Toxins & Environmental Health Case Study: Functional Medicine Series

Show Summary:

Welcome to a special series on the Capital Integrative Health Podcast! I am your host, Dr. Andrew Wong, and this is a podcast dedicated to exploring the root causes of both disease and wellness.

I am a co-founder of Capital Integrative Health, a clinic with a mission to create a revolution in healthcare by educating, leading and inspiring people towards optimal health and true wellbeing.

We’re excited to offer you this series as an insightful look into functional medicine and walk you through case studies that exemplify how we think about and approach care with our patients.

These cases are de-identified and names used are placeholders.

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Full Transcript:

Dr. Andrew Wong 

Welcome friends to a special series on the Capitol Integrative Health podcast. I'm your host, Dr. Andrew Huang. And this is a podcast that is dedicated to exploring the root causes of both disease and wellness. I am honored to be a co founder of Capitol Integrative Health Clinic in Washington DC area with a mission to create a global revolution in health care by educating, leading and inspiring people towards optimal health and true well being.

One of the key modalities we utilize in our clinic to help patients and be of service is functional medicine. We're excited to offer you this series is an insightful look into functional medicine, otherwise known as root cause resolution medicine, and walk me through case studies that emphasize how we think about and approach holistic care with our patients.

So in today's episode, we're walking through a case study on toxins and environmental health and the functional medicine approach to that. So today, we have Rob who is a 43 year old male who has allergies to a bunch of things including pollen and pet dander, and he's noticed an increase in symptoms even outside allergy season. He also moved into an older home recently, that was about 50 years old, and water damage was discovered and he also noticed that the basement had some mold, some water stains on it as well. He also in his past worked as a mechanic in his late teens and early 20s. He does have a family history of autoimmune disorders and respiratory conditions including asthma, and for allergy relief. Occasionally he takes over the counter antihistamines. Symptom wise Rob often feels tired and lacks energy even after full night's sleep. He has trouble recalling words when speaking occasionally. And he also has more than occasionally brain fog and difficulty focusing while working. He also has seen on his neck and arm sometimes skin rashes that appear. He doesn't really tie it to eating or anything specific, but just appearing randomly and these are itchy skin rashes. about one to two times a week. He also has headaches. He has chronic congestion regularly feeling the need to clear his throat and random sneezing. And then finally, he has some chemical sensitivity where he experiences headaches. When exposed to frequencies in particular things like perfumes, or cleaners. In terms of his lifestyle. We asked him about his nutrition, and he does follow a high protein diet. He does include fruits and vegetables every day tries to eat organic when possible. He also eats out several times a week and relies on protein bars when working for snacks. Generally he tries to limit gluten and sugar because he's noticed that this worsens digestion. It doesn't seem like he's tried to reduce dairy yet. From a stress perspective, he does have occasional periods of high stress working as an office manager. And overall he rates his stress at about a five out of 10. movement wise as an office manager, he spends a lot of time indoors, he spends a lot of time sitting in his chair at a desk job sedentary job, he does do some weight training at the local gym and some cardio an average about 30 minutes, three times a week. So for this patient, Rob, I would first got asked what what really makes things better or worse, if he can really kind of pinpoint a little bit more how his body's reacting to different different things. We know that all disease and imbalance is related to the mismatch between his genetics and between his environment. And we talk about an environment where we often think about sort of environmental health in terms of toxins. And we'll get into that, but we also talk about, we also think about really the environmental inputs that someone is putting into their body like the food that they're putting in and the water, the air, you know, as the air clean or not. Are there any chemicals that are involved in the environment, home or work environment? We also think about thoughts, you know, thoughts, toxic thoughts can actually be a toxin as well, because that leads to neurochemical changes that then lead to inflammation in the brain and the nervous system.

