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Welcome to The Dr. Kumar Discovery, a health and wellness podcast hosted by Dr. Ravi Kumar, a board-certified neurosurgeon. This is the medical podcast for anyone who wants honest, evidence-based answers to the health questions that matter most. No corporate influence. Just a physician who reads the research, questions the dogma, and breaks it down in plain language so you can make better decisions about your own health.
Dr. Kumar is a practicing neurosurgeon who brings a surgeon's precision to topics most doctor podcasts only scratch the surface of. Each episode dives deep into the science behind metabolic health, cardiovascular disease, heart disease, hormones, nutrition, brain health, mental health, pain, inflammation, weight loss, aging, blood pressure, sleep, and longevity. Whether it's the truth about seed oils, the real data on GLP-1 drugs and weight loss, the science of cold water therapy, how light can heal the body, or why your testosterone is declining, Dr. Kumar goes straight to the peer-reviewed literature and tells you what the evidence actually shows, not what the headlines say. This is evidence-based medicine in plain English.
The show features three formats. Solo deep dives explore a single health topic from the ground up, covering everything from the biology to the practical takeaways you can use today. Expert interviews bring on leading researchers, clinicians, and forward-thinking voices in health and medicine for in-depth conversations you won't hear anywhere else. The Tribulations series tells the true stories behind medicine's greatest breakthroughs, from the discovery of penicillin to the invention of vaccines to a father's fight to save his son's life. These are the stories of the doctors, scientists, and patients who changed the course of medicine.
Topics covered on the show include testosterone and hormone optimization, sleep science, photobiomodulation and red light therapy, exercise with oxygen therapy, creatine, uric acid and gout prevention, gut health and probiotics, cardiovascular risk and Lp(a), cholesterol, PANDAS in children, PTSD and trauma, acetaminophen safety, glyphosate, foot health, and much more.
If you're tired of generic health advice and want to hear from a neurosurgeon who actually reads the studies, The Dr. Kumar Discovery is your podcast. New episodes drop regularly. Subscribe and join the discovery.
For show notes, references, and more, visit drkumardiscovery.com/podcast
Ravi Kumar MD (00:01)
Doctor Fine, thanks so much for joining me on the show. Can you explain to me and my audience what the exposome is and why we should know about it?
Dr. Anne Marie Fine (00:10)
Yes, definitely. Dr. Kumar, thank you for inviting me. I'm really happy to be here. The exposome is basically everything that our body is exposed to over our lifetime. And it begins in utero, actually, when the babies are born. unfortunately, via cord blood sampling, they're already exposed to pesticides and metals and PIFAs and
And other things like that. But then as we go through life, we're exposed to things in our environment, in our food, in our homes, in the outdoor air, but also stress is a part of the exposome, trauma. So it's really kind of the accumulation of all of the experiences and chemical, physical, emotional exposures that we have over our lifetime.
Ravi Kumar MD (01:06)
And this is important because it affects our biology, correct?
Dr. Anne Marie Fine (01:10)
Absolutely. This is this is how our our biology runs. All of these things are like, well, food, it's information for your your body and our experiences, our stress levels, all of these things dictate our physiology and our brain health and how our bodies work and whether or not they're going to be able to overcome cancer or or heal properly from an injury.
Ravi Kumar MD (01:39)
Yeah. I think that's, you know, really neat because we often think about, hey, what can we put in our body to make it work a certain way? But, you know, in the exposome is much grander than that. It's, hey, what is actually coming into our body? What is affecting our biology? And how could it be affecting our vitality, disease processes? And there's actually, even though most of us have never heard of the exposome.
There's actually a ton of literature on this. This is very heavily studied. And this is actually your expertise. So can you tell us kind of some of the science about how environmental exposures are influencing our bi our biology specifically in
Dr. Anne Marie Fine (02:27)
Yes.
Ravi Kumar MD (02:27)
in regards to, you know, disease processes and vitality?
Dr. Anne Marie Fine (02:31)
Yes. Yes, in fact, my business partner, Dr. Lynn Patrick, and I, we actually published a study in 2022 where we narrowed down the exposome into the pollutant, and we called it exploring the pollutant for solutions to chronic disease. And so now we're more narrow. Now we're really talking about chemicals and environmental toxins, not so much the more invisible things like stress. Although the chemicals are pretty invisible too.
And
so what we talk about is these chemicals in our environment, like the endocrine disruptors in particular, are messing up our hormones. And they are pushing like the PPAR receptors, they're pushing us to be fat, they're pushing diabetes. Some of these things are diabesogens, some of these things are obesogens, and then we have a lot of toxins are immunotoxic.
And so our immune system is under assault more now than ever before, simply because our environment actually has more chemicals in it now than it did decades ago. And that's not changing. And so we're some of the some of the toxicants like the PIFAs are newer on the block, microplastics, nanoplastics, newer on the block.
The first lecture I gave on microplastics was at Harvard in 2020. And in six years, I gotta tell you, that whole space has absolutely exploded. In 2020, it was all about, you know, your straw has microplastics in it, right? Your water bottle has microplastics in it. And now where the science is at is that it's in every organ in our body, and you know, the New Orleans Journal of Medicine.
Put out a report where they looked at N-Rectomies on patients. And the patients who demonstrated microplastics in the plaque, they studied them for almost four years. And the people that had the microplastics had like a four times higher rate of mortality, whether from an MI or stroke or whatever, but it was very stark.
compared to those who didn't have any microplastics. And of course, my question was, I want to talk to the people who didn't have any and find out what their deal was. Because
Ravi Kumar MD (05:03)
Right? Yeah, exactly.
Dr. Anne Marie Fine (05:05)
how is anybody unexposed at this point in time? And so that's kind of gives you a brief idea of how it's affecting our bodies because even though we do have a liver and we do have kidneys and we do have the ability to sweat
we have overwhelmed our system with things in our environment that we did not evolve to deal with. And so we are we are paying the price. And a lot of that, you mentioned the word vitality. now you're just gonna get an ear fill. Everyone is just so tired. Nobody has energy anymore. And a lot of these things are mitochondrial toxins. And our mitochondria have have their own.
DNA
and they're it's just more fragile compared to the rest of the body. And the oxidative phosphorylation chain is just like so close to where the DNA is, it's easy to damage the mitochondria. And the mitochondria is what's giving you ATP, which is your energy. And so we have a lot of people.
You know, they really rely on going to Starbucks more than once a day or or drinking energy drinks because people are really fatigued.
Ravi Kumar MD (06:24)
Yeah. I mean, it's true. Our world is becoming more and more toxic every day, unfortunately. And a lot of these chemical pollutants, like you had just mentioned, like the PFAs, they're they're they never go away. In fact, I think that
Dr. Anne Marie Fine (06:38)
They're called the forever chemicals.
Ravi Kumar MD (06:40)
they're forever chemicals. They're forever in our environment because biology hasn't yet figured a way to metabolize them and break them down into the the basic.
atomic particles that make them make them up, which we made in a laboratory somewhere. so you gave a good intro to a lot of the like maybe the symptoms and feelings that people have that may be related to toxic exposure, toxic exposures, even though sometimes we don't, or most of the times I would say we don't know that we're actually being exposed to toxic chemicals or environmental pollutants.
That are affecting our biology. We just know that we're getting tired. maybe our our parents they're developing Alzheimer's or we're developing heart disease. I mean, these all these chronic diseases are happening. We think we're living clean, but there may be some role of environmental pollutants in these disease processes. And I there was one really neat study you sent to me before we got on the podcast, and it was looking at these different.
biological ages and grouping them by organ systems. And the two organ systems that showed the I think it was the most correlation to aging were the brain and the immune system. Am I getting this right? Okay.
Dr. Anne Marie Fine (07:58)
Absolutely, and aren't you
surprised it wasn't the heart?
