Todd LePine, MD presented on assessing and measuring environmental toxins in the body, known as the exposome. The exposome represents all external exposures absorbed and detected in blood and tissue. Many chemicals are widespread in food, water and consumer products. Specific toxins discussed include heavy metals, pesticides, BPA, PCBs, and volatile solvents. Testing blood and urine can measure body burdens and help target treatment like detoxification support and lifestyle changes to reduce exposures. Q&A addressed interpreting results and developing treatment plans.

1. The Exposome: Assessing and
Measuring the Body Burden of
Environmental Toxins
Todd LePine, M.D.
September 25, 2013
12:00PM EST & 8:00 PM EST
© Genova Diagnostics

2. Christine Stubbe, ND
Medical Education Specialist - Asheville

3. Todd LePine, MD

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6. The Exposome: Assessing and Measuring
the Body Burden of Environmental Toxins
Todd LePine, MD
Staff Physician at the UltraWellness Center, Lenox MA
Consultant for Genova/Metametrix Labs
Faculty Member for A4M
www.ultrawellnesscenter.com

7. Essential Amino Acids,
Essential Fatty Acids,
Nutrients, Minerals, CoFactors
EndoToxins,
Environmental
Toxins & Stress
Pharmaceutical/Agri
cultural Industrial
Complex

8. The Exposome represents the
combined exposure from all
sources that reach the internal
chemical environment, which can
be detected in the blood or serum
by signatures or biomarkers
Environment and Disease Risk
22 OCTOBER 2010
VOL 330 SCIENCE

9. 1. If you are sitting on a tack, it takes a lot of aspirin to
make it feel good. (SUPPRESSING SYMPTOMS)
2. If you are sitting on two tacks, removing just one does not
result in a 50% improvement. (WEB-LIKE RELATIONSHIPS)
• The “Tacks Rule”
– Dr. Sidney Baker
• Toxic exposures:
Endotoxins & Exotoxins
Detox & Biotransformation

10. 10

11. “The true burden of
environmentally induced
cancer has been grossly
underestimated...
With nearly 80,000 chemicals
on the market in the United
States, many of which are used
by millions of Americans in
their daily lives and are un- or
understudied and largely
unregulated, exposure to
potential environmental
carcinogens is widespread.”
TIME Magazine – May 2010

13. • Heavy Metals : mercury, lead, arsenic, cadmium
• Chlorinated Pesticides
• Organophosphate Pesticides
• Phalates and Parabens
• PCB’s
• Volatile Organic Solvents
Measuring the Body Burden of Toxins

16. Pesticides and You
These children are also very
aggressive. They have
very short memories and they are
very weak physically. They
cannot jump rope long or do a
whole lot of other physical tasks.
Now these children are reaching
puberty. The boys are developing
breasts, which are very painful and
they have mammary tissue in
those breasts.
Pesticides and You
Warren Porter, Ph.D.Vol. 27,
No. 4, 2007-08

17. Pesticides and You
Warren Porter, Ph.D.
Vol. 27, No. 4, 2007-08

19. “scientists at the University
of Maryland and the US
Department of Agriculture
have identified a witch’s
brew of pesticides and
fungicides contaminating
pollen that bees collect to
feed their hives.”
SOURCE: www.qz.com

20. “Thus more attention must be
paid to how honey bees are
exposed to pesticides outside
of the field in which they are
placed. We detected 35
different pesticides in the
sampled pollen, and found
high fungicide loads”

21. A Phenolic Chemical Used in the
Manufacture of Polycarbonate Plastics
and Epoxy Resins

22. Bisphenol A Affects Mitosis

23. According to vom Saal,
bisphenol A has exhibited
endocrine disruption in animals
and humans at ppb doses.
“There are situations where
bisphenol A is causing effects at
a thousand times lower than
the amount in the average
human body,” he said, adding
that current global production
of bisphenol A runs about 7
billion pounds per year.

25. According to the National Institute of
Environmental Health Sciences, a wide range of
substances, both natural and human-made, are
thought to cause endocrine disruption, including
pharmaceuticals, dioxin and dioxin-like
compounds, polychlorinated biphenyls(PCBs),
DDT and other pesticides, and plasticizerssuch
asbisphenol A.

26. • Avoid polycarbonate containers that contain BPA,
which usually have a #7 or a #3 on the bottom
• Reduce your use of canned foods
• BPA can leach from plastic when there is a change
in pH or when heated.
Identifying Exposure Sources
27

27. Molecular Interventions
P450s: From Knowledge to Exploitation
F. Peter Guengerich

28. Molecular Interventions
P450s: From Knowledge to Exploitation
F. Peter Guengerich

31. • Contractions in head
• High blood pressure
• Prone to anxiety
Chief Complaints
72-Year-old Female

32. • Had many chemicals on golf course
• Has a lot of crowns —used to have lots
of amalgam fillings, that were removed
• She likes tuna sushi — used to eat a lot
of swordfish
• “ I Want to get tested for Toxins”
Environmental Exposure Hx

33. Supplements
• MVI
• Fish oil
• Vitamin D
• CoQ10
• Calcium
• Lipoic acid

34. • Cozaar – 100 mg, 1 tab once a day
• Lipitor – 40 mg, 1 tab once a day
• Doxazosin – 2 mg, 1 tab once a day
• Bystolic – 5 mg, 1 tab once a day
Medications

35. • Continue Cozaar, Doxazosin and Bystolic
• Start CoQ10 – 200 mg po qd
• Stop Lipitor
• Start CatecholeCalm – 2–3 caps po bid
• Start NAC – 600 mg po bid
• Start Alpha Lipoic Acid – 800 mg po qd
Initial Empiric Treatment

36. PCB’s

37. 38

38. 39
Notes: The levels shown on this figure represent the sum of the 12 PCB compounds that resemble dioxin, widely recognized
as the most toxic of all industrial pollutants, and linked to cancer as well as to damage of the nervous, reproductive, and
immune systems. PCB concentrations are shown as toxic equivalents (TEQs) of 2,3.7,8-Tetrachlorodibenzo-p-dioxin, the
benchmark of dioxin chemical. Source: EWG analysis of data from Axys (2003), Easton et al. (2002), EPA (2000a and
2000b), Fiedler et al. (2000), Jacobs et al. (2002), NMFS (2002), NAS (2003), Schecter et al. (2001), and USDA (2002).