So I think the first thing would be you know, what kind of makes things better for Rob? What kind of things make things worse for for him as well? What treatments has he tried before that have worked for him? Or not? You know, what treatments? Have you tried that that haven't worked for him? Now looking back at his patient history, we do see that his allergies are getting worse over time. And one thing that happens is there's a connection between immune system dysfunction and inflammation. And it's kind of like a vicious cycle where someone has more allergies and inflammation that generates more triggers, so to speak for the immune system. That immune system over activation then actually triggers more inflammation in the body. In fact, most of his symptoms like allergies Like being tired and lacking energy, the brain fog and trouble recalling words, the skin rashes and headache and the chronic congestion can all be linked to one word from a functional medicine perspective, which is inflammation. So we know that inflammation is something that is very helpful for us to mount a defense and a response against viruses and illnesses and disease. But when inflammation is chronic and unchecked, and unmitigated, then it actually causes a lot of collateral damage to the to the body as a whole to different organs, different tissues. And you kind of see that in this case with Rob here. So I would certainly ask him another thing to ask him that first, because we know that one of the big causes of energy issues is actually something called sleep apnea, obstructive sleep apnea. So he does have a full night's sleep sometimes, and even with that he's feeling tired, and, and not having energy.

So another thing would be, you know, as he's snoring is he having trouble breathing at night, if he has a bed partner does that partner notice that he's having trouble breathing in the middle of the night, if any of those are positive, and there's some questionnaires we can give him as well, we would want to do either in a lab or an in home sleep test that would, that would either roll on a roll of sleep apnea, which would actually be one of the big causes of fatigue. We also know that the immune system where it's trying to rebalance at night often and also help with detoxification, if the person is not getting enough deep quality sleep or quality sleep with a lot of deep sleep, I should say, that's actually going to impact the immune system function as well so that people that have short sleep or decreased deep sleep, are actually going to have a lot of immune system dysfunction, allergies, trouble detoxing, so that's a big factor too. I would ask them to also ask them about the the water damage especially, we know that water damage when there's water damage, then often there's mold. Now mod is a type of basically fungi that basically creates a lot of toxin so so the mold basically does compete with with different species of mold to they compete with each other. And one thing that happened is in that competition with with each other, these secrete something called mold toxins or mycotoxins. The mycotoxins are really even potentially carcinogenic to the body, they could be contributing to things like cancer, things like inflammation, but certainly with someone with allergies, and chronic sinus congestion and skin rashes and fatigue, that is a flag in the in the functional medicine, dynamic of potentially having mold. We also know that in the United States, 60% of buildings in United States are what are called W dB, which are water damaged buildings, that's just because the age of the buildings, you know, just like, you know, maybe over time, or bodies take different hits, you know, inflammation, and that can lead to imbalances in body over time, as we go through life. This also happens to home. So homes, apartments, workplaces, they can actually have a lot of, you know, water damage over time, pipes can burst or, you know, toilets can run and things like that it causes some floor damage, it kind of leaks, leaks into the walls, and then might not be discovered for years or decades. So that's another big piece is looking at, you know, was that water damage that was discovered was that remediated, what was happening there? What were the symptoms, his did his symptom, getting worse, kind of time correlate with when he moved into that older home. So I think that's that's really important, important. Basements also can be a big factor, because right basements are going to be more humid and you know, there's about I think, you know, at a certain percentage of humidity, then mold is going to grow more. So he did move into an older home recently, it has a basement, the basement showed some mold. So this is going to be a big area of looking at at that factor for him as well.