Ravi Kumar MD (08:02)
Yeah, I know. And so like tell tell me how environmental pollutants might be playing a role in the way that our brain and our immune system ages and why that's so important for our longevity.
Dr. Anne Marie Fine (08:16)
Yeah, that was such an amazing study. I had already done several podcasts on the epigenetic age tests, like the second generation grim age, not so much the first generation. And then I found this UK biobank study, the one you just referenced that looked at 44,000 people and they looked at 11 different organs, and I was so shocked that the heart was not number one.
brain
and immune system. And in fact, you know, the brain is really interesting to me. I have a paper out accepted on Alzheimer's, which obviously you know what I'm going to talk about. But so Alzheimer's is is a in a very on topic for me. And in the study they discover and they used protein proteionics. They didn't use the epigenetic age test. They actually were looking at plasma proteins. And they they when they
found brains that were youthful, they found that these brains acted as if they were homozygous for ApoE2, which is your protective genotype for Alzheimer's disease, whether or not you really were APOE2. And the aged brains, conversely, acted like they had an APOE4, which is our strongest genetic risk factor for Alzheimer's.
Your blood is telling you more than your genome. That was the striking finding that I found in that particular study. And if you break it down even a little bit more, the neurofilament light fiber NFL that they tested as one of the proteins, there are things in our environment that I know very well, like cadmium, DH DEHP diethyl hexalthalate, which is one of the plasticizers that are increasing.
NFL and we can infer aging the brain from the study. And one of the most shocking parts about that was an air pollution study. Every 10 micrograms per cubic foot of PM 2.5 increase in the environment increase NFL by up to 100 percent. We have a lot of wildfires and wildfire urban interface fires right now.
We have a lot of PM two point five and also the ultrafine particles that they didn't they didn't look at that. But yeah, so I found the brain aspect fascinating.
Ravi Kumar MD (10:52)
Yeah.
So Dr. Fine, explain what NFL is a little bit better to everyone so we can understand why that's important and then and then jump back into the air pollution and tell us what PM two point five is.
Dr. Anne Marie Fine (11:04)
okay, okay, yeah, okay. So NFL
is what your damaged axons in your brain puts out into the bloodstream or the C CSF. And so you can measure it. It's measurable in a lab. It is measured. If you look at the Alzheimer's studies, some of them, not all of them, they do look at it. it's different than tau or beta amyloid, but it is in the neurodegeneration studies, you'll see it. And so this is one of the
proteins that they looked at in the UK Biobank study. They also looked at GFAF or GFAP,
Ravi Kumar MD (11:42)
Yeah, G F A P.
Dr. Anne Marie Fine (11:43)
but I'm not going to talk about that one. PM2.5 is particulate matter. 2.5 refers to the size, 2.5 microns. There's also PM10, that's 10 microns. There's also ultrafine particles, PM1 or below.
And the problem with those really small ones is that you not only inhale them, but they can go through the alveoli into your blood systemically. And that's how they get to the brain, right? They don't like go through your forehead. You you breathe them in and then they go up.
Ravi Kumar MD (12:22)
Yeah. So, okay, so these environmental pollutants are affecting the way our our brain ages. And, you know, we've often been told, hey, if you have these certain gen genotypes like ApoE4, your basically potential for del developing Alzheimer's or your risk for developing Alzheimer's is much higher versus if you're Apo E2 or Apo E3. Now this study is saying, hey, wait a second.
You can be APOE4, you can be APOE2, these genetic risk factors that we've talked about. But if you have advanced brain aging that's related to these toxic exposures, you're going to act like an ApoE4, meaning you're going to have a much higher risk of developing Alzheimer's.
And if you have very low brain aging, meaning you're likely not exposed to these toxins that are accelerating this aging process, you're gonna act like an APOE too, w no matter what your genotype is. And so we might be Yeah.
Dr. Anne Marie Fine (13:26)
Blood Trumps Genome. This is such
a hopeful message for everyone. I hope that's what people are taking away from this. That this whole modifiable, we want modifiable
Ravi Kumar MD (13:34)
Because it's modifiable, right? It's modifiable. Yeah.
Dr. Anne Marie Fine (13:38)
interventions. That's the that's one of the one of the I wrote a book in 2017 on epigenetics. That was my whole thing. my gosh, because remember when the Human Genome Project came out and
2003 and 2004, everyone was so excited. Yes, we're gonna find the gene for every disease that we're working on. And that's not exactly what happened, is it? And so epigenetics talks about how your environment turns genes on and off, which is super hopeful. But also this particular study on the APO, the APO, APO, it's like having one copy of APOE4 gives you a three to four.
times higher risk having a homozygous ApoE4 is like a 10 to 15 times risk. But what this study is saying is hold on. Is your brain aged or youthful, depending on these blood plasma proteins? Super hopeful and it should give people motivation for changing what they can in their lives now to get the youthful brain.
Ravi Kumar MD (14:47)
Yeah. Very interesting. So toxins likely affect our brain aging. They affect our cardiovascular system, and which that study on carotid endarterectomies tells us, which is a folks, by the way, a carotid endarterectomy is when you get plaque in your carotid artery. And those are the arteries that run through your neck and feed blood to your brain. And that plaque starts to narrow the carotid artery. It can actually flake off and send embolite to the brain, give you a stroke. So surgeons like me will go in and
Open your neck and open the carotid artery, scoop out the plaque and then sew it back together. And that's where they were seeing those microplastics and basically creating a correlation to longevity among those patients. Okay, what about endocrine system? I mean, because the endocrine system is active throughout our lifetime, but it's very, very important, especially hormonally in the young years. Are toxins affecting our end our hormones?
Dr. Anne Marie Fine (15:42)
Absolutely. Those are called endocrine disrupting chemicals. And this is an area that I've spent a lot of time BPA and phthalates and even PIFAs are endocrine disruptors too. And the problem with your endocrine system is hormones themselves act at, you know, picomolar level. I mean very tiny levels are moving things in your body. And so these
Endocrine disrupting chemicals have the ability to basically mess up your hormones by you know either affecting the receptor or acting like an estrogen themselves. want to briefly mention this really cool study that came out in 2023 on endocrine disruptors. It was BPA and phthalates. They took two groups of women, so not rats, women, nobody had breast cancer in the study.
And the way they tested them was through fine needle biopsy. And the intervention was short and sweet, 28 days, the length of a cycle. And in the intervention group, all they did for these ladies is they took away their makeup and skincare products, very high in like BPA and phthalates and parabens, right? And they gave them non-toxic products. And in the other group,
Nothing changed. And then they did the fine needle biopsy. In 28 days, the pro-oncogenic genes decreased expression. And the the anti-cancer genes increased expression in only 28 days. And this is again should be hopeful for people who are wondering: A, what to do, how to make a change, and B, would it make any difference?
And
how much time does it take to make a difference? So those are endocrine disruptors, and those things have been implicated in breast cancer as well as diabetes, which is you know a huge problem, and and obesity, and there are things that decrease testosterone. You know, one of the things I do in my men is I I have a lab value for testosterone, and then I gave them, I give them just
A few words. I say nothing in plastic bottles, nothing in cans for six weeks, and then they come back and re-retest. I haven't given them any testosterone. There's no exogenous testosterone given. And I have seen testosterone levels rise by 30% just by taking away some of these packaging problems that are putting endocrine disruptors into people's bodies.
And so so it's not just women, it's it's men as well. We see effects of of
endocrine disruptors on, you know, delayed or premature puberty too and and all kinds of things. Yeah, it's
Ravi Kumar MD (18:47)
So the thing that worries me the most about this endocrine disruption is not just adults, because yeah, you have to worry about that. Men have declining testosterone, women are going through perimenopause earlier. there's definitely been a change over the years in our hormonal status, but our children, you know, the the young people who are sexually maturing.
