2 - A8394 Hormones, Food and Our Environment 2
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Transcript of 2 - A8394 Hormones, Food and Our Environment 2
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8/3/2019 2 - A8394 Hormones, Food and Our Environment 2
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Conflict of Interest DisclosureConflict of Interest Disclosure
The commercial entities with which I
Harvey P. Katz, MDHarvey P. Katz, MD
Current Clinical Issues in Primary CareCurrent Clinical Issues in Primary Care
healthcare-related products or services
relevant to the content I am planning,
developing, or presenting for this activity.
Hormones, Food, and OurEnvironment
Harvey P. Katz, M.D.
Department of Population Medicine
Harvard Medical SchoolBoston, MA
How much do we know aboutthe foods we eat?
dangercontains
food
What commonly prescribedfood :
Can lead to MR in infantsCan cause hypothyroidism inadultsCan possibly protect against
breast cancer
Twin A-B.G.
35 wk gestation
C/S breech & oligohydramnios
Birth wt. 2.2 kg.
Hypothermia-10 days in isolette
Mild jaundice (bilirubin T/D 8/4/0.7)
Abnormal thyroid screen
Courtesy, Rosalind Brown, M.D.
Exam-11 days
Wt. 21.kg (25th %ile)
Mild jaundice
? Umbillical hernia
Normal general exam
Feeding problem-formula changed
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Twin A: congenital
hypothyroidism*
Age T4ug/dl
Free T4ng/dl
TSHmU/L
CommentsRx
4 days 150 L-T4 25 ug
11 days 2.5 0.8 >150 37.5 ug
2 wks 3.5 QNS >100 50 ug
4 wks 150 37.5 ug
2 wks 3.5 QNS >100 50 ugSoy Formula
4 wks
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Prepubertal =
always investigate
and include an
environmentalhistrory-why?
Another Cause of Prepubertal Gynecomastia
lavender
Tea treeoil
Aids to Identify Cause
Any medication; OTCs?
Any herbals or homeopathics?
Soy?
Lotions?
Lavendar soaps, shampoos,conditioners?
Left anything out?
CA Bloch
Hormones, Food, and OurEnvironment: Goals
Definition of endocrine disruptors (EDCs)
Potential adverse clinical effects of EDCs
Importance of the environmental history
Anticipatory guidance for patients
Data surrounding the 6 most common EDCs
Increased awareness, research, and regulation
What are Endocrine Disruptors?
Endocrine disruptors are exogenoussubstances-natural or synthetic- that canmimic or modify the action of endogenous
hormones.- rd ,
An exogenous substance or mixture thatalters function(s) of the endocrine system andconsequently causes adverse health effects inan intact orgnism, or its progeny, orpopulations
World Heath Organiztion
Why the Recent Resurgence ofInterest:
Some Unexplained, Troubling Observations
Trend towards earlier puberty
Increase in newborns wi h cryp orchidism
Increasing trends-testicular cancer
Increasing infertility rates
Increased Type 1 diabetes and thyroid disease
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HEADLINES
Exposure of fetuses & children to endocrinedisruptors: A ESPE & PES call to action
Gender-bender chemicals puttng everyone at risk
Thyroid action disrupted by BPA
Pioneer in Environmental Health:Herbicides, Pesticides, Insecticides
as Poisons
Silent Spring Dedication
To Albert Schweitzer
Who said:
capacity to foreseeand to forestall. Hewill end bydestroying the earth.
Examples of Other Endocrine
Disruptors
Bisphenol A Phthalates DDT PCBs Bovine GH PCBs Dioxins
Man can hardly even recognizethe devils of his own creation
Over 80,000 1000-2000 new
in use in theUnited States
introduce intocommerce/yr.