Dr. Andrew Wong 

So those are some of the questions we would ask and these things would take time to ask them, we also are going to ask him about his lifestyle a little bit more. So we do know that you know, he's having trouble sleeping. Again, we'll do that testing for him potentially to rule out sleep apnea. I think another thing on the lifestyle is that he does work pretty hard as an office manager. And you know, we know that maybe he's not getting outside very much. So he's not getting outside very much. He's not really getting the vitamin D that you would need to get out in the middle the day that we're the skin would make vitamin D so I would say getting a lunchtime work break where he's going outside a little bit getting a little bit of vitamin D exposure that helps to rebalance the immune system. Vitamin D is one of the key vitamins it actually acts as a hormone. And it helps to balance what are called T regulatory cells which basically translated me means that it helps to balance the immune system. So if someone has immune system imbalance, which he clearly does with allergies with a family history of autoimmune disorders, and asthma, then he's going to have some sort of immune imbalance and vitamin D is a very important factor there. So getting outside would be a very cost free and easy way and also reduce some of his stress as well and work to to do that to have at lunchtime break as well. I would ask him about alcohol. We didn't get that in the case so far. But alcohol is one of the big drivers of immune dysfunction, we know that a lot of the immune cells are suppressed when drinking even one drink of alcohol, unfortunately, so are previous. You know, when I was in school, you know, we were taught that there was one or two drinks a day is moderate drinking, you know, now there's studies that show that even two drinks a week is related to cognitive impairment. So this patient does have some trouble with recalling words and brain fog and difficulty focusing. So if he's drinking alcohol, that's one of the things I would recommend is making sure he's not drinking, he's not smoking, he's not putting any drugs in that are going to kind of mess up his brain even more than than it's getting messed up right now. I'm also kind of wondering about for his nutrition, you know, he does have chronic congestion and sneezing So, and he does eat a high protein diet, but I would definitely ask my dairy, we know that dairy is mucus producing. So any anyone eating potentially milk, yogurt, cheese, butter, maybe there's some there's some food sensitivity there going on. So an easy thing to do would be to reduce the dairy. There's also a difference sometimes between what are called a one KCN and a two KCN. So casein is type of milk protein. And sometimes people will find that they can tolerate goat's milk, or sheep's milk, but not cow's milk, because a goat and sheep have more than a two KCN versus cow's milk, which has a one. So that's another piece, if someone is trying to say the hell out of chronic congestion, one of the first things that you really want to think about is dairy sensitivity. And they could if they don't want to give a beer completely, they could try a kind of non cow's milk or non Kallal dairy program and see if that helps. So So lifestyle, I think sleep, looked at the nutritional more except including dairy, and then getting the lunchtime walk as well. And then testing. So we talked about sleep apnea testing a few times already. I do like the home sleep test for this because it's a bit more comfortable for a patient that can be in their own home. When they do that, I would certainly make sure that we get a vitamin D serum level, there's something called 25 hydroxy, vitamin D, and we typically like the level between above 50 To 50 to 80 nanograms per deciliter, so to optimize immune health, but I would say vitamin D would be helpful. We would check also, potentially allergy testing depending on kind of what's going on. There's a lot of options that can be done things like subcutaneous immunotherapy or sublingual immunotherapy. As a result of that. We would also consider gut microbiome testing. As we know, in functional medicine, everything goes back to the gut. So gut microbiome testing is important because the immune system, most of the immune system about 70, or even 80% of the immune system, some of those cells that help defend or protect us are actually living in the gut. So if we know about gut microbiome health, this can be very important and trying to figure out why someone is having brain issues or allergy issues or fatigue issues. So I would definitely consider a stool microbiome test on this potentially, we would do have definitely some lab work, you know, going back to some of the hormones, and we're going to be covering hormones in another episode as well. But someone with tiredness and lack of energy and trouble focusing, you always have to look at thyroid function as well. So a full thyroid panel, that would include things like TSH free T for Free at three, reverse T three and then the third antibody, so we would definitely want to do that. I think I would also say um, depending on what he does, we didn't really ask him about his drinking beverages, but let's say he drinks water, that's fine. If he's drinking coffee, he's trying to kind of get get up for the day, you know, get get to work, get to his office, and maybe he's tired and needs like one or two cups of coffee or even an espresso or something like that. There is something that you know, coffee can be very helpful for kind of energy and kind of lifting someone up, but it does cause a diuretic effect which means that it does cause trouble, not trouble but more urination and one thing that happens is that magnesium is peed out more when when we're drinking a lot of coffee. So I would want to check his magnesium level because that could be another cause of things like headaches and fatigue. So that's another lab that can be done pretty easily on a blood draw. I think those are the tests I would start with there's there's certainly some other things. We could also there's a special test on on some of the commercial labs called a meg A check, I think that's a nice test that looks at something called omega three fatty acids. So fatty acids are, are part of the body there, they make up part of the cell membrane. But for purposes of inflammation, which is the root cause of his disease here, I think omega three fatty acids are very important in reducing inflammation. They're actually two types of main fatty acids for simplification here, omega threes, and omega sixes, and Omega three and Omega sixes kind of work in tandem, where you need both types of fatty acids. But in the modern diet and lifestyle, a lot of times there's the increased ratio of omega six to Omega three. So we want to actually look at that ratio, we want to check the Omega three levels, to see if that's affecting levels of inflammation that's affecting his whole body. So that's, that's what I would do on the testing side. And then practitioners and functional medicine, as a famous functional practitioner, Dr. Jeff bland, said, We could be sort of one of the godfathers of functional medicine, don't do things alone. Don't be a cowboy or cowgirl kind of person, where you think you can do it all yourself. It's taking a team approach here. So you know, practitioners that I think Rob could benefit from certainly a functional nutritionist makes sense. I think he's doing pretty well on the physical training side. So I would say nutrition would be important there, potentially someone for stress management, maybe a therapist, or even referring to Heart Math, which is a mind body technique that is a specialized technique that can really help to reduce stress and increase resilience. I think we could also, we could also look at potentially with, with his allergies, depending on how severe they are, we could refer him to an allergist, we could do allergy tests, and the clinic per se. And then I would say, depending on his on his trajectory, I mean, he's only 43. But, you know, we're seeing more and more people that are younger and younger that that even have early dementia, I think this would be very, not as common as say, after age 65. But if he's having, you know, trouble with brain fog, and recalling words and memory, and it continues to get worse than seeing a neurologist could be very helpful. A test that I didn't mention, which I think I'll mention another episode is something called the E Vox or evoked potential scan, which is a quantitative EEG that can also look at someone's brainwaves and brain health function as well. So I think those are practitioners, I would, I would kind of go go go with in terms of referrals, but certainly a functional medicine practitioner would be useful in this situation. And depending on the the, the results of testing, you know, potentially we could go into, you know, certain specialties of functional medicine. I also didn't mention, because I'm just kind of looking at this case here, that if we really suspect mold, then we can actually do with something called a urine mycotoxin test. That's a test that that you can do at home. You can also do various other tests like environmental relative Moldiness index, which is, er, am I said, that's another test that you can do at home. So these are some of the tests you can do at home to check for mold or mycotoxin exposure.

