Episode 59: Environmental Toxicology: Swimming in the Solution with Dr. Lyn Patrick

One of the bright lights in the naturopathic/FxMed world, Dr. Lyn Patrick has devoted much of her career to training physicians in environmental medicine. She’s got loads of exquisitely valuable information, and I spent every inch of our hour together mining as much as I can for you. Take a listen and let me know what you think.

Dr. Lyn Patrick has a doctorate in naturopathic medicine from Bastyr University and has been in private practice as a licensed naturopathic physician for the last 30 years. She is a published author of numerous articles in peer-reviewed medical journals and she speaks internationally on the integrative medical treatment of chronic hepatitis C, environmental medicine, liver disease, endocrine disruption and other topics. Currently, she is co-chair of the American College for Advancement of Medicine (ACAM)’s Education Committee and Chelation Committee, lecturing in the area of environmental medicine and metal toxicology. In this podcast, Dr. Fitzgerald talks with Dr. Patrick about the dangers posed by environmental toxins and how to mitigated those risks for patients.

[embed_popupally_pro popup_id=”28″]

Lyn Patrick ND graduated from Bastyr University in 1984 with a doctorate in naturopathic medicine and has been in private practice for 30 years.

She is an author of numerous articles in peer-reviewed journals, a Contributing Editor for Alternative Medicine Review, a Medline-indexed journal of complementary/alternative medical research and recently authored a chapter in the newly released textbook Clinical Environmental Medicine (Elsevier). She speaks internationally on environmental medicine, liver disease, endocrine disruption, metal toxicology and other topics. She is currently Faculty for the Metabolic Medicine Institute Fellowship in collaboration with George Washington School of Medicine and Health Sciences.

She is on the Board of Directors of the American College for the Advancement of Medicine (ACAM) and a planner and faculty member for ACAM’s continuing medical education conferences, lecturing in the area of chelation and metal toxicology. She is also a founding partner and presenter at the Environmental Health Symposium, an annual international environmental medicine conference based in the United States.

In her spare time she enjoys biking, hiking and kayaking the mountains, lakes, and rivers of southwestern Colorado.

Dr. Kara Fitzgerald: Hi everybody. Welcome to New Frontiers in Functional Medicine where we are

interviewing the best minds in functional medicine and today is no exception. I am thrilled to be here

with Dr. Lyn Patrick. Let me give you some background on her. I know you’re already well aware of her really kind of illustrious career in our world. I know she’s been a teacher of mine and inspiration to me for many years, and you’ll be sure to glean a lot of good information from Lyn today. She graduated from Bastyr University in 1984 with a doctorate in naturopathic medicine. She’s been in private practice for 30 years. She’s got lots of peer-reviewed journal articles, and some of those are open access. And, you know, Lyn, if we can get some links to be able to download some of your articles…

Dr. Lyn Patrick: Sure.

Dr. Kara Fitzgerald: They’re useful. I mean, you write for the clinician, your content is kind of

Monday morning friendly. Things that we use in practice a lot. I know I have used your writings in putting together my treatment plans and so forth. So yeah, just make a note of that and we’ll get them from you.

Dr. Kara Fitzgerald: You are a contributing editor for Alternative Medicine Review. What else? You’ve just authored a chapter in Clinical Environmental Medicine, and that’s Elsevier.

Dr. Lyn Patrick: Correct.

Dr. Kara Fitzgerald: Let me see, and you speak internationally, you speak all over the place on liver

disease, endocrine disruption, metal toxicology. I think those are your big areas.

Dr. Lyn Patrick: That’s right.

Dr. Kara Fitzgerald: Right. Incidentally, you did a great … You knocked it out of the park on hepatitis

at IFM some years ago. That was a PowerPoint that I continued to refer to and nothing like diverging from reading a Bio, but let me just say that I interviewed Bob Rountree on New Frontiers maybe two, three months ago. And he was talking about…

Dr. Lyn Patrick: That was a great interview.

Dr. Kara Fitzgerald: Yeah, and he was talking about nonalcoholic fatty liver disease and he got a lot

of his content from you and he sung your praises, which he’s done before. So, folks, we’re not going to be talking about liver disease today, so if you’re interested in that, if you’re interested in Dr. Patrick’s work there, you can certainly go to Dr. Rountree’s New Frontiers podcast with me and his slide deck is downloadable. You can access that.

Dr. Kara Fitzgerald: And then, Dr. Patrick will give us some links to some of her publications on

hepatitis. And, I mean, I know you published an Alt Med review on hep c specifically, that’s 1999, and I

think that that’s useful, but if you’ve got any more current content we can access, that would be great.

Dr. Lyn Patrick: Things have changed so dramatically just in the last five years. Yeah.

Dr. Kara Fitzgerald: Okay. So whatever you’ve got in that arena for new writing, give us links to.

Dr. Lyn Patrick: Okay.

Dr. Kara Fitzgerald: Let me see. You’re on faculty for the Metabolic Medicine Institute Fellowship in

collaboration with George Washington School of Medicine and Health Sciences. You’re on the board of directors for ACAM. You are a founding partner and presenter at Environmental Health Symposium, and then in addition to this, occasionally it looks like you say you get out and ride your bike and hike.

Dr. Lyn Patrick: Oh, yeah.

Dr. Kara Fitzgerald: Good. Good for you. You got a lot going on.

Dr. Lyn Patrick: Oh, yeah. I love the whole idea of having relativity, health and relativity, and

understanding what’s important in life and being in nature. That’s my big thing.

Dr. Kara Fitzgerald: Well, you know, it’s essential when you’re talking about toxicology. I mean,

because otherwise it’s a very morose and kind of heavy area.

Dr. Lyn Patrick: It is. Well, I think the problem is that sometimes we can get stuck in the

problems and we don’t always gravitate and live in the solutions. And I found that I’m much more able to handle the problem, and the reality, and the overwhelm, when I swim around in the solutions most of the day.