Their bodies are are changing, they're growing, they're developing these secondary sex characteristics. And we got all these toxic chemicals that interfere with that natural process that we've never dealt with for the history of mankind. And so now, you know, I mean, and it's not just these plastics, right? It's these mycotoxins and pesticides and toxic heavy metals that that are in there just trying to.
gunk up the biology that we designed to run on. let me ask you about that fine needle study again. So they were doing fine needle aspiration of the breast, correct?
Dr. Anne Marie Fine (19:47)
Of the rest.
Ravi Kumar MD (19:48)
Okay. So this fine needle for the audience is it's a it's a tiny needle and it has a core. And when it goes into tissue, it pulls out a tiny core of tissue where you can actually look at the cells, you can test the genetics. And you know, these women didn't have breast cancer, so they were just
Dr. Anne Marie Fine (20:04)
No,
Ravi Kumar MD (20:05)
Testing their breast
Dr. Anne Marie Fine (20:05)
no van.
Ravi Kumar MD (20:05)
tissue. Yeah. And then they were basically taking away makeups, which, by the way, folks, look up your makeup. The makeup that you put, the stuff you put on your face, which is right next to your brain, majority of makeup is so toxic. And you're putting it straight on a broad absorbative surface right next to your brain.
We've done we've had problems with this in our family with my daughters, and we cleaned up their makeup completely, and it made such a massive difference in their mental health. But with these women with breast cancer, they took that away from them, gave them healthy or or makeup that didn't have toxic chemicals in it, and they saw a difference in the gene expression of tumor suppressor genes. Basically, they were less likely to develop breast cancer because they were not.
giving themselves a deluge of toxic chemicals to their makeup. Is that an accurate representation of that study?
Dr. Anne Marie Fine (21:01)
That is an accurate
assessment of that study. I actually, that was the subject of my book in 2017. It was I it's called Cracking the Beauty Code: How to Program Your DNA for Health, Vitality, and Younger Looking Skin, because that stuff is also not good for your skin. And I have a whole chapter in there on how to read labels so that you can avoid these things and what to look for. And so that is super important.
And the studies that have been done have shown differences. The Hermosas study, which is done in Central California, in teenage girls. You talked about your daughters. Well, they they're the biggest makeup users of anybody is teenage girls. And they took away their makeup but gave them non-toxic stuff so they didn't have to be barefaced. And in three days, the declines in parabens and phthalates.
were I mean it wasn't a hundred percent, I'll be honest, but it was pretty darn good.
Ravi Kumar MD (22:06)
yeah, and those are the most vulnerable population too, right? These young people.
Dr. Anne Marie Fine (22:10)
Yes,
and the other thing I wanted to say on endocrine disruptors is phthalates in particular, are they're notorious for decreasing the anogenital distance in the newborns and in in the male babies, that's like an index or an indication of masculinization. and so that that was shown
Ravi Kumar MD (22:34)
Explain that
that enogenital index.
Dr. Anne Marie Fine (22:36)
They anna from
the anus to the genitals, that distance and the anogenital distance, they've seen it in more phthalate exposed baby boys. It's it's shorter, and that correlates to less masculinization. In other words, the phthalates are kind of feminizing them. And you know, I also and then you know, there have been problems with also you know.
cryptorgism
and things like that. But right now I'm just talking about the enogenital distance. And and so right from birth you're seeing concrete evidence of these endocrine disruptors. And you know I study one of the things I study is pregnancy trimester by trimester and you can see where the environmental toxicants are having their effect
And so, yeah, our babies are being born pre-polluted. It's it's a huge problem. And you know, we used to think the placenta blocked anything bad from going to the fetus. And then we found much to our chagrin that that was not the case. In fact, the placenta can actually concentrate certain things like mercury. If you
Have a mother who just gave birth to a baby and you test her for Mercury and you test the baby for Mercury, the baby can have more.
Ravi Kumar MD (24:10)
you know, we're talking about all these to toxins and toxins or toxicants as you describe them and environmental exposures. and it's good to know about this stuff and it is scary, but the reason you don't want to turn a blind eye to it or stick your head in the sand is because a lot of this stuff is avoidable if you know about it. So you can actually do something about it. There's modifiable behaviors and lifestyle.
you know, things that you can do that reduce your exposure, reduce your children's exposure, your family's exposure. So that's why we're talking about this, folks. Not to get all scared and worried and and hopeless. Yeah.
Dr. Anne Marie Fine (24:46)
Right, right, right. No, I think it's
I think it's hopeful. I think
Ravi Kumar MD (24:51)
Yeah.
Dr. Anne Marie Fine (24:52)
that's one of the reasons why I'm so passionate about teaching environmental medicine to physicians. Physicians do not routinely test for the things that I'm worried about. They don't routinely test for lead mercury or cadmium. Cadmium. In terms of epigenetic age tests, cadmium was the top chemical that was
Pro-aging in the populations tested, and cadmium also is implicated in breast cancer and osteoporosis at levels that I see all the time. We call cadmium the sleeper chemical, the sleeper metal, because some people know about lead and mercury and they know they're not good. People don't tend to know about arsenic and cadmium and thallium and
And some of these others, but there's I think it's very hopeful that I would like to train more doctors so that we can start testing everybody for these things and intervening before it leads to a bad outcome. In the case of the mothers, I'm a big proponent of preconception care. And so that is detoxing mom and dad before.
conception and it makes a difference. It does make a difference. There's just not a lot of physicians doing it, but that does make a difference. and then you know throughout the lifespan and that's something that's why I really got into environmental medicine is because I was seeing so many complex chronic patients with really mystery illnesses that their other doctors couldn't figure out.
And so I had to become like a medical detective and you have to look into their body burden of chemicals to see what's to see what's going on. You have to look at their exposures.
Ravi Kumar MD (26:55)
you mentioned cadmium. let's kind of do a quick run through of the different toxins out there, the most common and the most impactful ones. Because like you said, most people think of mercury and lead when they think about heavy metal toxins or or pollutants. But
Dr. Anne Marie Fine (27:10)
Mm-hmm.
Ravi Kumar MD (27:11)
No one ever talks about cadmium. I mean you can
Dr. Anne Marie Fine (27:12)
Now very
Ravi Kumar MD (27:13)
go through all the like the health and wellness podcasts and you know all the the public view websites out there talking about toxicology and none of them are talking about cadmium. But the research shows that it's very impactful. So let's start with cadmium and then let's kind of march through maybe the metals and then go into some of the synthetic chemicals and and go from there.
Dr. Anne Marie Fine (27:35)
Okay, so let's start cadmium. It's a good one. And unfortunately, one of the top sources of cadmium is cigarette smoke. And you may say, Well, I don't smoke. That's great. A lot of people don't smoke anymore, it's wonderful. But if your parents smoked, you got it as a baby, and the half-life is like 10 to 30 years, and so we find
Ravi Kumar MD (27:58)
In the thirty years.
Dr. Anne Marie Fine (28:00)
in the kidney, and we find that
People whose parents smoked typically have a higher cadmium level, even if they themselves didn't smoke. But cadmium is in, you know, industrial you know, burning and you know, dumps metal fabrication and I think it's even an auto exhaust. Cadmium is an auto exhaust. It's
It's not rare and I think it's also found in seafood and it's found in chocolate and it's found in sunflower seeds and it's found in cannabis. That was a small study though. But I I want to make a point here before I go a little bit deeper, is some of these heavy metals we are finding them in food because they're in the environment and they get into the soil. Nobody's adding them to your sunflower seeds. It's just
The things that grow in soil pick up things that are in the soil, right? That's how it gets into chocolate, right? and so there are food sources as well, but definitely the shellfish, not not so much fish. Shellfish is a pretty good source of cadmium, definitely an agreement. It's found in batteries, that's why you find it in dumps, right? Because there's a lot of batteries.
