Dr. Haase & Mr. Why

WHY is my kid bouncing off the wall?   Maybe he/she is toxic.   Seriously.   In a recent study of US children, those with higher levels of organophosphate (OPs) pesticide metabolites in their urine were more likely to have attention-deficit/hyperactivity disorder (ADHD) than children with lower levels, researchers report in the June issue of Pediatrics.

“Each 10-fold increase in urinary concentration of organophosphate metabolites was associated with a 55% to 72% increase in the odds of ADHD,” says lead study author Maryse F. Bouchard, PhD, of the Department of Environmental and Occupational Health, University of Montreal. ADHD is characterized by inattention, impulsivity and hyperactivity to the degree that the child has an impaired ability to learn and function at home and at school.

The Centers for Disease control says about three to seven percent of school-aged children suffer from ADHD, but it seems like more and more kids are being put on drugs to ‘calm them down’.  At MaxWell Clinic we have been doing more and more EEG neurofeedback and non-drug interventions to address this epidemic of attention and it is obvious that there is far more going on in the cause of this than just family history.   This is part of the “soup” of the brain that is being compromised.

In our testing of environmental toxins (which include organochlorine pesticides, PCB’s, VOC’s, parabens, phthalates, lead, mercury, and others) we are often shocked at the high body burdens present.    These compounds are by definition TOXIC, but because they occur in such great numbers and interact with each other over a long life-time and because each person’s genetics upon which they act are unique it is very hard to sort out the cause-and-effect nature of these things… Yet that does not excuse us from doing something about it!    I have given up on the cop-out that we need omniscience before action is taken.

Previous investigations of pesticides have focused on special groups with high levels of exposure, such as children from agricultural communities, and reported pesticides-related cognitive deficits (involving memory and attention), and behavioral problems. “This is the first study to link exposure to pesticides at levels common in the general population with adverse health effects,” noted Dr. Bouchard.

Dr. Goldstein, a specialist in child neurology with Western Neurological Associates in Salt Lake City, Utah, said the data on organophosphate pesticides and ADHD are similar to the data being developed 30 to 40 years ago with lead exposure, and it may turn out to be the same thing — that even small exposures (to organophosphate pesticides) are very harmful to kids.

People are commonly exposed to OP pesticides through eating fresh and processed vegetables, contacting pesticide-contaminated surfaces, breathing air near pesticide applications (both indoors and outdoors), and drinking pesticide-contaminated water.

Approximately 40 organophosphate pesticides are registered with the US Environmental Protection Agency (EPA). About 70% of insecticides (pesticides that kill insects) used in the United States are OP pesticides.

Peaches, apples, grapes, green beans, and pears are among those fruits and vegetables that are conventionally grown with OP pesticides and are most commonly eaten by children, according to FoodNews.org. A 2008 US study revealed detectable concentrations of the organophosphate malathion in 28% of frozen blueberry samples, 25% of strawberry samples, and 19% of celery samples.

Other top uses of OP pesticides include corn, cotton, wheat, other field crops, and for termite and mosquito control. Certain pest control products for cats and dogs contain OP compounds.

OPs of primary concern include: azinphos-methyl (product name Guthion,chlorpyrifos (products Lorsban and Dursban), diazinon (product name Spectracide), dichlorvos (DDVP), dimethoate, thephon, malathion, methamidophos, naled, and oxydemeton-methyl.
How can we limit exposure?

Because of the known dangers pesticides pose to humans, the U.S. EPA limits how much residue can stay on food. But “the new study shows it’s possible even tiny, allowable amounts of pesticide may affect brain chemistry,” warns Virginia Rauh, a PhD at Columbia University’s Center for Children’s Environmental Health who has studied prenatal exposures to pesticides. It seems prudent, therefore, to reduce pesticides exposure by reducing their use in agriculture.

