The chemical disruption of human metabolism.

BACKGROUND: Recent evidence highlights the reality of unprecedented human exposure to toxic chemical agents found throughout our environment - in our food and water supply, in the air we breathe, in the products we apply to our skin, in the medical and dental materials placed into our bodies, and even within the confines of the womb. With biomonitoring confirming the widespread bioaccumulation of myriad toxicants among population groups, expanding research continues to explore the pathobiological impact of these agents on human metabolism. METHODS: This review was prepared by assessing available medical and scientific literature from Medline as well as by reviewing several books, toxicology journals, government publications, and conference proceedings. The format of a traditional integrated review was chosen. RESULTS: Toxicant exposure and accrual has been linked to numerous biochemical and pathophysiological mechanisms of harm. Some toxicants effect metabolic disruption via multiple mechanisms. CONCLUSIONS: As a primary causative determinant of chronic disease, toxicant exposures induce metabolic disruption in myriad ways, which consequently result in varied clinical manifestations, which are then categorized by health providers into innumerable diagnoses. Chemical disruption of human metabolism has become an etiological determinant of much illness throughout the lifecycle, from neurodevelopmental abnormalities in-utero to dementia in the elderly.

Vitamin D, Essential Minerals, and Toxic Elements: Exploring Interactions between Nutrients and Toxicants in Clinical Medicine.

In clinical medicine, increasing attention is being directed towards the important areas of nutritional biochemistry and toxicant bioaccumulation as they relate to human health and chronic disease. Optimal nutritional status, including healthy levels of vitamin D and essential minerals, is requisite for proper physiological function; conversely, accrual of toxic elements has the potential to impair normal physiology. It is evident that vitamin D intake can facilitate the absorption and assimilation of essential inorganic elements (such as calcium, magnesium, copper, zinc, iron, and selenium) but also the uptake of toxic elements (such as lead, arsenic, aluminum, cobalt, and strontium). Furthermore, sufficiency of essential minerals appears to resist the uptake of toxic metals. This paper explores the literature to determine a suitable clinical approach with regard to vitamin D and essential mineral intake to achieve optimal biological function and to avoid harm in order to prevent and overcome illness. It appears preferable to secure essential mineral status in conjunction with adequate vitamin D, as intake of vitamin D in the absence of mineral sufficiency may result in facilitation of toxic element absorption with potential adverse clinical outcomes.

Approach to patients with unexplained multimorbidity with sensitivities.

OBJECTIVE: To explore the underlying causation of unexplained multimorbidity with sensitivities and to discuss the management of patients who present with this perplexing condition. SOURCES OF INFORMATION: Medical and scientific literature was used from MEDLINE (PubMed), several books, toxicology and allergy journals, conference proceedings, government publications, and environmental health periodicals. MAIN MESSAGE: Multimorbidity with sensitivities has become an increasingly common and confusing primary care dilemma. Escalating numbers of debilitated individuals are now presenting to family physicians and specialists with multisystem health complaints, including sensitivities and fatigue, with no obvious causation, a paucity of laboratory findings, and a lack of straightforward solutions. In the recent scientific literature, there is discussion of sensitivity-related illness, an immune-mediated disorder that frequently manifests with multisystem symptoms, commonly including sensitivities and fatigue. This condition appears to be originally caused by adverse environmental exposures and toxicant bioaccumulation-an increasingly prevalent and well-documented problem in contemporary culture. CONCLUSION: Various toxic exposures and their bioaccumulation within the body frequently manifest as sensitivity-related illness. In clinical settings, patients with this disorder often present with otherwise unexplained multimorbidity and sensitivities. The health status of patients with this condition can be ameliorated by removing triggers (eg, scented products), optimizing biochemistry, removing further sources of toxicant exposures, and eliminating the internal dose of persistent toxicants.

An assessment of the intestinal lumen as a site for intervention in reducing body burdens of organochlorine compounds.

Many individuals maintain a persistent body burden of organochlorine compounds (OCs) as well as other lipophilic compounds, largely as a result of airborne and dietary exposures. Ingested OCs are typically absorbed from the small intestine along with dietary lipids. Once in the body, stored OCs can mobilize from adipose tissue storage sites and, along with circulating OCs, are delivered into the small intestine via hepatic processing and biliary transport. Retained OCs are also transported into both the large and small intestinal lumen via non-biliary mechanisms involving both secretion and desquamation from enterocytes. OCs and some other toxicants can be reabsorbed from the intestine, however, they take part in enterohepatic circulation(EHC). While dietary fat facilitates the absorption of OCs from the small intestine, it has little effect on OCs within the large intestine. Non-absorbable dietary fats and fat absorption inhibitors, however, can reduce the re-absorption of OCs and other lipophiles involved in EHC and may enhance the secretion of these compounds into the large intestine--thereby hastening their elimination. Clinical studies are currently underway to determine the efficacy of using non-absorbable fats and inhibitors of fat absorption in facilitating the elimination of persistent body burdens of OCs and other lipophilic human contaminants.

Exceptionally high serum concentrations of perfluorohexanesulfonate in a Canadian family are linked to home carpet treatment applications.

Perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA) are normally the dominant perfluoroalkyl substances (PFASs) in human serum, but here a Canadian family of seven was identified with particularly high exposure to perfluorohexanesulfonate (PFHxS). Disproportionately high serum PFHxS concentrations (range 27.5-423 ng/mL) and moderately high PFOS (range 15.2-108 ng/mL) and PFOA (range 2.40-9.23 ng/mL) concentrations were detected in the family members, with all three chemicals being highest in the youngest children. We therefore sought to identify the source(s) and pathway(s) of this unusual exposure, and to study the excretion of PFASs for this family. Serum, urine, and stool were sampled from family members, carpet, dust, and air were sampled in the home, and a questionnaire was administered. Over 15 years, the family's household carpets were treated 8 times with Scotchgard formulations. Elevated concentrations of PFHxS were detected in household dust (2780 ng/g dust) and in family room carpet (2880 ng/g carpet), and the primary mode of excretion for the major PFASs was through urine. The high PFHxS and moderately high PFOS concentrations in serum and household samples are consistent with the known PFAS content of certain Scotchgard formulations, and exposure was likely through dust ingestion and/or inhalation.