And then you wanted to talk about lead?
Everyone thinks, you know, we we we banned lead and paints and gas a long time ago, 1978. And so it should all be gone. Well, it's definitely less, which is a good thing, but everybody born before 1980 has a load of lead typically stored in our bones.
And some interesting things about lead is now we have these urban wildfire interface things where buildings are burning. And a lot of times these buildings have lead in them because they're older buildings. One of the most striking findings in the LA fires from a year or two ago is the amount of lead that was put into the air.
very very high amounts and then they tested the residents of Los Angeles and they did find elevated lead and they did find lead in the soil. when I see a patient who's high in lead, one of the first things I have to ask them is did you recently renovate your house? Because people are renovating their older homes that have lead paint in them.
And if you have lead paint, I mean it's kind of it's like a hazmat situation. I mean, you really it's getting everywhere, and it's getting into your your children too, and it's getting into the air, it's getting into the dust. So recent renovations are a source of lead, but in women, particularly, even though men turn over bone as they go through life as well. What you'll sometimes often see in women as they go through menopause is they're
Lead levels will rise because they're losing bone. And they are basically self-poisoning themselves with the lead that they got in childhood. So that's lead. Mercury fish is probably our biggest source. Coal-fired power plants in China are sending over two plumes of mercury to the west coast of the United States, like the Shanghai plume and another plume.
And while it's coming over the Pacific Ocean, it's dropping into the ocean and it's getting into the fish supply. And so that's why fish is high in it. But then it's also coming over here as well. you know, people say, yeah, I used to play with mercury thermometers. I used to break them and then just roll it around in my hands. Well, that's elemental mercury. people have fillings in their mouth and those
Fillings essentially vaporized for the life of the filling. Your teeth are right next to your brain. That's mercury vapor going up into your brain.
Ravi Kumar MD (32:13)
that's something I never
understood. How a field of medicine, essentially, dentistry, thought, yeah, let's pack mercury into the mouths of children and adults. It it just doesn't make any sense. And I I know the argument is, hey, this is a form of mercury that's non-toxic. Yeah, BS. You know, I mean, th these these forms are interchangeable and it mercury plays no role in human biology, and we do know it.
leaves these fillings. So it just, I don't know. That that that blows my mind honestly. And I don't understand why more people haven't questioned it, especially dentists, the ones actually putting it in and breathing the fumes as they drill those mercury fillings out to put deeper
Dr. Anne Marie Fine (32:56)
Because they get cognitive
impairment from the fumes. dentists and dental hygienists are among the sickest patients we see and they have the highest amounts of mercury. And you know the Mad Hatter disease, you've heard of that. Well, it's because in okay, in
Ravi Kumar MD (33:15)
Explain that to the audience, the madhat urgencies.
Dr. Anne Marie Fine (33:18)
the in the olden days in the olden days when they made hats and so you had hat making people, they use
mercury in the felt to make the hats and it made them crazy and that's called the mad hatters disease. And and so dentists I think, well, first of all, I mean, you know, the regulatory agencies are also saying it's perfectly all right. And so they've made it difficult for dentists to really go against that. But I mean if you need if it's a hazardous material
getting to your office and when you drill it out, getting rid of it, then how does it become non-toxic when it's in somebody's mouth right next to their brain? You know, that's one way to think about it. So that's my gosh, they've done well, because I just did that paper on Alzheimer's, they've looked at how many fillings someone has compared to how much mercury they have in the brain.
And they have they have seen a correlation, which is kind of nuts when you think about it. So that's that's mercury and then PIFAs. There's forty seven hundred different PIFAs in the environment. Okay.
Ravi Kumar MD (34:32)
Yeah. Okay. Let's talk about PIFAs. I think you're
gonna have to d explain what a PIFA is, where it comes from, and why it's called a forever chemical and and how
Dr. Anne Marie Fine (34:38)
Okay, okay, okay, okay.
Ravi Kumar MD (34:42)
they then you can talk about how they affect our biology.
Dr. Anne Marie Fine (34:45)
Okay, so PIFAs are a class of 4,700 different chemicals. And that's the class called the Forever Chemicals because the Half-Life is long in the body. And if you ever want to see an amazing movie on it, watch Dark Waters because that did a really good job talking about the PIFA's effluence in, I think it was West Virginia, and how the cows got sick.
first, but then the people got sick too, and they had just this huge lawsuit trying to get some justice and getting PIFAs into people's minds as being something that we don't want. And so the legacy PIFAs are PFOA and PFOS and those are things like in your raincoat, it's waterproofing.
Or in your boots, it's waterproofing or scotch guard for your couch. So when you spill something on it, it doesn't stain. Or there used to be, I don't know if they do this anymore, one of the sickest families I had was a family where everybody got sick, the whole family, mom, dad, kids, after they added a carpet application of scotch, scotch guard.
So that it would not stain. And so those those are some of the places where PIFAs are, but they're also found in food packaging materials. Of course they are. For example, microwave popcorn, it has to be water and oil proof, or that oily stuff in the microwave is going to get out and explode everywhere, right? And so it's in food packaging material.
as well. gosh, there's a big lawsuit on finding PIFAs in period panties a few years ago. Yeah, I mean, I
Ravi Kumar MD (36:42)
God. Unbelievable. Yeah.
Dr. Anne Marie Fine (36:45)
know, I mean, right up against a sensitive area of the body.
Ravi Kumar MD (36:49)
Of a
of a young girl, 'cause I mean that's usually who wears those. And they're okay. So how did
Dr. Anne Marie Fine (36:53)
I know, I know.
Ravi Kumar MD (36:55)
how are these disrupting biology? To explain like the mechanisms that are happening here.
Dr. Anne Marie Fine (36:58)
They are immuno,
they are immunotoxins. A lot of toxic a lot of toxicants. A ton, I should say, a toxin is more like snake venom. It's natural, but it's a toxin. You still don't want it. A toxicant really is just kind of a nuanced way to say it's a man-made chemical that's also not good for you, right? That's really the basic difference there. and so the PIFAs are a lot of toxins, and toxicants are immunotoxic.
The story with PIFAS is well there there's two parts of it. they did a they did a study with adolescents and adults and they correlated their viral loads and this is not COVID stuff, this is pre-COVID, other HSV, CMV, you know, other chronic viral loads.
And they tested how much their viral loads was compared to how much PFAS they had in the body. And both the adolescents and the adults, the higher their PFAS level, the higher their viral load. It's immunotoxic. One of the things that hasn't really been mentioned too much, but I always mention it, is PIFAs are now affecting antibody production in vaccines. And this came out probably
eight years ago in and they started looking at it in kids who had gotten diphtheria and tetanus vaccines as part of their normal childhood vaccines and they were finding that the antibody level the whole idea of getting a vaccine is so you can produce antibodies. So if you are doing the vaccine and you're not getting the antibodies, you didn't get your money's worth, right? And they're finding that the pe the people, the kids
Higher in PIFAS had lower antibody production to some of these vaccines. And there's some discussion that maybe this is part of why like the protessis vaccine doesn't work as well. And in certain populations, I'm thinking of one school in Texas had a protessis outbreak.
And the thought was, it it must be the unvaccinated. And so they went back to the school and asked, and they were like, no, we have a 100% vaccination rate. And they did not test for PIFAS there, but it it does make me wonder antibody production, that's part of your immune system. When you are exposed to a biologic virus, bacteria, your immune system is supposed to make antibodies to it.
So those are some things that PIFAs do, and they're also considered endocrine disruptors, too. They're closely related to testicular cancer, I think kidney cancer. the National Academy of Sciences and Medicine have made a beautiful one sheet on PIFAS and what to look for for you as a clinician.
What levels mean what when you are clinically managing these patients? we don't have time to go over that, but that's something that I teach my
Ravi Kumar MD (40:15)
Yeah.