Dr. Andrew Wong 

So a lot of things that we discussed today talking about toxins and environmental health for, for Rob, what are his top three most important steps that that he could take? I think one of the things is, you know, from a sleep perspective, and I know we're talking about environmental health here, but in functional medicine, we're connecting the dots with everything, because it's really about whole person health is that if he does have sleep issues, and it's related to sleep apnea, that increases the risk of many things for Rob, it increases the risk of low testosterone, atrial fibrillation, and even more importantly than that cardiovascular and cerebrovascular events. So and translated, that means he would have an increased risk of heart attack and stroke, he would also have an increased risk of dementia, if that was not caught. So I think one of the big things is, if he's having fatigue, even after, you know, seven, eight hours of sleep, getting that home sleep study, or getting that M lab sleep study to rule out Sleep apnea is actually very important here. I would also check some other other lab work as well, thyroid would certainly make sense here, taking the lunchtime walk from a lifestyle perspective to get some vitamin D get fresh air, get out of potentially a toxic environment, depending on you know, where he is working. So, you know, it says he's working as an office manager, but in this post COVID time now we're all working kind of hybrid. So maybe he's working at home, you know, we have to ask them, you know, how many days of work a week he's working at home? And you know, is he working in the basement, you know, which is where a lot of people work is in the basement, they have their home office there, so I'd love to ask him about that as well. And if that's the case, you know, getting outside more and if he feels better when he's outside then we know that there's an environmental toxin component to you know, the root cause of why he's having these issues. So those are the some of the things and then the other thing I think would be pretty important from a dietary perspective is is to try to cut out dairy you No, dairy is a big cause of allergies. And he does have some environmental allergies, which we see pet dander and pollen. But we also know that if you treat other pieces of the puzzle, helping out inflammation, like if treating food sensitivities would be helpful, that might actually help his environmental allergies. And that's something I've seen myself as well, the more clean that I eat, the less environmental allergies I have. So it's kind of an interesting connection there between different types of allergies. So I think with the functional medicine approach, Rob is going to do very well. But you know, we're going to follow him over time, we're going to connect the dots with his biology, and we're going to work with them as a whole person. And I think the biggest thing for these type type of cases, too, is that there's so much going on that we do have to follow up with Rob and we do have to focus on the most important things so that we can peel the onion step by step and help Rob take charge of his own health. I hope you enjoyed this episode environmental health and toxins and we hope that route feels better soon. Join us next week in the series on our next episode on hormone health. Thank you so much for joining us today for this episode of the capital Integrative Health podcast. A quick reminder that the information we share on this podcast is meant for educational and informational purposes only. It's not a substitute for professional medical advice, diagnosis or treatment. We highly recommend that you speak to a qualified health care provider before making any medical or healthcare decisions. This episode please take a few moments to subscribe and leave us a review. Your reviews help us reach more people and continue to offer innovative insights and information to better optimize your health and wellness.