Human elimination of phthalate compounds: blood, urine, and sweat (BUS) study.

BACKGROUND: Individual members of the phthalate family of chemical compounds are components of innumerable everyday consumer products, resulting in a high exposure scenario for some individuals and population groups. Multiple epidemiological studies have demonstrated statistically significant exposure-disease relationships involving phthalates and toxicological studies have shown estrogenic effects in vitro. Data is lacking in the medical literature, however, on effective means to facilitate phthalate excretion. METHODS: Blood, urine, and sweat were collected from 20 individuals (10 healthy participants and 10 participants with assorted health problems) and analyzed for parent phthalate compounds as well as phthalate metabolites using high performance liquid chromatography-tandem mass spectrometry. RESULTS: Some parent phthalates as well as their metabolites were excreted into sweat. All patients had MEHP (mono(2-ethylhexyl) phthalate) in their blood, sweat, and urine samples, suggesting widespread phthalate exposure. In several individuals, DEHP (di (2-ethylhexl) phthalate) was found in sweat but not in serum, suggesting the possibility of phthalate retention and bioaccumulation. On average, MEHP concentration in sweat was more than twice as high as urine levels. CONCLUSIONS: Induced perspiration may be useful to facilitate elimination of some potentially toxic phthalate compounds including DEHP and MEHP. Sweat analysis may be helpful in establishing the existence of accrued DEHP in the human body.

Enantiomer fractions of chiral Perfluorooctanesulfonate (PFOS) in human sera.

Perfluorooctane sulfonate (PFOS) is the most prominent perfluoroalkyl contaminant in humans and wildlife, but there is great uncertainty in exposure pathways, particularly with respect to the importance of PFOS-precursors (PreFOS). We explored the hypothesis that nonracemic proportions of chiral PFOS in serum are qualitative and semiquantitative biomarkers of human PreFOS exposure. A new chiral HPLC-MS/MS method was developed for alpha-perfluoromethyl branched PFOS (1m-PFOS, typically 2-3% of total PFOS) and applied to enantiomer fraction (EF) analysis in biological samples. In blood and tissues of rodents exposed subchronically to electrochemical PFOS, 1m-PFOS was racemic (EF = 0.485-0.511) and no evidence for enantioselective excretion was found in this model mammal. 1m-PFOS in serum of pregnant women, from Edmonton, was significantly nonracemic, with a mean EF (±standard deviation) of 0.432 ± 0.009, similar to pooled North American serum. In a highly exposed Edmonton family (mother, father, and 5 children) living in a house where ScotchGard had been applied repeatedly to carpet and upholstery, EFs ranged from 0.35 to 0.43, significantly more nonracemic than in pregnant women. Semiquantitative estimates of % serum 1m-PFOS coming from 1m-PreFOS biotransformation in both subpopulations were in reasonable agreement with model predictions of human exposure to PFOS from PreFOS. The data were overall suggestive that the measured nonracemic EFs were influenced by the relative extent of exposure to PreFOS. The possibility of using 1m-PFOS EFs for assessing the relative contribution of 1m-PreFOS (or PreFOS in general) in biological samples requires further application before being fully validated, but could be a powerful tool for probing general sources of PFOS in environments where the importance of PreFOS is unknown.

Blood, urine, and sweat (BUS) study: monitoring and elimination of bioaccumulated toxic elements.

There is limited understanding of the toxicokinetics of bioaccumulated toxic elements and their methods of excretion from the human body. This study was designed to assess the concentration of various toxic elements in three body fluids: blood, urine and sweat. Blood, urine, and sweat were collected from 20 individuals (10 healthy participants and 10 participants with various health problems) and analyzed for approximately 120 various compounds, including toxic elements. Toxic elements were found to differing degrees in each of blood, urine, and sweat. Serum levels for most metals and metalloids were comparable with those found in other studies in the scientific literature. Many toxic elements appeared to be preferentially excreted through sweat. Presumably stored in tissues, some toxic elements readily identified in the perspiration of some participants were not found in their serum. Induced sweating appears to be a potential method for elimination of many toxic elements from the human body. Biomonitoring for toxic elements through blood and/or urine testing may underestimate the total body burden of such toxicants. Sweat analysis should be considered as an additional method for monitoring bioaccumulation of toxic elements in humans.

Evolution in pediatric health care.

BACKGROUND: There is disturbing evidence of escalating chronic disease among children--a phenomenon that is extracting a heavy toll from individuals, families, and health-care systems. METHODS: This review was prepared by assessing medical and scientific literature available from Medline, as well as by reviewing numerous books, conference proceedings, and government publications. RESULTS: Knowledge translation in medical science, the process whereby new research is incorporated into clinical practice, remains lethargic. Nutritional and environmental factors have recently been recognized as common determinants of modern illness, and various diagnostic techniques in molecular medicine are now available to facilitate diagnosis of disease etiology. CONCLUSIONS: A re-evaluation of the current pediatric clinical paradigm is required in light of emerging research from fields such as epigenetics, molecular medicine and environmental health. Education about these branches of medical science should be integrated into pediatric medical education, and important research information from these disciplines should be incorporated into public health care and clinical practice relating to children.