Dr. Anne Marie Fine (40:16)
students.
Ravi Kumar MD (40:16)
But this is not this is not fringe medicine at all. This is real essentially indestructible synthetic chemicals that have very meaningful effects on our biology in a bad way. There's no inert or good or useful portion of PFAs in our in our body. They they disrupt the biological machinery.
Dr. Anne Marie Fine (40:36)
No.
They do. They do. And you know, the firefighters have the highest amounts of PIFAs because it's in firefighting foam. And our military. It's a
Ravi Kumar MD (40:48)
Yeah. Right. It's a it's a flame retardant, right? I mean it
Dr. Anne Marie Fine (40:51)
flame retardant. And so they have the highest level. Well guess what? Firefighters have the highest cancer rates too.
Ravi Kumar MD (40:58)
Yeah. I mean, they're they're running into you know, they're using these chemicals to stop fires or control fires and then they're running into buildings that are burning and these buildings are made of man made things that weren't meant to burn and be released into the the air. I mean, they they wear respirators and but I mean it's all over them and they c it's all over their fire trucks, it's all over their suits, and these guys are s meticulous about cleaning things afterwards. So yeah, I I just
Dr. Anne Marie Fine (41:26)
And they're
in good shape. They're in good shape too, or you wouldn't be able to do that job. They're
Ravi Kumar MD (41:28)
Yeah. Yeah. Mm-hmm.
Dr. Anne Marie Fine (41:31)
young and they're in good shape. Yeah, it's it's it's not good.
Ravi Kumar MD (41:35)
which and it's and it's it's not fair because these guys, you know, these guys are on the front lines helping us at our in our greatest need. I mean, even my family, we've had that call the fire department a couple of times for very serious things. And they were there at a moment's notice in the middle of the night. And here these guys who are our first responders are being put in the way of this toxic deluge with fires and the chemicals they have to use to stop fires. And it's just it seems
Seems unjust, you know. They're taking the biggest risks and paying the biggest price at the same time. let's talk about we always
already kind of what
Dr. Anne Marie Fine (42:12)
Benzine We can't miss benzene.
Ravi Kumar MD (42:15)
yeah, let's talk about benzene.
Dr. Anne Marie Fine (42:17)
I wanna talk about benzene because benzene is an
Ravi Kumar MD (42:19)
Because this is something we're
all exposed to essentially.
Dr. Anne Marie Fine (42:22)
Unbelievably. I had the shock
Ravi Kumar MD (42:23)
Yeah. Yeah.
Dr. Anne Marie Fine (42:25)
of my life last year finding out how much I had. Benzene found in gasoline. Every time you put gas in your car, you're exposed to benzene. It's in auto exhaust, it's in industrial emissions, it's in air pollution, and it's in gas stoves. And one really interesting study
They took a home and they put the stove on for an hour. And then they turned it off. And then hours later, three to four hours later, they went through every room in the house and tested the benzene level in the air. And they found even in the room the furthest away from the kitchen, they found benzene levels that were higher than the EPA allowable benzene in outdoor air. So that benzene from your
Gas appliances can also be a a problem too. And that one is something that we have ways ways to manage too. I don't think we're at that part yet, but yeah, we do.
Ravi Kumar MD (43:29)
So, okay, so benzene is part of fossil fuels. It's a aromatic compound. So it
Dr. Anne Marie Fine (43:35)
Carcinogen.
Ravi Kumar MD (43:36)
it yeah, and it's a carcinogen, it volatilizes it vol it's very volatile. So it goes into the air, enters your lungs, enters your body, essentially. let's see in vehicle exhaust, it's in tobacco smoke, it's in industrial processes. So we it's it's all around us. And there's there are people specifically
That work in industries that have very high benzene exposure and they've well defined the syndromes around this. It's very toxic. but who knew that using a natural gas stove or a propane stove in your house, which they're in a lot of houses, is actually adding benzene to your indoor air, which is fairly stale air in most homes. Yeah.
Dr. Anne Marie Fine (44:17)
It is more toxic
than your outdoor air, even in LA. They've tested it in LA. They've gone to inner city LA and they're like, inner city LA is pretty toxic area. Let's test the outdoor terrible air compared to the indoor terrible air and see which is worse. And it was still the indoor air.
Ravi Kumar MD (44:38)
Gosh.
Let's talk about mold and mycotoxins now, because this is this is actually not a synthetic man-made chemical, but this is made by an organism that's trying to defend and fend off
Dr. Anne Marie Fine (44:50)
Live.
Ravi Kumar MD (44:51)
competitors, which human beings might be in this situation. So tell us about mold and mycotoxins and why this is not just some biohackers conspiracy theory that that causes illness.
Dr. Anne Marie Fine (45:04)
People are getting really sick for mold and mycotoxins. And you're right, mycotoxins would be an example of a toxin, not a toxin. It's completely natural. Still don't want it. And we we just see more problems with mold and mycotoxin now because homes are so shut in. People don't really air out their homes, right? And then any you you can get a leak in the back of your refrigerator or
There's pinhole leaks that I'm in Southern California and there's a pinhole leak problem where your water, our water supply, the chlorine, it's getting dirtier, the groundwater. And so they have to add more chlorine. But you there are federal regulations on how much chlorine you can add to your water because it's not benign. And so because they couldn't add in
And this is all over the United States. When you can't add any more chlorine, you're at your limit, you add ammonia with it. That's why it's called chloramine. And chloramine is more toxic to pipes. And so you get these little pinhole leaks, tiny little leaks. And it's just dropping. You can't see it. It's in your walls and ceiling. And it's just drop by drop. But with time you can get, you know, a mold, mold issue with that, compressors and
HVAC systems and and air conditioners. So the mold and mycotoxin problem is and and the problem with mold and mycotoxins is they're also immunosuppressive as well, and they they damage your ability to make glutathione. And so these people you use glutathione as one of your top detoxin antioxidant molecules in your body, and if you damage your enzymatic
Ability to make it like the mycotoxins do, then not only can you not get rid of those toxins, you can't get rid of the lead and mercury and cadmium and PFAS and everything else, and they the mold and mycotoxins make people really tired and they get brain fog, fatigue, and brain fog are the top to.
symptoms that we would see with people with mold and mycotoxins and it's it's not it's not a conspiracy theory. It's unfortunate that conventional medicine looks at mold like you can be allergic to mold, but that's it.
Ravi Kumar MD (47:39)
Yeah. Conventional medicine is completely ignored. Yeah, it's completely ignored molden mycotoxins
Dr. Anne Marie Fine (47:40)
And that's the only test they do. Allergy. Yeah.
Ravi Kumar MD (47:46)
folks, you know, when you when you hear this, I mean, we get these dogmatic channels of thought. And when one group of people start saying molden mycotoxins are making people sick, and they're not mate necessarily in the mainstream of medicine, medicine automatically goes to saying, No, they're not. We don't, we're you can have an allergy, but otherwise
We're not gonna follow that. We're not gonna make that a thing in medicine. But here listen to this. The federal government regulates mycotoxins in our food because they are so toxic. Okra toxin, aflatoxin, these these are toxins made by molds. And if they get to certain levels in their food, I mean very tiny amounts, they cause cancer in the body. In fact, I think aflatoxin is the most carcinogenic toxin in the world. Yeah.
Dr. Anne Marie Fine (48:29)
Yes, they do. Liver liver cancer.
Ravi Kumar MD (48:33)
Causes liver cancer in kids.
And so you know, mycotoxins are real. They do come from molds and molds grow in your house and release them if you don't keep a proper
Dr. Anne Marie Fine (48:43)
They do. And
they are ionophores. They can go through walls, ceilings, floors. They can go through concrete. They don't stay in one place. And myclophenolic acid is a mycotoxin that is so strongly immunosuppressive, they made it into a pill.