Dr. Kara Fitzgerald: Perfect. Yeah. That’s great. So we’re going to be very … We’re going to swim in the solution today. We went through that, actually, we went through that in IFM and had to kind of reframe and make sure we were swimming in the solution. And then at the laboratory, when I was at Metametrix, and we were doing research on the various panels that we were releasing, the organotoxins panels, when you’re in the literature you can get depressed quickly. So, swimming in the solutions is essential. And you guys have been doing some work lately on the wildfires and smoke exposure and you were just talking to me off air about flooding that’s happening now.

Dr. Lyn Patrick: Correct, in Northern California. Yeah. So, when the air quality situation

happened in San Francisco this summer, the board of directors of the Naturopathic Association of Environmental Medicine, which I just stepped down from the presidency of that last night, I’m happy to report, because I was president I think for a decade or something.

Dr. Kara Fitzgerald: Wow, wow!

Dr. Lyn Patrick: Yeah, we have a new president. So anyway, the board of directors got together,

one of them lived near Santa Rosa and has been very involved. There’s a tremendous amount of research going on right now looking at the exposure from the Santa Rosa fires, but I think it was a really important wake up call for all of us, especially the docs in Southern California, and in the San Francisco Bay area, to really start understanding what’s in our air, and specifically what happens as a result of air exposures to wildfire smoke. So, we did a two-part webinar on that and Dr. Louise Tolzmann, who is a wonderful environmental medicine and oncology, naturopathic oncology, doc in Portland who has worked with several fire companies of firefighters, I actually worked with them, did part of that and we actually really went through, toxicant by toxicant, what do we know about the exposures and what can we do about it?

Dr. Lyn Patrick: And there’s some wonderful research looking at extremely simple, very elegant

solutions. For example, methylation, just improving methylation actually has a very profound effect on the exposure that we have from wildfire smoke in terms of how it damages us. So that’s all available, free webinar. You can either go to Environmental Health Symposium 2019, go to the blog, webinar’s there for free, both of them. And then the NAEM website, naturopathicenvironment.org.

Dr. Kara Fitzgerald: All right, we’ll get the links and put them on the show notes.

Folks, just go to Dr. Patrick’s page on our show notes. We’ll have links to those resources. Thank you. That’s a really valuable service. All right, so you threw out one teaser on this methylation thing in a sentence, Lyn, because we’ve got so much else to talk about. What are the methylation interventions that they saw?

Dr. Lyn Patrick: Well from what we know, and this was done actually in humans and we talk

about … Let’s see, I think this was part two of the webinar, was the simple interventions that we, some of us, take for granted.

Dr. Kara Fitzgerald: Like B Vitamins?

Dr. Lyn Patrick: Methyl B12 and methylfolate. It’s something that simple, actually has a

profound protective effect and we never really directly link them, right? We think of them as separate. Methylation assists with hormone metabolism, and improvement in glutathione production, and recycling them homocysteine, and improvement in SAMe production, and things like that, and all the spinoffs that we know. But we don’t really think about the actual effects of toxicants on our epigenetics and how methylation is protective.

Dr. Kara Fitzgerald: Okay, yes, absolutely.

Dr. Lyn Patrick: It’s very protective, and it’s absolutely necessary, and it’s absolutely necessary

for everyone who, I’m going to go out on a limb here and say, breathes urban air in United States of America. So, I think we have to take that more seriously.

Dr. Kara Fitzgerald: I would love to see…

Dr. Lyn Patrick: I’ll send you that article. I’ll actually post it. It’s open access.

Dr. Kara Fitzgerald: Okay. Yeah, shoot it over, and we’ll put it on our show notes as well.

Incidentally, I am doing an epigenetic research study at Helfgott at NUNM, specifically we’re looking at 900,000 data points of DNA methylation, CPG sites, at baseline, and then lifestyle intervention. So, I’m really interested in that area.

Dr. Lyn Patrick: Oh, yeah. Absolutely. I’m going to get you this article.

Dr. Kara Fitzgerald: Yeah, I’m psyched! Okay, so let’s just go on into some of these questions. We’ll

do a deeper dive into talking about heavy metal toxicity and I’d love to be able to talk about persistent organic pollutants, time permitting. But you mentioned to me earlier that there are five conditions in your mind that are just really unequivocally related to toxicant exposures. Can you … What are those?

Dr. Lyn Patrick: Sure, let’s go through it. All right. So I’m going to talk about them from their

importance as epidemics, right? So we know there’s an epidemic of obesity, 40% of our adult population and as a corollary, I’m not going to say obesity causes anything. I think obesity is more a symptom than it is a cause, actually, but we know that there’s a corollary for obesity of Type 2 diabetes. And Type 2 diabetes, it is becoming clearer and clearer and clearer, there’s overwhelming evidence that Type 2 diabetes is not simply a disease of over consumption and under use, under exercise. It is a disease of exposure. And Duk-Hee Lee, I’m sure you’re familiar…

Dr. Kara Fitzgerald: Yes, yes, yes. Yep.

Dr. Lyn Patrick: With her research showing that obese individuals who had low body burdens of

persistent organic pollutants were no more at risk for Type 2 diabetes than normal weight adults. But it was the highest risk of course, is being obese and having a high body burden of these  persistent pollutants.

Dr. Lyn Patrick: So, so far I’ve actually talked about three conditions, you know, cardiovascular

disease, obesity, and Type 2 diabetes, but the kind of perfect storm that it makes is metabolic syndrome, cardio-metabolic syndrome. And that’s also, we know that 50% of our population now, and this was American Journal of Clinical Nutrition in 2018, is insulin resistant now. Flip a coin.

Dr. Kara Fitzgerald: Well, you know what though? If you tighten those

parameters, like a study that was really interesting to me was the San Antonio heart study.

Dr. Lyn Patrick: Yes.

Dr. Kara Fitzgerald: Right? And they showed insulin levels well within normal limits as being

associated with cardiovascular disease. And I think it was five, the cutoff was five.

Dr. Lyn Patrick: Yup, exactly.

Dr. Kara Fitzgerald: And so you could tighten up, you could look at functional ranges of

cardiometabolic disease and zoom that way down to most of us.

Dr. Lyn Patrick: Right and if you … Yes, I agree. And I think this is where we get into the

uncomfortable conversation that I’m used to having every day with clinicians of, “What are you going to do in your patients who are on Keto? Who are Keto adapted? Who are on a Mediterranean diet that’s grain free and they still look very cardio-metabolic?” That’s where we get into this discussion of what are the toxicants that you need to look for. So..