No routine assessment of safetyby the EPA
Vandenberg et al., BPA & the Great Divide: Controverises infield of EDCs.End Reviews 2009
Hormones, Food, and OurEnvironment: Goals
Definition of endocrine disruptors (EDCs)
Potential adverse clinical effects of EDCs
Importance of the environmental history
Anticipatory guidance for patients
Data surrounding the 6 most common EDCs
Increased awareness, research, and regulation
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6 Other Major Endocrine Disruptors
Part 2
Foods Beef
- BPA and Phthalates
Persistent PCB and Dioxin
Drugs DES
What is your beef?
Hamburgerthyrotoxicosis
Bovine GH
Steroids
Is Milk from GH Rx Cows Harmful
From the GH no: From IGH:Protein,vitamins,minerals,Lipids-same
maybe link tofuturemalignancy??
From sex steroids: ? Cause of early puberty andpremenopausal breast ca. Linos et al. Cancerepidemiol. biomarkers, 2008
HGH-How does it work?
Plasticizers
BPA Phthalatesa es p ast c
more rigida es p ast c
more flexible
BPA-Unanswered Questions
Are dental sealants harmful
Is IV tubing safe
How can I reduce exposure
Is it a cause of autism
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Estrogenicity of BPA
An estrogen receptoragonist
Possible link to PCOAS
Possible cause of earlypuberty
Induced proliferation ofbreast cancer cells
BPA-Everywhere
Present in >95% of Population 50 million metric tons / yr
Toys Baby bottles
a er o es Cans Dental sealants Eye lenses IV tubing Sports helmets
Tips to Avoid Exposure
BPA and Phthalates
Look at codes Avoid 3,6, & 7
o p ast c nmicrowaves to warmfood/formula
No plastic indishwasher
Tips to Avoid Exposure
BPA and Phthalates
Use glass wherever possible Store fruits/vegtables in glass jars Buy only BPA/Phthalate free products
BPA-Bisphenol APlasticizers
BPA Phthalatesa es p ast cs
more rigida es p ast cs
more flexible
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U.S. Scientists to EPA: Phthalates Are aHealth Concern
Phthalates, a class of hormone-mimicking chemicals
found in toys, cosmetics, air fresheners, plastics and
other common household products, need urgent
study, according to the National Research Council.
Phthalates-Ubiqitous
Toys Solvents and Lubricating oils
Soap, cosmetics, hairspray Nail olish IV tubing Vinyl flooring Garden hoses Enteric coated medication
Phthalates:Anti-Androgens
Leach out of products easily Inhaled, ingested, dermally Decreased fertility Cryptorchidism Hypospadius Testicular cancer
Prevention
OrganochlorinesHighly Toxic Carcinogen
&
EDC
Victor Uchenko, Ukraine-Poisoned
PCBs-Derivative of DDT-In pesticides-Flame retardant-Electric insulator-Banned in 1977
-Enters food supplyvia animal feed-Long half life-No regulatorystandards-Multiple masspoionings
Organochlorines-Endocrine
Disruptor
-Decreased spermconcentration & motility-An anti-estrogen-Link to type 2 diabetes-Decreased t4, Incrased TSH inanimal studies-Effect on puberty and growthbeing investigated
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DES
Synthetic estrogen used toprevent miscarriage that causes:
-vag na cancer n aug ers-testicular cancer in sons-urogenital anomalies in sons-infertility
Eight American Research Socities
Letter to Science
Although chemical testing hasbeen in the domain of
toxicologists, it is clear that the
guidelines and better methods ofassessing risks posed bycommon chemicals to which allAmericans are exposed requiresthe expertise of a broad range ofscientific and clinicaldisciplines.
Recommended Reference
AAP
References
Pediatric Environmental Health, 3rd ed. AAP
Endocrine News; Mixed Messages on Soy, April 2011
Science 2011. Assessing chemical risk 331:1136
Vandenberg et al. A review of controversies in the Field ofEDCs. 2009. 30:75-95
Chorazy, P. et al. Persistent hypothyroidism on soy formual.
Pediatrics. 1995, 148-150.
Henley, D. et al. Gynecomastia and lavender.NEJM2007, 356:479-85
Exposure of fetuses and children to EDC: Call toAction Statement. JCEM 2011,96:3056-3058.