That they give transplant patients so that they don't reject the pill, mycophenolic
Ravi Kumar MD (49:08)
Mm.
Dr. Anne Marie Fine (49:09)
acid. So whenever whenever I'm gonna test a patient for mycot, I have to ask them, are you on mycophenolic acid? Did you get an organ transplant? Because it'll come back high. and and we need to know ahead of time, you know, is it the mold or is it the medication that you're taking?
Ravi Kumar MD (49:26)
Right. Okay, so let's move on to something else that I think that when I saw this on your list of mic of toxicants that that we should talk about, I was actually pretty sus surprised. And it's DDT and DDE. And if for those of you who don't know what DDT is, it's that pesticide that was essentially made illegal back in nineteen seventy-two. The when the EPA started.
It did a study and it got rid of it. And it all started from Rachel Carson's book, Silent Spring, which kind of brought attention to this chemical that was persistent in the environment and it was working its way up the food chain and making eggshells of birds very fragile, and then the bird populations were were collapsing and then the whole ecosystems were collapsing because of it. And she was right. And then the EPA
Dr. Anne Marie Fine (50:16)
Mm-hmm.
Ravi Kumar MD (50:17)
was formed by Kennedy, and then they made it illegal. So that was nineteen seventy two.
Why is D D T still found in humans human beings' bodies? Cause it is, right?
Dr. Anne Marie Fine (50:29)
99% of Americans today still have DDE, which is the major metabolite of DDT in their bodies. 99%. Because it's a persistent organic pollutant, it's an organochlorine pesticide. That whole class of organochlorine pesticides is persistent. That's why they started banning them and getting the organophosphate pesticides, which they thought would be better.
Because they're persistent in our bodies, our mothers pass them through to us. And but not only that, they're in our environment, and again, they're in the soil, and they can get into our food supply, into our animal fat food supply. They can get into some the countries, there aren't a lot of countries that use it anymore, but if we are importing produce.
From those countries, we do have the ability to get some new that's so rare. when I when I have seen it, it's DDE, not DDT. But if if you would find DDT, then you would say, that's a recent exposure. So yeah, 99% of us still carry DDE in our bodies, and it is not doing you any favors. It's immunotoxic, strongly immunotoxic.
It's one of the things that is linked to breast cancer. Yeah. Let's see.
Ravi Kumar MD (51:56)
Yeah. Yeah. So the
the last thing I I want to talk about before we move on to, you know, before we stop scaring everyone and move on to like what you can actually do about this to to reduce your toxic exposure and get toxins out of your body. The last thing I wanted to talk about is gadolinium because
Dr. Anne Marie Fine (52:14)
yeah.
Ravi Kumar MD (52:15)
honestly this is something I prescribe all the time. when I get an MRI
Dr. Anne Marie Fine (52:18)
you do?
Ravi Kumar MD (52:19)
of the brain and a patient who has brain tumor, we give a contrast called gadolinium, which is a heavy
Dr. Anne Marie Fine (52:25)
Mm-hmm.
Ravi Kumar MD (52:25)
metal.
And what happens is tumors in the brain, they their vessels are leaky. So contrast that you give into the veins, it'll extravisate, it'll get through those vessels and and go into the the surrounding brain only where there's a brain tumor. And so that gadolinium will light up on an MRI and I can see exactly where the brain tumor is. But this is a heavy metal. And there's you're you sent me some research that shows that there are potential effects to.
Multiple rounds of gadolinium.
Dr. Anne Marie Fine (52:58)
Yeah, we're seeing gadolinium deposition disease in some patients now who somehow are just not able to clear it as well as other patients and it's also something that depletes NAD plus, right? And these people get really, really sick. And I I test everybody for metals. I test for a whole like 10 or 12, including cadmium, mercury, lead, arsenic.
gadolinium, thallium, test per thallium, another heavy metal. Nobody talks about it. But I've I've had patients who had very high levels who were very, very sick. And so gadolinium, there's mitochondrial dysfunction based on gadolinium. And we see it not on everyone, but every time I see it I ask, when's when's your last contrast MRI?
that you had. And sometimes it's just a little and it's not problematic. But there are some people who have to get, it's not only chelation, it's a special form of chelation to complex with the gadolinium and get it out of the body. And it's it's a pretty complicated procedure to get into.
Ravi Kumar MD (54:16)
Yeah. Okay. So that's something to understand. I can't stop prescribing gadolinium for brain tuper tumor patients because we don't have a a better option. but hopefully that'll be something that we can understand better and and work on in the future.
Dr. Anne Marie Fine (54:30)
Mm-hmm.
Ravi Kumar MD (54:30)
okay. So we've talked about all these toxins, toxicants, toxins and toxicants.
Let's talk about first this sick population of people. People that know there's something wrong with them. They're just not working the way they used to. How can they test and see if they are do have toxic exposures to these these molecules we just talked about?
Dr. Anne Marie Fine (54:55)
Yeah, I mean, for for those people, I recommend going to an environmental medicine doctor. Here's what you don't want. You don't want to go to just anybody who goes, I know how to test you for heavy metals, or I know how to test you for heavy metals and mold. You don't just want to throw things on the wall and just you want to do a proper evaluation and assessment before you ever test. It's bad medicine.
To just test everything because you don't know what you're looking for. And so what we recommend is seeing a practitioner who understands how to assess your environmental exposures, correlate them to your symptoms and your illnesses. It doesn't matter if someone's really high in mercury, for example, if their particular issue has nothing to do with mercury, right?
You you have to use discernment. And so you want to get an idea of what they've been exposed to. You want to match it up with the symptom and illness picture they're presenting. And then you want to narrow down what you're going to test for. So that's evaluation, assessment, testing, and then you need to know how to treat. And it's it's it's more nuanced. And that that takes takes me a year to teach.
the physicians in my clinical training course how to do all of this, but that's that's what needs to be done.
Ravi Kumar MD (56:27)
Right. So if you are worried about toxic exposures, an environmental medicine doctor is the type of doctor who's been trained specifically to evaluate your toxic exposures and figure out if they are messing with your biology. I would say just from my own experience as a patient and as a doctor.
If you go to your primary care doctor and tell them all these concerns and say, maybe I think it's mycotoxins or maybe it's cadmium, they're gonna look at you like you're crazy most of the time. It's just not, and it's not because they're not compassionate, honestly. It's because it's not in their training. I mean, it when we go to medical school, we're taught to think in this box. You don't, you you don't go outside it, you just you you see what you know the Merck manual correlates with these symptoms and what drug treats it and you give it to them. And
And that is the very useful in certain sick circumstances. It can save lives, but it also in in circumstances where you gotta be creative and you gotta understand complex processes and you've got to be willing to spend some time and explore to help this person out of a very difficult situation, you've got to go to a certain person for that.
because it's not
Dr. Anne Marie Fine (57:41)
Yes.
Ravi Kumar MD (57:42)
your usually not your primary care doctor. And environmental medicine is
Dr. Anne Marie Fine (57:45)
Absolutely.
Ravi Kumar MD (57:46)
specifically trained for that. And that's the type of doctors that you train. Okay, so we we can't we obviously can't say exactly what tests they need, but what are the types of testing modalities that you will use what that are available to you, I should ask.
Dr. Anne Marie Fine (58:00)
That
are available. Well, see, that's the other thing. We use specialty labs that your primary care doctor doesn't use. It's not Lab Core and Quest. Now you can get you can get blood lead and blood mercury from Lab Core and Quest for sure. Those are those yeah, those are easy to get. but a lot of the things we do are specialty labs that they don't have.
It's not on their formulary, it's not on their plan, it's not covered by insurance. So we have labs that do tests for mycotoxins, we have labs that test for endocrine disruptors, we have we now have a lab that can test for PIFAs. And a few years ago I was so excited because Quest started doing this. prior to
Quest doing it, I had to send it to a specialty lab that no insurance covered it was eight hundred dollars. My patients hated me. Quest was doing it for so much less. I was super excited. And then for some reason they stopped doing it. I can't I can't explain it, but we have another lab that does it with a fingerprint test.