Dr. Kara Fitzgerald: These are … That’s awesome. So super clean eaters, they’re on the diet that we

would have prescribed and still they’re marching on the cardiometabolic continuum and then what?

Dr. Lyn Patrick: Right. And they might be skinny fat. We know about the skinny-fat people.

Those wonderful people whose BMIs are 24 and 25, but because of these exposures that we’re going to talk about, their stem cells, and I’m serious about this when I say this, their stem cells, instead of making bone cells and muscle cells are making adipocytes, right? And so they’re going to have fatty bone, fatty muscle, and fatty liver, and that’s number five, is fatty liver.

Dr. Lyn Patrick: So I could add all kinds of other diseases into this huge Venn diagram like

infertility, and dementia, and ADHD, but I think if we just stick to the cardiometabolic related conditions, it’ll be a better example of how toxicants affect the very nature of our metabolism. They’re not even called … now we have renamed endocrine disrupting chemicals, metabolism disrupting chemicals, because we’ve figured out that they don’t just disrupt hormones, they actually disrupt nuclear receptor sites in the nucleus of the cell where oh, let’s say T3, in order for it to work, has to dock not only on the cell site, so receptor site, but has to move into the nucleus and actually interact with the nuclear receptors. And that’s where these chemicals that we don’t want to think about, but we have to start thinking about, like PCBs.

Dr. Kara Fitzgerald: Yeah, yeah, yeah. Well, listen, let me just say this. This is so fascinating. You’ve

said a ton. I look at thyroid function as a bit of the canary in the coal mine, kind of like breast tissue is, you know, the thyroid gland, and that would be a really clear piece there, the interruption of T3 actually docking.

Dr. Lyn Patrick: Exactly, because … And we don’t like to talk about this because it’s so not neat.

You know what I mean? It doesn’t fit into our very well ordered algorithms of how we do thyroid. And believe me, I went through a year of not being able to really reconcile my understanding of environmental medicine with what I did clinically because I just didn’t know how those two work together. But in our patients who don’t respond to T3 exogenous or exogenous T3 and T4, we can’t just keep upping the dose because we know what happens when you give a patient too much T3 or too much T4.

Dr. Lyn Patrick: And we have to start looking at the fact that, at some point, we have to rethink

our intervention because truly when we look at things like, oh, I’m going to pick on a couple of toxicants, PCBs specifically, we know that they interact with the nuclear receptor. And we know that PCBs, phthalates, and BPA, there’s good clinical research that shows that the higher for BPA and plastics phthalates, that the higher the levels in urine, the lower the levels of total T4, total T3, and of course the higher the level of TSH. And that’s a direct correlation. So, we can see that in large population studies. We know that. And these large population studies have corrected for all the confounders including lack of exercise.

Dr. Kara Fitzgerald: Yeah. I got it.

Dr. Lyn Patrick: Including diet. So there is a direct correlation there, and so we

need to be able to start thinking in our thyroid armamentarium, “What else can I do to help my thyroid patients so that this metabolic problem that’s happening at the level of the nuclear receptor is reversed?” And thankfully, researchers are starting to do clinical studies and publish. We’ve had them speak at EHS on how to lower levels of these toxicants in people just by doing simple avoidance. Well, it’s not simple, but avoidance, I’m going to call it avoidance.

Dr. Kara Fitzgerald: Yeah, okay. So, what…

Dr. Lyn Patrick: And these are published protocols.

Dr. Kara Fitzgerald: Eating organic? I mean, talk to me about those protocols.

Dr. Lyn Patrick: Well, I’ll talk to you about Dr. Todd Hagobian at Cal Polytech and his research in

women looking at BPA and some metabolic indicators. So he’s starting to measure serum insulins, et cetera. What he’s found is that at least looking at urinary BPA, you measure it in urine, right?

Dr. Kara Fitzgerald: Yep.

Dr. Lyn Patrick: The Genova Panel I think is the only one that looks at BPA in urine and in Europe

they look at blood, but I think urine’s actually better, honestly. One of the things that Hagobian has found and Dr. vom Saal, who’s also going to be speaking at EHS here next month, has found that cash register receipt contact is actually a significant exposure for men and women, but more for women because we use all kinds of personal care products that break down our skin barrier and allow the BPA to be absorbed more efficiently.

Dr. Lyn Patrick: So he found in his research, Dr. Hagobian, that if he gave his female patients in

this study their own personal care products that were BPA free, and glass containers, and asked them not to eat canned food, and number four is very important, that they not have contact with thermal receipts, which are receipts, you know, and that would include airline tickets, that he was able to … And this was only, I think, six weeks study, he was able to significantly decrease their urine BPA levels.

Dr. Kara Fitzgerald: That’s amazing.

Dr. Lyn Patrick: And that’s important because BPA is a high-volume production toxicant. We produce more BPA in this country than any other endocrine disruptor or high-volume production toxicant.

Dr. Kara Fitzgerald: Yeah, it’s huge. Let me ask you two questions. And I’m so sorry folks. You’re like,

“Kara, stop interrupting her.” Because what you’re saying is so important. But we’ve got a lot to add on this. So, A, did he show improvement in thyroid function after removing BPA? And for, B…

Dr. Lyn Patrick: That study has not been done.

Dr. Kara Fitzgerald: Okay, so that’s what we need to be looking at.

Dr. Lyn Patrick: That’s the next study. Somebody has to do that study, researchers out there.

Dr. Kara Fitzgerald: Yep, and clinicians gathering data in your office, we’re going to adopt the  promise here as part of our evaluation so we can actually have a validated questionnaire that, so we could technically publish with some … Anyway, folks, you could actually, you could do that. And I will also get this paper from Dr. Patrick and make sure that it’s on the show notes.

Dr. Kara Fitzgerald: And so then my second question, thinking about my daughter, I’ve got a one

year-old at home. BPA-free toys are ubiquitous. They’re everywhere. Then there’s all these BPA metabolites that they’re loaded with. I mean, can you just make a couple comments on those?