Initial steps to take:

Change your mindset -  Organic foods don’t look as pretty because a few insects have taken a bite of them.   That is better than the fruit taking a bite out of your brain.   See the inner beauty of a not-so shiny apple that has been raised organically.

Choose organic produce, including frozen organic produce. A 2008 Emory University study found that in children who switched to organically grown fruits and vegetables, urine levels of pesticide compounds dropped to undetectable or close to undetectable levels.

Check the labels on any older pest control or gardening products in your household to make sure they do not contain chlorpyrifos (or Dursban, its trademarked name). If they do, contact your sanitation department for information on how to dispose of it as household hazardous waste, or check www.Earth911.org for information on hazardous waste disposal in your area.

Checking the label on pet care products. Avoid flea collars that list propoxur, tetrachlorvinphos, amitraz or carbaryl (recently cancelled for use in flea collars) as active ingredients. Instead, give your pet regular baths with a pesticide-free pet shampoo, and use a flea comb between baths; launder your pet’s bedding in hot water, and vacuum carpets regularly to eliminate flea eggs that could be hidden there. If you do need to use a chemical flea-control product, choose those dispensed in pill form as they usually contain the least toxic chemicals, and won’t leave a residue on your pet or in your home.

A good article at the Organic Authority has some more hints.  Leah Schuchter – who has interest in peri-natal wellness has this to say.

If you have not seen this video, then take the 20 minutes to watch it.   It is necessary for our economic, physical, and social survival to make changes in the very way our economy works.     It is up to all of us to make this happen.

Asking WHY is important not just for understanding what creates health for our bodies, but our world as well.

Did you know that withdrawal from many drugs CAUSES the same symptoms the drugs were prescribed to TREAT?

• Anti-depressant medication withdrawal often cause acute depression and all kinds of other wacky symptoms.
• Anti-anxiety medication withdrawal often causes severe anxiety – even worse than the initial symptoms.
• AND Anti-ACID drugs used to treat GERD or heartburn – upon withdrawal – will often cause WORSE heartburn than what the person originally experienced when starting the medications.

This has been an observation of mine for years, and the reason I harp that we must look for, and address the underlying CAUSES of dysfunction and disease as opposed to suppressing meaningful symptoms with powerful new-to-nature drugs on a regular basis.     Drugs often blow away the “smoke” of the symptom while letting the “fire” of the underlying abnormality rage on.

A study in Gastroenterology has deeply vindicated my position.     It showed concvincingly that a Proton-Pump Inhibitor (PPI) , or “purple pill” or specifically in this case esomeprazole (Nexium) when given to HEALTHY people without any heartburn whatsoever for an 8 week period caused often severe heartburn, dyspepsia, and GERD symptom in 44% of these people when the medication was stopped!    In most of these individuals the symptoms persisted for greater than the 4 week follow-up period!   There is no reason that other PPI’s such as Prilosec, Protonix, Aciphex, or Prevacid would be expected to act any differently.

This means HEALTHY people now have a new long-term problem due to taking this medication (some forms are now over the counter).    That sounds like a problem to me.  This opinion article reflects my concerns and gives a nice review of the full scope of the problem.  Now, it is certain that these drugs truly benefit some individuals long term (meaning that the benefit they provide over-weighs the detriments they induce) , and I am also certain they are massively overused.  Especially since there are so many effective cause-focused approaches available.

So what has occurred is the rise of a highly profitable class of  medications that help initially, but now we know that many patients are assured of feeling even worse when they stop that medication.    Sounds like a great business plan. 

Another problem is that in real life healthy people don’t take medications – sick people do.   People with heartburn and reflux.       But allow me to ask…  WHY do they have these symptoms?    The presence of these powerful drugs that so quickly and completely removes symptoms have seduced patients into thinking that the problem is that they have a “purple pill” deficiency as a cause of their symptoms, and has equally seduced doctors into believing they are doing the best for their patient because the symptoms go away.

