mg per day. Patients without pain can usually safely start at 50 mg per day.   

Wow, so that was a lot. Oxalates are a topic of much interest in our patient population so I want to be as thorough as possible. If in doubt, call the lab and speak with a consultant. We have lots of experience looking at tests results and can provide insight into the patterns that are occurring on the results.

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References:

Finkielstein, V., Goldfarb, D., (2006). Strategies for preventing calcium oxalate stones. Canadian Medical Association Journal , 174 (100). Published online doi: 10.1503/cmaj.051517

Herb, Nutrient, and Drug Interactions. (1st edition). (2008). St. Louis, MO, Mosby, Elsevier

Liebman, M., Costa, G. (2000). Effects of calcium and magnesium on urinary oxalate excretion after oxalate loads. Journal of Urology, 163(5): 1565-1659.

Matkovic, V., Heaney, R.P., (1992). Calcium balance during human growth: evidence for threshold behavior. The American Society for Clinical Nutrition, 55(5): 992-996.

Pennistion, K., Nakada, S. (2009). Effect of Dietary Changes on Urinary Oxalate Excretion and Calcium Oxalate Supersaturation in Patients With Hyperoxaluric Stone Formation. Urology, 73(3):484-489.

Physicians Desk Reference for Nutritional Supplements. (2nd edition). (2008). Montvale, NJ: Thomson PDR

Rushton, HG., Spector, M. (1982). Effects of magnesium deficiency on intratublar calcium formation and crystalluria in hyperoxaluric rats. Journal of Urology, 127(3): 598-604.

Poore, R.E., Hurst, C.H., Assimos, D.G., Holmes, R.P. (1997). Pathways of hepatic oxalate synthesis and their regulation. Cell Physiology. 272(1), C289-C294

Shaw, W. (2009). Autism: Beyond the Basics. Self Published, USA.

Weaver, C. (1994). Age related calcium requirements due to changes in absorption and utilization. Journal of Nutrition, 124(8): 1418S-1425S.

GPL-TOX: Managing our Toxic Environment

Welcome back to the GPL blog.  I am really excited to be entering our second month of providing what we hope is useful information to the community.  Last month I discussed some of the uses of the GPL-SNP1000 test.  This month we will be discussing environmental toxicants.  Some of the topics covered will be the most prevalent toxicants in our environment, the best way to test for them, and relevant case studies. In the last blog this month I’ll cover some ways to detoxify the body and what tests can determine how well a patient is able to detoxify.

The Great Plains Laboratory introduced GPL-TOX (our toxic organic chemical profile) last July that measures 168 different toxic chemicals.  Our goal was to provide a test that measured as many chemicals as possible for a reasonable price.   These compounds fall into the categories of phthalates, benzene, pyrethrin insecticides, xylenes, styrene, fuel additives, 2,4-Dicholrophenoxyacetic (2,4-D), and organophosphate pesticides. Once a person has been exposed, the chemicals undergo several metabolic changes in the process of elimination and detoxification.  We measure the end products in the urine to determine how much chemical exposure has taken place.  Last October we introduced a test for the toxic compound glyphosate which is the world’s most widely produced herbicide. You have probably heard of it already, as it is the active ingredient in the broad-spectrum herbicide Roundup TM.  

Here at GPL, our scientists are continually working to improve our tests.  Later this month we are introducing eight new analytes to our GPL-TOX test for no additional cost. The new analytes are acrylamide, acrylonitrile, diphenyl phosphate (fire retardant metabolite), perchlorate, butadiene metabolite (carcinogenic component of rubber), dimethyl thiophosphate (pesticide metabolite),  propylene oxideacid and bromopropane.  Even before our recent update, GPL-TOX was one of the most comprehensive toxic chemical tests available.  Next week, I will discuss how all of these new analytes can affect a patient’s health.   This week I am going to provide more details about the analysis and review  a few of our current toxic analytes. I am also going to provide a few examples of case studies.   

To better understand the relevance of GPL-TOX, I’d like to explain the percentiles on our report.  The CDC issues a report of the exposure of many different chemicals to the US population.  Our percentiles are pulled from these reports.  If you are in the 95th percentile, then that means that only 5 percent of the population would have a higher value than yourself.  Since we do not know what the safe amounts are for many of these compounds we recommend reducing levels as much as possible. 

Every year over 1,000 million tons of organophosphates are used in the agricultural industry and in our home gardens.  This is a problem that is affecting us all, because even if we eat exclusively organic food, there is evidence that many of these organophosphates have contaminated the water supply.  The evidence of this has been centered on the increasing prevalence of depression, ADHD, pervasive developmental disorder, and birth defects, linking these toxins to these disorders. GPL-TOX looks at two metabolites related to organophosphates, Dimethylphosphate (DMP) and diethylphoshate (DEP).  Together these two metabolites allow us to track over 151 different organophosphates through urine, including nine of the ten most commonly used organophosphates. 

Another marker that makes GPL-TOX useful is monoethylphlate (MEP), which is a metabolite of phthalate exposure.  Many of us know about the pervasiveness of these compounds, which seem to be found in so many common products.  These products include lubricants, paints, perfumes, children’s toys, gels, and pesticides.  We are seeing many of our sickest patients possessing high values of phthalates.  Some of the symptoms we are seeing are fatigue, depression, ADHD, and arthritis.   

I want to share a couple of case studies to help illustrate what we are seeing.  The first is a painter with arthritis, fatigue, and depression.  The MEP on this patient’s GPL-TOX report came back at 19,110 (see Figure 1), which was ten-fold higher than our 95th percentile.  We recommended a detoxification program to this patient, which many of our patients are using with great success.  I will discuss different means of detoxification in my blog on May 30th, so check back for that.

Figure 1

Here is one more interesting case study.  We have all heard about fracking (the process of injecting liquid chemicals at high pressure far underground, in order extract natural gas or oil) and some of the resulting damage it does to the environment and our water supplies. The results below are from an extremely autistic patient with PANDAS who lives near fracking wells in the summer (see figures 2-4).  This sample was taken months after he was exposed.

Figure 2

Figure 3

Figure 4

These results are pretty alarming.  Obviously not everyone has high values like this, but even if we don’t live near fracking sites, we are exposed to toxic chemicals in our environment more and more every day.  If you do come up high for one or more of these chemicals, there is hope.  On May 30th I will discuss potential treatment options to detoxify the body and recommendations to avoid future exposures.  After treatment and avoidance, I recommend running the test again to make sure that you have sufficiently decreased the toxicants. 

Next week I will talk about the new analytes for the GPL-TOX test and why measuring these particular analytes is important.  In the meantime, stay vigilant about the many chemicals you and your family may be exposed to on a regular basis in every area of your home, from the food you eat and the water you drink, to all your household products.

Email gplblog@gpl4u.com if you have any questions about this blog post.