Dr. Lyn Patrick: Sure. So, bisphenols as a class. There are literally, I think now, about 120 of

them that have been chemically produced. They’re synthetic. They don’t occur naturally. And so they’re not exactly congeners, but they’re different forms of bisphenol. So we have BPA, BPF, BPS, and then there’s a new one Dr. vom Saal’s going to talk about, that’s like a BPS, BPFSX972 or something that they’re going to use in thermal receipt paper. These are called, by people in the environmental research field, regrettable substitutions. Why? Because they were thrown into commerce with absolutely zero testing about their ability to be endocrine disruptors. So anything’s that labeled BPA-free can be legally BPS or BPF. BPS appears to have more estrogen disrupting activity than BPA does. And BPS is the most commonly used regrettable substitution.

Dr. Kara Fitzgerald: That’s so not okay. And so basically, if you’re seeing a BPA-free

plastic, you’re like, “Get rid of this. Throw this far and wide.” Correct?

Dr. Lyn Patrick: Correct. Correct. So these are all polycarbonate plastics. Those are the plastics

that need BPA added to them. So the idea here is, and I know this is hard, especially if you are a parent and you live in a world of plastic…

Dr. Kara Fitzgerald: Yeah, they’re everywhere. It’s insane. I’m a new parent…

Dr. Lyn Patrick: To substitute other substances for polycarbonate plastic. So all the toys that are

made out of BPA, BPS, and BPF that say BPA-free may have, they don’t all, Eden canned food is the one shining example of an actual bisphenol-free can, but it’s the only one that I…

Dr. Kara Fitzgerald: Eden canned food.

Dr. Lyn Patrick: Yeah, E-D-E-N, you know that company. They went back to what … You know

what we used to use before we use bisphenols?

Dr. Kara Fitzgerald: What?

Dr. Lyn Patrick: Plant resins, plant resins. Right? Because you have to cover up the seal on the

metal to prevent the acid in the food from eating away at the metal. That only happens at the seal. So any metal, water containers that are aluminum may actually be lined with bisphenol. There are, again, shining examples of bisphenol-free water containers. I don’t know if I can say commercially names…

Dr. Kara Fitzgerald: Yeah, yeah. Yeah, you sure can. Yep.

Dr. Lyn Patrick: Klean Kanteen is the one that we know for sure. It is bisphenol free.

Dr. Lyn Patrick: So anyway, it is difficult and many moms I’ve seen are starting to blog now

about how to live with alternatives.

Dr. Kara Fitzgerald: Alternatives, yeah. I mean you just gotta go old school, you know, wood,

stainless steel…

Dr. Lyn Patrick: Mm-hmm (affirmative), glass containers.

Dr. Kara Fitzgerald: Silicon. Yeah, that’s right. That’s right. But man, it’s a plastic world when you’re

in a kid’s world, although it’s paradoxical. And then I’m going to shut up. On one hand, there’s extra effort to make certain things clean and they’re easier access if you go into the baby aisle. But then on the other hand, there’s all these BPAs, alt BPAs.

Dr. Kara Fitzgerald: Now, all right, so listen, I wanted to just say a couple things and then we’ll talk

about metals. So you’re hanging your hat on, if somebody’s walking along the continuum of cardiometabolic disease, which I would say, when we look at functional ranges, really, unless we’re very intentionally living our lives not to be on that path, we’re on that path. It’s a strong river that the Western lifestyle just pushes you along.

Dr. Lyn Patrick: That’s correct.

Dr. Kara Fitzgerald: But then you jumped in to stop talking about thyroid. And I mean, really the

underpinning for all of these imbalances, one of the very obvious easy to look at ones is inflammation. And so these persistent organic pollutants are turning the volume up on inflammation. And so we’re going to see, just with any chronic disease, Lyn, I’m imagining is going to have as a core component, in your opinion, toxicant exposure driving it. Would you say that that’s true?

Dr. Lyn Patrick: I have to qualify that because the world that I live in, toxicants are not in one big

barrel. We have to separate the toxicants that cause inflammation from the toxicants that are endocrine disruptors because not all endocrine disruptors increase. For example, if we want to look at some of the inflammatory cytokines or something as simple as HSCRP, not all toxicants will do that. So we can’t equate them.

Dr. Lyn Patrick: But for the most part, and I’m going to include certain endocrine disruptors like

PCBs, which are also liver toxicants, then they increase liver steatosis, right?

Dr. Kara Fitzgerald: Yes.

Dr. Lyn Patrick: So in that kind of Venn diagram where metals and PCBs come together, yes,

absolutely, not only will you see increased cytokines, but you’ll see increased levels of ALT and GGT in those patients that are overloaded.

Dr. Lyn Patrick: So I think in general, if you want to use the most generic definition of

inflammation, yes, for the most part, we’re talking about a pro-inflammatory cytokine storm as a result. And so then we can pull autoimmune disease in as well as you know that that’s one really important pathway for autoimmune disease, which we know that according to the most conventional, the most conventional endocrinologist, autoimmune diseases are 33% genetics and 66% environmental.

Dr. Kara Fitzgerald: Environment. Yeah! And that research has been around a long time. I mean, I

remember at the Institute for Functional Medicine a decade plus ago just speaking about lupus and, 1999, there was a study looking at smoking and GST mutations and so forth and yeah.

Dr. Lyn Patrick: Yeah, so Aristo Vojdani, you know Aristo Vojdani, has really done some seminal

research in this area and he’s looked at the fact that we actually make antibodies to BPA, for example. And others…]

Dr. Kara Fitzgerald: Right. Yeah, that’s right. Yeah, that’s right.

Dr. Lyn Patrick: And so we make antibodies to solvents as well. Probably one of the most

well researched, and documented models of autoimmune disease is TCE, which is a common waterborne and now soilborne solvent from industry. In the South Bay area, the San Francisco Bay area, the tri cities area, there’s a huge super fun site where housing was built on top of some industrial sites and the EPA has, for the last several years, been going into homes to check the soilborne vaporization levels, meaning the stuff is coming up through the soil and vaporizing inside the house through the foundation of the house and actually having to evacuate people as a result of their TCE. That was a segue. I mean, that was a tangent, sorry.