This twin seduction of  doctor and patient closing their eyes to a bigger problem because of a quick fix is the same problem that leads to narcotic addiction, stimulant addiction, sleeping pill addiction, etc.    I currently live in the state that has had the dubious honor of prescribing the most lortab (a potent narcotic) per capita of any state in the union.   Is that because Tennesseans hurt more than people in other states…. obviously not.   The answer is complex … like most truths, but at the center of the problem is the culture we have together developed that cure comes in the form of a drug that will block, inhibit, or short-circuit a normal function of the body.

On the national scale this situation presents a larger problem because 5% of the developed world is taking this EXPENSIVE medication class.  That is a lot of health-care dollars that you and I needlessly pay.

So what are some causes of the severe reflux and heartburn that some people encounter?   My fingers don’t go fast enough to cover all I want to say, but let’s think of some big-bucket causes.   Certain foods can loosen the sphincter that separates the stomach from the esophagus – coffee, chocolate, milk, and sugar are the biggest culprits in the scientific literature, but I can tell you many foods can cause it.   Many foods can cause sensitivities or allergies that will have as a symptom heartburn (remember another class of medications used to treat acid issues are H-2 blockers… the “H” stands for histamine which is a major chemical in the allergy cascade).  Emotional stress both chronic and acute definitely contributes,  Small bowel bacterial overgrowth,  yeast overgrowth or sensitivity, parasite infection, Poor diet leading to inflammation, recent anti-biotic use, recent viral infections, Hiatal hernia (which I have witnessed respond to visceral manipulation in several of my patients), hormone imbalance, Celiac disease, some toxins, some commonly used medications.

WHY is the most important question we can ask when we have a symptom… our body is giving us an early warning that something is not right, and we then get the opportunity to investigate, address the cause and potentially gain side-benefits in other areas of our health from our cause-focused intervention.

WHY may find the cause is actually a LACK of adequate stomach acid leading to poor digestion, bloating, and all kinds of skin problems.    WHY may lead to the understanding that eating machine-poop instead of real-food does not adequately fuel our lives and help in the attainment of our highest life purposes.   WHY may give the bravery to re-claim your life choices as your own, and give the opportunity for you to start living your life your way.   WHY may lead to you seek a comprehensive evaluation which could identify that weak link in your chain that would shorten your life otherwise.  WHY could get you to the cause of persistent weight gain… and lead to remarkable weight loss.   I have witnessed all these things.   Good stuff that WHY.

Find the Root Cause and give the Right Treatment.

It is my opinion that with the exceptions of acute ulcer healing, erosive esophagitis and Zollinger-Ellis Syndrome we should be very cautions in prescribing these Proton Pump Inhibitors for anything over 1-2 weeks.  Now that rebound acid secretion has been demonstrated to induce symptoms, we are probably obliged to inform patients about rebound acid hyper-secretion and its potential effects.   There is evidence for these meds contributing to dysfunctional long-term gut function, osteoporosis, mal-digestion of  proteins, inhibition of vitamin B12 absorption, and significantly thinning your pocketbook if you take them personally, or if you pay taxes for other individuals to unnecessarily take them life-long.

Fatty Liver is an epidemic at present…  It can lead to liver failure and death and the cause of this current scourge has caused much debate.   Alcohol is a huge contributor to fatty liver disease, but the huge rise in the occurrence of this malady can’t be accounted for just by a higher number of margaritas per capita.     Something else is going on….

People who are overweight or obese (now nearly 60% of the population of the US!) are at higher risk, and so are diabetics,  but not ALL people with diabetes or a bulge get fatty liver disease…   WHY?

How do you know if you have it?   A good place to start would be some blood tests: (liver tests, glucose, hs-CRP, Triglycerides, and Insulin) at the time of your annual inside-and-out physical -  but even those tests are not perfect.

I had noticed something for years – that people with Fatty liver often had hypothyroidism (they also often have inflamatory bowel disease, and/or previous gastric bypass surgery…but more on those later).   And now there is a study that confirms there is a connection.