And so that is something that actually people can do at home without a script from their doctor. I don't know if that's of interest. We could put it in the show notes. But then I would say, you know, the the flip side to that is if you if you or your doctor don't understand what the results mean, then that might not be the best option. You have to understand what the results mean and
Some of those results, unless you're in the absolute lowest level of PFAS, it's work for your primary care physician. They need to treat you differently than their other patients based on the result of that test. And what I mean is more surveillance for certain cancers and thyroid disease and things like that.
and so we just we have different tests available. I I now have trained my doctors to use a tox lab in Switzerland for persistent organic pollutants because we don't have a good way to test for those in the United States. Twenty-five years ago, when I started practicing medicine, we did fat biopsies of the buttocks.
Ravi Kumar MD (1:00:35)
No.
Dr. Anne Marie Fine (1:00:36)
Your
adipose tissue is where you're hiding all that stuff and that's not available anymore. And so we send we send that to specialty labs in Europe to look at that. I I hope they come back to the United States though. And so those are s those are some of the tests that we can do.
Ravi Kumar MD (1:00:56)
Okay.
okay, so that's that's a person who's worried about their toxic exposure. They need to go to an environmental s environmental medicine doctor, and there's gonna be a specialty set of specialty set of labs based on their clinical symptoms that'll be ordered. So that's a that's a tough one to do on your on yourself. I would say even if you're a
doctor, that's a tough one to do on yourself. So I think you need
You need help. You need someone to look at you objectively and figure that out.
Dr. Anne Marie Fine (1:01:22)
Yeah,
you do. And on my website I do have a list of practitioners that we have trained. and so that's of help. It's not is there's not as many and it doesn't cover as many states as I would like, but that is one way to get some of these practitioners. There's also the American Academy of Environmental Medicine, that's the organization that I am fellowed with,
They have a listing of physicians who can do this as well.
Ravi Kumar MD (1:01:54)
Okay. Yeah. So we'll put a link to that in the show notes.
Dr. Anne Marie Fine (1:01:57)
Yeah.
Ravi Kumar MD (1:01:58)
Now let's just say you feel okay, but you just want to of like try to avoid as much toxic exposure as possible. Where are the most high yield things you can do?
Dr. Anne Marie Fine (1:02:08)
Yeah,
love that question. Have thought about it a lot over the years. My answer has changed over the years. the first rule of environmental medicine, believe it or not, is avoidance. Anything you can avoid is something you will never have to detox out of your body. Twenty-five years ago, I would only recommend an air purification or an air filter for people with asthma or COPD. And now I think everyone.
should have one in their homes. We've already shown that your indoor air in your home because your one of the top indoor air toxins is formaldehyde. It's it's a it's a carcinogen. Your cabinets that are and furniture made with pressboard have formaldehyde in it and it just off gasses into the air. Your luxury vinyl flooring is off gassing phthalates, off dusting phthalates into your home.
I think a air filter is a must for everyone. I think water filtration is a must for everyone. these are two major levers for people to do. I think buying organic food is a must. Getting rid of the plastics in your food storage and in your kitchen is super important. Cleaning up your makeup is super important as well.
So these are things that you can do around your home. But guess what? We spend 90% of our time in our home. So that's not a bad place to start, is in your home. You can get organic sheets and you know, organic duvet covers, and you can not put Scotch Guard on your carpeting. You can get HIPAA filter. I mean not no no no HIPAA vacuum cleaners, because some vacuum cleaners that aren't HEPA.
I mean they they do pull things out of your carpet and then they spew it into the air and then you breathe it. Dust in your home is not I used to think dust was like dried up skin cells. That's what I thought dust was. No, no. There's plastics in there, there's phthalates, there's BPA, there's there's PIFAs in there. It's like
All of the stuff that's off-gassing in your home is precipitating out in dust. And so another thing that nobody wants to hear, because nobody likes to dust, is you should really be better about dusting your home. That's it's basically a pile of toxins.
Ravi Kumar MD (1:04:46)
Yeah. Okay. I I one thing that we do is have a very good air filter in our home. And then the other thing you can do is have it an air exchanger if if that's within your means, that exchanges your indoor air for outdoor air. And it's a something an HVAC person can install for you, but it it does sample if it will sample out the air and without losing the heat or the cooling very efficiently.
Okay, so let's say okay, so we've we've talked about kind of these general avoidance things that you can do. Now let's say that you are dealing with some toxic exposure and you want to support your ability to to detoxify. And there are a number of things in the biology of how toxins affect us that that can be targeted with supplements, correct?
Dr. Anne Marie Fine (1:05:41)
yes,
there are. Mm-hmm.
Ravi Kumar MD (1:05:43)
And w the one one part of the biology I I really wanted to talk about was NAD, because NAD is very interesting. It's it's a key molecule in our energy metabolism. And when you're constantly damaging your DNA, you talked about this molecule. PPAR is an it's an enzyme that goes in and basically repairs DNA. And it uses NAD as a energy source. And NAD is used for a whole host of things, including
energy metabolism. And so if you're highly exposed to toxic exposures, you're using up a ton of your NAD. So what what can we do? Is there a is there something we
Dr. Anne Marie Fine (1:06:22)
Yeah, and
it's such an interesting dilemma because everyone is promoting NAD and NAD plus and I would say get rid of the toxins as the toxins are also depleting your NAD plus and you're using them up and they're getting depleted. And so there are other things that you can do to deplete your body of toxins. You can get a sauna for your home. Sauna is
An amazing addition to your home. Knowing your own genetics and looking at maybe your glutathione SNPs and seeing how well you're making and utilizing glutathione day to day can be helpful for you as well. those are some things
So no, I don't I don't really recommend NAD plus and I don't my patients who detox with me, their energy improves. it's proof their mitochondrial function and ATP production are increasing as they reduce their body burden of toxins. But
For people who may not know this, are they getting benefit from NAD plus? I think what you're saying is yes, and you've used it and your patients are reporting good results.
Ravi Kumar MD (1:07:47)
So but you don't generally recommend supplementation. You say first get the just the toxic burden out and let the biology find balance again. Is that kind of your your general
Dr. Anne Marie Fine (1:07:57)
Well, I do like
that. As particularly if I'm going to prescribe bioidentical hormones, I want people to clean up their homes and environment first because if we can get someone's testosterone to come up like thirty percent, that's less testosterone that they need to get exogenously. And with the women, you know, in terms of giving someone estrogen and you've already got all these xenoestrogens, which are
Foreign estrogens in your body and in your life. I mean, I would like to see what you what your hormone profile looks like when you're not doing all of the exogenous hormones. but do I like supplements? I do like, I do like supplements. but I'm I'm very individual in how I prescribe them for patients. I very much for my GSTM1 null patients or GSTT.
One null patients, and those are patients who are lacking. If you get one gene from mom and one gene from dad for most of the genes in your body, and you get a glutathione S transferase null, that means mom didn't give you one and dad didn't give you one. You're null, you're just missing it. This may sound like a malformation or congenital malformation.
About 30 to 40 percent of Americans, or the studies I've seen, at least 30% of people are GST M1 null. And these people have higher rates of cancer, they get asthma, and glutathione production in the body is super important. And you can protect that by giving actual
liposomal glutathione, you can protect that by giving an acetylcysteine, which is more of a precursor. I think that's super important. There's other things that you can get vitamin C, I think people would be well served by being on a good a good vitamin C to deal with how do all these toxins, toxicants and toxins, one of the ways they are
damaging us is through oxidative stress. So there you go with your vitamin C, right? So vitamin C, clean water. Yeah.