Dr. Lyn Patrick: My point was that we have very clear evidence that these toxins cause

autoimmune disease and in that situation specifically, inflammation and antibody formation to the toxicant causes the damage and can initiate the autoimmunity. So yeah, I think there’s very specific toxicants that, through that model of immune dysfunction, will lead to a disease state. So yeah, go ahead.

Dr. Kara Fitzgerald: Well, a big pro for me, I just want to underscore again, is this idea that people

come to us on clean diets who are really working at living cleanly and are still stuck.

Dr. Lyn Patrick: Exactly, exactly.

Dr. Kara Fitzgerald: And so that’s a big, huge flag and something that we’ll kind of underscore. The

other thing is I have two other comments here is, again, being at Metametrix lab when we were working on adopting the CDC panels, in fact, Walter Crinnion was working with us on that and I think we did a good job on figuring those things out. And then we, of course, we had PCBs, we were looking at a whole handful of persistent organic pollutants. We were trying to look at the bad guys and these guys, you know, as we were in the literature around it, the half-life of these, the reason they’re called persistent organic pollutants is because they stick around. I mean, they don’t go anywhere. In my mind, they’re these man-made chemicals that our liver just looks at and doesn’t know what the hell to do with. And so we end up sequestering them. We have an exquisitely sophisticated detoxification system to move out metal things that we evolved with. I mean metal, we’ve been exposed to toxic metals since we were in a primordial ooze.

Dr. Lyn Patrick: The dinosaurs.

Dr. Kara Fitzgerald: Yeah!

Dr. Lyn Patrick: Mercury. No, seriously. Mercury from the volcanoes.

Dr. Kara Fitzgerald: It’s true. Yeah!

Dr. Kara Fitzgerald: Yeah, it’s part of the earth’s crust. PCBs are not and so were these foreign

energies that we have to sequester. I mean, that was my kind of big, “Aha! Of course the half-life is a decade plus.” And so then, we … But here’s the thing, and there’s no literature on successfully lowering them, but here we are in the lab…

Dr. Lyn Patrick: But there is … Go ahead.

Dr. Kara Fitzgerald: Okay. Well, one of the things … and I think that it’s newer literature, so my time

in the lab when we were looking for it, there wasn’t many, and this was a big, huge omission, but we were seeing anecdotally as we were practicing on ourselves and doing interventions that we could actually lower them. So these were like N of one, and two, and three cases where we would follow a relatively standard integrative detox protocols and actually see that we could budge these numbers.

Dr. Lyn Patrick: Oh, that’s such important … Those N of ones are so important.

Dr. Kara Fitzgerald: So important.

Dr. Lyn Patrick: And if you guys can publish that data, but boy do we need that.

Dr. Kara Fitzgerald: Well, one of the big ones was Andy Bralley. I mean I’ve presented on him a long

time ago. He owned Metametrix and then sold it to Genova.

Dr. Lyn Patrick: Yes, I know him. Yeah.

Dr. Kara Fitzgerald: Well, Andy was eating, you know, he developed a pesky little habit of having a

farm raised salmon bagel everyday for not long.

Dr. Lyn Patrick: Oh, jeez.

Dr. Kara Fitzgerald: Yeah, right. Well, and it’s handy. He happens during this lab that’s looking at

PCBs now so that we could see that his were shot through the roof. So obviously the first thing was, “Okay, stop the salmon bagel. Okay, now let’s detox you.” I think he chose a standard process detox protocol, but it’s not different than Metagenics or a Designs for Health or like any of the quality companies we’re working with and we saw them drop. We saw them drop.

Dr. Lyn Patrick: Was it on 153 and 180, the drop?

Kara Fitzgerald: It was, well, it was definitely the 153. I’d have to actually pull up my

PowerPoints and look at the other ones….

Dr. Lyn Patrick: And just for the audience, that’s probably an important clinical point that 153 is

the PCB congener that is found most often in those who eat farm salmon.

Dr. Kara Fitzgerald: Well and the half-life on what he had, the half-life is very long. I mean, it’s no

joke. We don’t expect to move it. So it was heartening for me to see this anecdotally that we were successfully doing something about it. But I want to hear the literature showing evidence of dropping it.

Dr. Lyn Patrick: Yeah, so coincidentally, I think this is so important that I’m going to be

presenting at EHS on this very subject is how do we deal with, and I’m specifically going to be talking about endocrine disrupting and metabolism disrupting chemicals. So imagine that, and I think this was back in the 50s and 60s, scientists found a way to synthetically combine halogens, right? Bromine, fluorine, and chlorine with long chain carbon molecules. And they invented persistent organic pollutants basically by doing that. So PCBs, well, in the 40s and the 30s actually for organochlorine pesticides, flame retardants are brominated and nonstick compounds are fluorinated. And those fluorinated chemicals, do you know that they don’t even know the extent of the half-lives on PFOS and PFAS. They literally, they literally, don’t understand how they’re ever broken down.

Dr. Lyn Patrick: And Dr. Stephen Genuis, these are the new toxicants we have to start paying

attention to, tried to eliminate them in cohorts that he was studying and the only way he could get them out to lower the levels really was phlebotomy and cholestyramine.

Dr. Kara Fitzgerald: Wow, okay.

Dr. Lyn Patrick: Yeah. And he tried everything else including [inaudible 00:33:44]. And that’s

probably [crosstalk 00:33:44].

Dr. Kara Fitzgerald: And has he published on that?

Dr. Lyn Patrick: Yes. So, Dr. Genuis has published a series…

Dr. Kara Fitzgerald: In Canada?

Dr. Lyn Patrick: Of three articles on dealing with perfluorinated toxicants. He started this

because he had a family who was very sick and the only thing he could surmise was it was something in the home. And it turns out that they had their entire home was carpeted, except for the kitchen. And they had somebody come in once a month, I think, no, it was once every three months, excuse me, not once a month. And completely Scotchguard the entire home. They would clean the carpets, right? And then they would re-Scotchguard. So they had extremely high levels of perfluorinated chemicals and he actually put the whole family: the mom, the dad, and a couple of teenagers on a phlebotomy protocol where you had them go donate blood every three months. And then four years.