So what is the connection?   Did you hear him stumble over this with a guess?    He basically said that hypothyroidism caused obesity which caused diabetes all of which contribute to the development of Fatty liver or NASH (which is Fatty liver WITH inflammation).   I’m not beating up on him here, as I am glad for the research, but really the most likely answer is that there is some cause at the root of all of this that is the real culprit.

There are 2 causes he didn’t mention; Mitochondrial Dysfunction and Oxidative Stress.

I know …. MitoWhatchamaCallits?    Mitochondria.   They are the energy factories of the cells that take FAT and SUGAR and make body-energy in the form of a molecule called ATP.   If you have low ATP you have low energy.  If your mitochondria don’t work then it is nearly impossible to make ATP.    Since we do not have a drug that magically kicks them into gear or makes more of these little marvels not a lot of attention is given to them.   But interestingly diet, lifestyle, and certain supplements can have big effects.

How do you find out if your mitochondria are working or not…  the best test is called an Organic Acid analysis (from Metametrix) because it looks at metabolism under the hood from multiple different angles.   Frankly, as a doctor that is somewhat obsessed with the question “WHY?”  I don’t know of a single lab panel that gives me more information for the money than this gem.    This link goes to a document which further describes this test.   To learn more check out this video of two colleagues of mine in the field of Functional Medicine -  Todd LePine, MD and the founder of Metametrix, J. Alexander Bralley, PhD.

Oxidative Stress is the other reason I mentioned…  Whenever fuel is burned (oxidized)  we get fumes & soot.   When metal is oxidized we get rust.   When molecules and tissues in our bodies of all types are injured by this process of burning and rusting called oxidation it is called “oxidative stress”.

This concept has a long and inglorious history of being used to push this vitamin and that as “super-anti-oxidants” which lo-and-behold in high doses and without adequate balancing can actually cause the body harm!

If your ‘engine’ is burning too much fuel, or is burning it in a way to cause lots of fumes, soot, and rust, don’t you think the body would have a mechanism to slow down the damage?   Indeed it has many – one of them is called insulin resistance and it slows the penetration of your body tissues by glucose.   This shuts off the “fuel line”.   But what happens when the glucose can’t get in the cells to do it’s work?  It builds up in the bloodstream and then goes to the liver, and it turned into fat.    Fatty Liver.   What happens when the liver is full?  Fat starts spilling out into the bloodstream (High Triglycerides) and finally ends up being stored in a fat cell somewhere.

The thyroid too, can be damaged by oxidative stress.   It is injured very easily and is somewhat of a ‘canary’ in a coal mine when it comes to toxicity.    Thyroid dysfunction then makes mitochondria work less efficiently…. leading to less energy, the storage of more energy (fat), and potentially worsening ‘combustion’ efficiency in the mitochondria which may cause more oxidative stress.

Body fat (especially arround the tummy) goes up with oxidative stress.   And this belly fat leads to more inflamation and oxidative stress as well…   a viscious cycle.

Diabetes basically sets in when you no longer can produce enough insulin to tell your cells to suck up glucose from the bloodstream.   This decrease in production of insulin may have at it’s heart inflammation and you guessed it… oxidative stress.

So, if you have stuck with me through all this gobbledegook of concepts, tissues and hormones then you will see that a common theme of MULTIPLE ORGAN DYSFUNCTION occuring in a self-reinforcing cycle is what may be at the heart of not just Thyroid disease and Fatty Liver, but Obesity, Diabetes, and Fatigue as well.    Now let me throw in that these processes of inflammation an oxidative stress also participate in heart disease, dementia, allergies, eczema, inflammatory bowel disease, post-gastric-bypass illness, depression, anxiety, headaches, periodontal disease, osteoporosis, and yes, even autism.

So what causes these evil sisters to rev-up and do their evil work?   That will be the tale for another rainy day…

Until then, keep asking “But WHY, Doctor?”    It could save your life.