39. • PCBs (both dioxin-like and non-dioxin-like) induce
apoptosis of monocytes and thymocytes.
• Dioxin-like PCBs can cause thymic atrophy and
immnosuppression.
• Dietary PCB exposure can lead to increased rates
of certain cancers (especially liver and lung).
Immune System Effects of PCB’s

40. • PCBs adversely affect thyroid levels, including
elevated anti-thyroid antibodies.
• As PCB serum levels increase, the thyroid hormones
triiodothyronine (T3) and thyroxine (T4) decrease.
• PCBs and other chlorinated compounds lead to
increased risk for type 2 diabetes.
Endocrine Effects
41

41. Dioxin Poisoning

42. • PCB 126 is associated with estrogenic and
adrenal effects and is immunotoxic.
• PCB 153 was significantly associated with
diabetes risk.
• The sum of PCBs 28, 52, 101, 118, 138, 153, and
180 was associated with low T4 and elevated
Gamma Glutamyl Transpeptidase (GGT).
Specfic PCB Effects
43

43. http://www.scientificamerican.com/article.cfm?id=obesity-insulin-resistance-organic-pollutants-fat-diet

44. About 200 pollutants were measured by either blood
or urine test in the NHANE participants. Cave's team
narrowed it down — and, he says, “ended up with a
list of 111 chemical pollutants which were
commonly found in at least 60% of NHANES
subjects.” Among the chemicals studied were lead,
mercury, and organochlorine pesticides. “And, so
from this list, we found several chemicals
associated with a dose-dependent increased risk for
abnormal liver enzymes,” he says.

45. • Increase normal bowel excretion of fat
soluble toxins using Rice Bran Fiber and
Chlorophyll containing foods
Treatment Options to Lower PCB’s (POP’s)
46

46. 47
Inclusion of olestra in the diet resulted in
interruption of enterohepatic circulation of
hexachlorobenzene and reduction in all tissues
even during the periods of caloric restriction.
These observations suggest that an appropriate
regimen for the removal of lipophilic toxins is the
combination of caloric restriction and the
interruption of enterohepatic circulation with a
nonabsorbable fat.

48. Volatile Solvents

49. Chlorinated Pesticides

53. Whole Blood Toxic Elements

54. Metals
Result
µ/g creat
Reference Range In Range High Very High
Aluminum 3.0 < 35
Antimony 0.3 < 0.4
Arsenic 34 < 117
Barium 2.2 < 7
Beryllium < DL < 0.6
Bismuth 0.2 < 15
Cadmium 1.1 < 1
Cesium 7.1 < 10
Gadolinium 12 < 0.4
Lead 11 < 2
Mercury 110 < 4
Nickel 6.1 < 12
Tellurium < DL < 0.3
Thallium 0.7 < 0.5
Tin 4.3 < 10
Titanium N/A < 15
Tungsten 0.1 < 0.4
Uranium < DL < 0.04

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Method: ICP-MS
Provoking Agent: DMPS
Post Provocative
Creatinine: 30.3 mg/dL
Reference Range: 35–225

55. Porphyrins

56. 58
Toxic Effects Porphyrins Profile Interpretive Guide
Metametrix Laboratory

57. SNP Testing

58. Evidence of Increased Glutathione Demand

60. • Feeling much better!
– Headaches gone off Lipitor (on 40 mg before) nervous feeling gone:
“better than in years”
• Blood pressure better, saw cardiologist –
– 24 hr monitor in June good 24 hr average 137/65 with sleep 126/60
• ? PCB’s and HTN
Follow-up at 6 weeks

61. Conclusions:
In this cross-sectional study,
serum concentrations of PCBs,
especially those congeners with
multiple ortho chlorines, were
strongly associated with both
systolic and diastolic blood
pressure.
Alexey Goncharov, Marian Pavuk, Herman R. Foushee,
David O. Carpenter
Environmental Health Perspectives, Nov 2, 2010

62. • Start DMSA – 250 mg 1 three times daily before meals for
three days (M,T,W) every other week for 3 months
• Continue NAC – 600 mg po bid and
Alpha Lipoic Acid 800 mg po qd, add in Vit C 2,000 mg/day
• Sauna therapy
• Avoid mercury containing fish and farmed salmon
Follow-up Note

63. • Start Rice Bran Fiber– 2 Tbsps daily
• Start Cholestyramine 4 grams twice a day
• Investigate solvent exposure source(s) (paint, carpet, new car,
etc.)
• Take Glycine 1 gram twice a day to support detoxification
• Begin Botanical Antimicrobial along with Probiotic twice a day
Follow-up Note

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74. The Exposome: Assessing and
Measuring the Body Burden of
Environmental Toxins
Todd LePine, M.D.
September 25, 2013
12:00PM EST & 8:00 PM EST
© Genova Diagnostics