Dr. Kara Fitzgerald: Isn’t that fascinating? But you know what? That’s … Yeah,

go ahead. In four years?

Dr. Lyn Patrick: It makes sense, right? It makes sense.

Dr. Kara Fitzgerald: It is. Well, and it’s not rocket science. It’s actually pretty easy to go donate

blood, you know, recommend it.

Dr. Lyn Patrick: So that’s what we need to do right now is we absolutely need to create and we

have some protocols for depuration of these long-lived chemicals and I mean PCBs 50 year half-life when you really do that … Excuse me, 50 years to get the not a half-life, but 50 years to get the…

Dr. Kara Fitzgerald: Get it out.

Dr. Lyn Patrick: Out of your body. So we must look at both avoidance, not getting them in, in

the first place, which for BPA and phthalates works pretty good. But for these long life chemicals, we have to look at phase three, right? This is all phase three detoxification pathways. Getting them from the hepatocytes into the bile canaliculi in the liver and from the renal … Through the renal tubular cells into the lumen of the kidneys. That’s phase three, so protocols for that.

Dr. Kara Fitzgerald: Yeah, go ahead. Well just give me … And folks, we will … This is obviously a

bigger conversation than our time is permitting today, but Dr. Patrick is going to give us some links to where you can further your education in this arena.

Dr. Kara Fitzgerald: But in the meantime, I want to say two things. One is, again, lecturing in this

arena, specifically talking about fatty acids, essential fatty acids, you know, Omega-3s. I came across Hennig’s work at a University of Kentucky and Hennig has done some really cool animal studies where he looks at, when you drill down to the molecular level of what toxins and toxicants are actually doing, you end up seeing increased oxidative stress, disruption of molecules, and damage and so forth. The same kinds of things that we see when we look at the molecular level of any chronic disease when you really drill down there and balanced electrons, free radical activity, et cetera, et cetera.

Dr. Kara Fitzgerald: And so what he’s been doing over there at University of Kentucky is looking at

the Omega-3 influence on changing the impact of PCBs favorably and phytochemicals. So one of the things, the take home from this, the heartening kind of uplifting empowerment is take your essential fatty acids, eat your fruits and vegetables. I mean cleans sources, but transitioning over to a healthful diet is one piece of the detox protocol. So when I’m teaching, and people often want to know specifically, what is a detox protocol? Well, it’s do your foundational lifestyle interventions first and foremost.

Dr. Lyn Patrick: Absolutely.

Dr. Kara Fitzgerald: And as we’re taught as naturopathic physicians, the organs of elimination have

to be open and running, like pooping, and sweating, and all of this. And I want you to comment on that, but more importantly, I also want to ask you about so what are your interventions, because that is a huge question. What would be some of the fundamental nutrients that you might really turn the volume up on?

Dr. Lyn Patrick: Yeah. I’m going to really, really, abbreviate here. This is an hour long lecture that

I do, so please understand there’s more to it than just this. Certainly being able to utilize the organs of elimination and specifically the skin. So for many years I had an environmental medicine clinic, everyone who was capable of going into the sauna was given a prescription for medical sauna protocol, which is starting … We saw lots and lots of multiple chemical sensitivity, very sick patients. So sometimes they can go in the sauna for five minutes, sometimes they can go in the sauna for up to an hour. So we had nurses who would monitor them pre and post. We did blood pressures, et cetera, and so, for the majority of them, they could do 15 to 20 minutes. So it’s 15 to 20 minutes, five days a week times six weeks is one course. You have to shower afterwards. They have to use a lipid-based soap and they have to wash their hair, otherwise…

Dr. Kara Fitzgerald: What’s a lipid-based … Like, what would be a lipid-based soap you would

recommend?

Dr. Lyn Patrick: Oh, Kiss My Face … Well, I don’t like Kiss My Face. We got one from a small

company in Vermont that made an olive oil-based liquid soap and they went out of business, and so I haven’t found a substitute, but a soap that’s lipid-based that you know is a soap that will help really get the…

Dr. Kara Fitzgerald: Sop them up?

Dr. Lyn Patrick: The oils off the skin, yeah. That’s important, and then, of course, transit time,

normalizing transit time. So normalizing transit time is very different than asking people how many bowel movements they have a day. You actually test them for transit time and then you normalize it. And that, as you know, if you’re a clinician, is a project because it involves looking at GI function, but at least getting people on a good source of fiber.

Dr. Lyn Patrick: And really the fibers that tend to bind that have been published, especially for

the persistent organic pollutants are soluble fibers, Propolmannan is a very good one, Cholestyramine in patients who can tolerate it and in physicians who like to prescribe it. I do not like using clay internally because it’s high in heavy metals. Charcoal seems to work much better for patients. I know that one of the manufacturers of a clay-charcoal product, I don’t know if I can mention products to you.

Dr. Kara Fitzgerald: Yeah, yeah, yeah. Mm-hmm (affirmative). Yep.

Dr. Lyn Patrick: So, Bio-Botanical Research has GI detox. I know because I know that owner of

that company very well and she’s spoken on your podcast, Rachel Fresco, has actually had her clays assayed for metals to make sure that they are low in metals. But I just spoke with her in the last couple of months and they changed the raw material sourcing on her and because she’s so persistent about this, she is now looking for a new source of clay that is metal free. And she’s one of the few, if not the only manufacturer, I know that I can actually get a spec sheet from her and see that she’s tested her clay. So the only fiber from a plant, or excuse me, from a grain that we know that works really for these persistent organic pollutants is rice bran fiber, so you know, rice bran fiber. There’s some research with oat bran fiber, but I don’t like oat bran because you can’t guarantee that it’s gluten free, so I don’t use it. Rice bran fiber is [crosstalk 00:41:26]…

Dr. Kara Fitzgerald: Listen. What about would you see arsenic in rice bran fiber? Would that be

something that you would…

Dr. Lyn Patrick: There is arsenic in rice bran fiber and I have been asking manufacturers of rice

bran fiber for spec sheets on rice bran. Dr. Crinnion and I have had this ongoing animated conversation about this for years, and he’s convinced me based on the literature. Believe me. I was in his face about this and he said…

Dr. Kara Fitzgerald: Well, are you guys like, is this a late night bar, you know, whiskey conference?