Ravi Kumar MD (1:10:25)
Okay. Well that's that's great advice. I think we should wrap it up there. Tell me how if the listeners want to get a hold of you or learn more from you, how can they how can they find you?
Dr. Anne Marie Fine (1:10:38)
Yeah, my website is emeiglobal.com and I have several courses available. They are mostly available for physicians, however, because we figured out a couple of years ago, not everyone is going to be able to find an environmental medicine doctor. So we did create a class or a program for consumers, the general public.
And it's called How to Survive in a Toxic World. And that's available on there. We have a podcast, and that's available. Anybody can listen to that. And we have a mentorship group on Wednesday nights for doctors who may not even be in our clinical one-year training program, but they have enough interest and some sort of background where they just want to say, Hey, I got this lab result back on mycotoxins.
What do I do with it? You know, what does it mean? you know, basic simple questions like that. So we do have some resources on there. the podcast is really interesting because, well, it might not be interesting to a lot of people because I basically review the literature, and my tagline is I review the literature so you don't have to. That's my tagline for the doctors. But there are other people who are just interested in what's happening.
I'll tell you what, environmental medicine is a fast moving, emerging field. And there's a lot of happenings going on in it. And we're getting more solutions like the double filtration plasmapharesis that I meant I mentioned earlier. We're getting other ways to remove body burden that are going to become more important.
Ravi Kumar MD (1:12:29)
Right. Okay. Well maybe before we wrap it up we should just talk about that real quick because that's a pretty interesting technology and
Dr. Anne Marie Fine (1:12:34)
Yeah. Yes, so
interesting. I do want to mention it because last year I went on a research brand to Switzerland to study double filtration, plasmapharesis. I actually did it myself. a blood cleansing therapy where your blood comes out and the first bifurcation takes the pack.
red blood cells away from the plasma. The plasma is the only thing that's getting fractionated, getting filtered, and the toxicants are coming out. And then the plasma goes back into your body. You're not losing anything. You get all your blood cells back. You get all your not all of your plasma back, but most of your plasma back. And then they take the Eluit, which is like the filtrate of what was filtered.
And they send it to the TOX lab in Switzerland and they analyze it for toxins. This is the best test out there because, like I mentioned earlier, we don't have the ability to see a lot of these toxicants anymore. And because a lot of the tests that we do are urine-based. Everyone loves the urine-based test because it's easy, it's accessible. and so what was really striking to me is that.
I saw everybody's results, and everybody from 30-year-old German men to the whole group. I was there with a group of environmental medicine doctors. We are people who have been saunaing and cleaning up our environment and taking good care of this aspect for decades, and everybody was full.
Of things that you would not believe. For example, DDT and DDE. People had DDT and DDE. Everybody had benzene and toluene and these solvents that really in environmental medicine we learned solvents had short half-lives. Did you learn that? Yeah, they're supposed to be short half-lives. No, no, I mean they're they're still in there.
we had metals coming out. We did a whole a large panel of pesticides. I didn't have well I eat organic and I have for many years. So that was confirmation that I don't have pesticides in me, but solvents, yeah, I had solvents, benzene, it was it was sobering because what we got out of that is that we we partitioned
Toxicants in our body, in organs and tissues. It's not all running around in our bloodstream ready to come out in our urine. Some of it's in our brain. And so the idea of double filtration plasmapharesis is that first the first time they run through, which is just your peripheral blood supply, they toss that. That's not what they're testing. They do something in between because they're trying to.
get the tissues and organs to dump into the bloodstream and then they're doing it again and then that's that's what they're testing and that is that is really interesting to see we all have a higher body burden than we would even imagine even based on the tests that we have available here. Now this this group
actually a group in Germany that does the aphoresis, they just put out a paper where they discovered they got out PIFAs and microplastics in this therapy, even though when I did it, those two things were not tested. I tested my own body before and after for PIFAs and I did lose PIFAs in it, even though in my filtrate that was not something that was tested.
And so I really think it was sobering, even for us who have been dealing with people's body burdens and our own for decades. It was very sobering to see how much we still had in us and where could it possibly have come from? I was very surprised there was a 30 something year old German man who had so much DDT. I'm like, you you were born after that stuff was
band, where did you get? I mean, it it's very interesting to think about your own exposures and and where you might have gotten them from. Very motivating though.
Ravi Kumar MD (1:17:17)
Yeah.
if so if someone wants to get this test, is it available to them or is it only for research purposes?
Dr. Anne Marie Fine (1:17:27)
no, it's available, but you right now you would have to go to Europe. But they started FDA trials in the United States recently. And and this is something that may be available at some point soon. But right now they've been doing it in Europe for about 17 years, and their insurance
Ravi Kumar MD (1:17:49)
okay. So it's not a new technology.
Dr. Anne Marie Fine (1:17:52)
their insurance pays for it. I mean they're
Ravi Kumar MD (1:17:54)
Yeah.
Dr. Anne Marie Fine (1:17:55)
I mean they use it on autoimmune diseases and different things like that. So it's kind of interesting if you if you think about autoimmune disease versus what I just told you. Autoimmune, that's a they're they're basically filtering out the autoantibodies, right? Now
Ravi Kumar MD (1:18:08)
Yeah. Mm-hmm.
Dr. Anne Marie Fine (1:18:10)
they're at the same time probably getting out other toxics
Ravi Kumar MD (1:18:13)
Pulling toxins as well.
Dr. Anne Marie Fine (1:18:15)
too that maybe are contributing to that autoimmune process, but their their main thrust is they're able to.
Filter out auto antibodies. And so that's
Ravi Kumar MD (1:18:27)
Yeah. These children with
pandas, children with pandas, which is that you know, pediatric neuropsychiatric disorder from strep infections. And they get, and these children, they, they suffer so badly because they got all these autoantibodies to strep that attack the brain. And one of the treatments, which is very hard to get in the United States unless you go to a very specific center, is plasmapheresis to pull those antibodies out of their blood. But in that
plasmapheresis, they're not pulling the toxins either as well, are they? Or do you have to go to
Dr. Anne Marie Fine (1:19:00)
you're talking about therapeutic plasma exchange? plasma phores
Ravi Kumar MD (1:19:04)
No plasmaphoresis here in the US where they're just pulling off the auto antibodies.
Dr. Anne Marie Fine (1:19:07)
okay, different. I don't know what they're doing. So that would be like
Ravi Kumar MD (1:19:10)
Yeah.
Dr. Anne Marie Fine (1:19:11)
plain old aphoresis, right? Aphoresis, yeah.
Ravi Kumar MD (1:19:13)
Yeah, aphoresis essentially. And so when
you go to Europe, you're having this, you know, double filtration technique done where you're actually getting the autoantibodies removed and possibly the toxins that are contributing to a lot of your immune reaction. Because a lot of these toxins, remember in the episode we just talked about, how they're affecting the immune system. They're either ramping it up so you're attacking your own body or they're tamping it down so you're not defending yourself against pathogens in the in the world that we
we're we can't really avoid exposure to half most of the time. So
Dr. Anne Marie Fine (1:19:46)
Right.
Ravi Kumar MD (1:19:47)
that's a very that's a very interesting technology. Well I think we should wrap it up there, Dr. Fine. I will put all those links you talked about in the show notes. And I'm super happy you came on the show. There was a lot to to hear and I think it was a ton of information. Remember folks, physicians have to study for a year with Dr. Fine before they get certification on this. So
You know, take as much of this as you can, use it to hopefully clean up your life a little bit with the tips that Dr. Fine gave. And then if you're really having trouble, see an environmental medicine doctor because that can actually make a big difference in in how you your biology works if you get these toxicants and these toxins out of your body. So thanks so much for joining us, Dr. Fine. It was it was a great time.
Dr. Anne Marie Fine (1:20:34)
Well, thanks for having me.