2 - A8394 Hormones, Food and Our Environment 2

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.

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2 - A8394 Hormones, Food and Our Environment 2