I’m just kidding.

Dr. Lyn Patrick: Yeah.

Dr. Kara Fitzgerald: You’re a [inaudible 00:41:57].

Dr. Lyn Patrick: It’s been awhile for me and whiskey, about 30 years.

Dr. Kara Fitzgerald: I’m just teasing.

Dr. Lyn Patrick: But yes, we have gone through the literature. It appears that the benefits, rice

bran fiber, outweigh the risks. I can say that from exploring the literature and me yelling and screaming about this with him, he’s like, “Nope, you don’t get it. Benefits outweigh the risks.” So he convinced me of that.

Dr. Kara Fitzgerald: Interesting. That’s so fascinating. Well, you know, he also said maybe we don’t

remove amalgam either. So that was kind of…

Dr. Lyn Patrick: So I’ve also gone to the mat with him about that. I think that I have proven that

that is necessary based on some of the data, a study done by a gentleman named Clark that Health Canada funded, where he found that the amount of amalgam in the mouth of an adult that would be correlated with intra-oral mercury, that would surpass the California EPA allowable levels for occupational air mercury exposure is 0.8 surfaces of a tooth. Meaning, you know, there’s four surfaces, four sides to a tooth, so that’s a side of a tooth, which means one amalgam. And that’s very good data. He did this, he actually had a probe, gas chromatic, graph probe and he put it in the mouths of about a thousand people. And then he correlated it with their urine mercuries and their blood mercuries and then he looked at the allowable levels for California EPA, which is the best. California EPA’s the most progressive EPA in the country, better than the feds.

Dr. Kara Fitzgerald: Right, right.

Dr. Lyn Patrick: So that was an interesting segue. I don’t know how we got there. But anyway,

back to one more thing I want to say that’s very important is I’m going to talk about the reviews on sulforaphane and resveratrol. And there was an article that was just published in 2019 by three conventional researchers, one of them is an OB-GYN, talking about the necessity for beginning to intervene in patients who have metabolism-disrupting chemicals onboard, which is everybody. And they talk specifically about fiber as an intervention. They talk specifically about sulforaphane as an intervention and they talk specifically about resveratrol as an intervention. This is brand new article in the standard conventional endocrinology literature, Frontiers in Endocrinology. It just came out this year.

Dr. Kara Fitzgerald: What’s the fiber that they were using?

Dr. Lyn Patrick: Yeah, what’s the what?

Dr. Kara Fitzgerald: The fiber that they were using?

Dr. Lyn Patrick: They talk about a variety of different style fibers.

Dr. Kara Fitzgerald: Oh, they do, okay.

Dr. Lyn Patrick: I would include propolmannan in that research. This is all published research,

and I think I’m going to be talking about this at EHS because it’s so revolutionary. What they’re saying now is we have passed the point of using the argument that it doesn’t, you know, this, resveratrol has not been proven in double blind placebo controlled randomized trials in patients who have PCB poison. We’re past that point. We’re way past that point. We have to start intervening with these…

Dr. Kara Fitzgerald: Yeah, yeah, it’s urgent.

Dr. Lyn Patrick: Phytochemicals, these dietary interventions now. And so I was really heartened

to see this article. It’s a huge review article and they actually, not only specify some brand new websites … I’ll give you this article if you want it.

Dr. Kara Fitzgerald: Yes, I do, yep, absolutely.

Dr. Lyn Patrick: They not only specify new websites that are created by the Collaborative for

Health and the Environment, very progressive groups, to talk about intervention and avoidance for clinicians to educate all their patients, especially their preconception care patients, but they talk about using phytochemicals like resveratrol and sulforaphane.

Dr. Lyn Patrick: Now, because they like Omega-3s, they actually minimize the cellular DNA

damage and the endocrine-disrupting capacity of these chemicals. And I think the reason I can swim around, as we were talking about before when we started recording this morning, swim around in this world of how toxic everything is, is that I spend a lot of time doing laps in the solution pool. So I swim around in the solutions all day long and there are so many effective solutions that are cost effective. We’re not asking everybody to get a hyperbaric chamber in there for their bedroom.

Dr. Kara Fitzgerald: Right. That’s right. Yeah. They’re natural extensions of a healthy lifestyle, like

eating good clean fish or taking extra Omega-3s.

Dr. Lyn Patrick: Teaching your patients how to grow broccoli sprouts. I will

tell you that I had been extremely successful in patients who you would never imagine would even be interested or willing to grow broccoli sprouts. But it’s now a daily part of their diet as they put them in your smoothies. One of the best…

Dr. Kara Fitzgerald: Well, listen, if you…

Dr. Lyn Patrick: Yeah?

Dr. Kara Fitzgerald: If you have a hand out, I want that as well.

Dr. Lyn Patrick: Well, you know the Johns Hopkins research is the third day is the highest level

of the sulforaphanes. But you have to actually get them out of the seed. So it’s not like from the third day of soaking the seed. It’s a third day of the actual sprout growth. And so yeah, I think I have a handout on that. I do.

Dr. Kara Fitzgerald: I’m actually kind of teasing you, but if you honestly do, that would be awesome.

Dr. Lyn Patrick: No, and this is the world we live in, right? Is we have to learn how to use

diet as medicine. It is crucial.

Dr. Kara Fitzgerald: Yeah, and it’s just really heartening for me. I’m with you in needing to swim

around in the solution pond because it’s very heartening that it actually … That we can do this. And, as clinicians, we’re thinking detox, it means supplements, and interventions, and protocols X, Y and Z. And it’s different from … You know, in that bucket, it’s different from the diet, which is different from the lifestyle bucket. When in fact, as soon as somebody walks through our door and starts to tell us their history and we begin to think about moving them out of the sympathetic overdrive, et cetera. All of our very foundational interventions are detox. They are influencing the journey.

Dr. Lyn Patrick: Improving phase one, two, and three. Simple as that.

Dr. Kara Fitzgerald: Let me just ask you, we’re wrapping up here sadly, but you and I talked about

metals. I know. There’s a lot of stuff we need to talk about and we talked about metals and I want you … And, folks, you can continue your education with Dr. Patrick. She’s teaching all over the place. But just give me the thumbnail. So we were, once upon a time, we were doing … We were getting baseline metals, actually Dr. Crinnion talked about this, “Get your baseline, urine metal, do your provocation, get your follow-up to assess body burden.” That was kind of our standard MO.

Dr. Lyn Patrick: And that was the way I was trained as well. And I practiced for at least, I would

say, almost a couple of decades until…

Dr. Kara Fitzgerald: Yeah, go ahead. Give me the overview and then we’ll launch people.

Dr. Lyn Patrick: Yeah, well, until the year 2012. In 2012, I was teaching for ACAM. You know

ACAM’s the MD, ND, DO organization that teaches chelation, or at least historically did. In 2012, the American Board of Medical Toxicology, which are the toxicologists, and the American Board of State Medical Boards, sorry, I don’t know the acronym, had a conference in which they talked about a heavy metal detox and provocation. And basically the toxicologists said there’s no science behind it, which is kind of funny because there is, it’s how we used to test all children for lead using EDTA provocation up until a very recent time, they apparently forgot their history. But what they said basically is it is not standard practice and anyone who does this should be reported to their medical board. At which point, the lawyers at ACAM and the doctors sat down and had a long discussion about how we needed to revisit the process of testing and treating for metal toxicity.

Dr. Lyn Patrick: So what we did is we spent the next five years diving deeply into the medical

literature. And Dr. Crinnion and I have both talked about this and changed the way we teach. So what we know now is that, and I’m going to be very specific for very specific metals, so pick up a pen if you’re listening. For lead and for mercury, you must test for whole blood because the majority of mercury burden is in the blood and the majority of mercury burden is from dietary exposure in most patients, not in everybody. And for lead, whole blood lead is the standard of care. If you were treating someone for lead toxicity, you must, and I really use that word for a reason, have a whole blood lead in the chart to protect yourself and because it’s standard of care, but more importantly, you can use that blood lead to make decisions about treatment.

Dr. Lyn Patrick: So we say safe levels of lead, right? This is the standard of care from the

American Academy of Pediatrics and the CDC, that any adult who has a blood lead of 10 and under that’s safe pediatrics, any kid who was a blood lead of 5 and under, that’s safe, neither of those things are true. The tender consensus to EMDR, you can look it up, which is a group of pediatric public health advocates has published in environmental health perspectives. They say that the standards need to be changed and the safe level is one and under, and many labs don’t even have that as their lower limit of detection.

Dr. Kara Fitzgerald: Yeah, they don’t. Mm-mmm (negative).

Dr. Lyn Patrick: In adults, it is two and under. And there’s a Bruce Lanphear just published in

Lancet Public Health last year using the Nhanes database to substantiate risk for cardiovascular disease in this country. There are probably about half a million people each year that die of cardiovascular disease with an underlying lead burden that promotes that cardiovascular event.

Dr. Lyn Patrick: And so if you do not, and we did this in our clinic, we just started testing whole

blood leads on all adults who had either cardiovascular history or who were over the age of 50, and I think we were probably way too conservative. We should be testing much lower because anybody born after 1980 has a body burden of lead that puts them at risk for disease. So we really should have used that. So anyway, that’s how we teach now at ACAM. And for cadmium and arsenic, the other two big metals, arsenic and cadmium, spot urine, not provocation urine.

Dr. Kara Fitzgerald: Oh, interesting. Spot urine. Spot urine. Huh.

Dr. Lyn Patrick: Is the diagnosing test, we use the epidemiological literature.

Dr. Kara Fitzgerald: Like anytime? I mean, would you recommend doing it in morning?

Dr. Lyn Patrick: Doesn’t matter.

Dr. Kara Fitzgerald: It really doesn’t matter?

Dr. Lyn Patrick: If you look at … Yeah. Random urine, we call it a random urine. And I think yeah,

so, of course we want to get the first morning urine. But in a situation where you’re looking at an acute exposure, where for cadmium, because of the toxicology of cadmium in the renal tubular cells, a non-provoked random urine cadmium, it’s going to be the same no matter when you do it. So, yeah. And so there’s tons of epidemiologic literature that underscores and substantiates the use of these tests as more indicative of a body burden or for arsenic. We don’t store arsenic in our organs, very short half-life. Acute exposure is where you’re going to really see the problem with arsenic from water contamination. So, yeah. And so that’s the abbreviated real Cliff Notes of what’s probably a good two-hour lecture.

Dr. Kara Fitzgerald: Yeah. Right, right. Along with what to do about it, which is another

conversation.

Dr. Lyn Patrick: Correct.

Dr. Kara Fitzgerald: All right, so where are you speaking next if people really want to get on this?

Dr. Lyn Patrick: So, in Environmental Health Symposium, which is coming up next month in

Scottsdale.

Dr. Kara Fitzgerald: In Scottsdale?

Dr. Lyn Patrick: Yeah, April 12th through the 14th, Environmental Health Symposium. And I’m

going to be talking about endocrine disruption and in very specific interventions for endocrine disruptors. We are not going to be talking about metals at this EHS, but there’s a ton of information. We did a bunch of lectures on metals for the NAEM, the NaturoPathic Academy of Environmental Medicine that is now just the National Association of Environmental Medicine. So I’ll send you the links to that. And for members, all that stuff is free. There’s hundreds of hours of all the webinars we’ve been doing for the last five years that are on the website that are free.

Dr. Kara Fitzgerald: All right. Fabulous. So, to be continued either here, on our podcast, or your

education as clinicians, we’ve got lots of directions for you to go in with Dr. Patrick and the really amazing team over there, including Dr. Crinnion, also a teacher of mine.

Dr. Kara Fitzgerald: Okay, well, Lyn, it was just really wonderful to get to spend this time with you

today. It’s just been fabulous having you on New Frontiers and thank you for your hard, hard, committed work. I so appreciate it.

Dr. Lyn Patrick: You’re so welcome. And thank you so much for doing your great podcast. I listen

to them all the time. They’re good. You really give us the information that we need as clinicians, and I really appreciate that.

Dr. Kara Fitzgerald: Thanks so much. All right. Take care.

Dr. Lyn Patrick: Bye. Bye.