Genes, Toxins, and Our Health

GENETIC TESTING: VALUES AND LIMITATIONS

Professionals and patients are excited about gene testing; many of us have recommended or sought out commercially available profiles like 23andme, and then had the job of figuring out how to apply the results. As a psychiatrist I find two potential applications: evaluation of methylation capacity (more about that below) and of the body’s ability to eliminate toxins. However, I’ve discovered that knowing a patient’s methylation capacity doesn’t take into account other important factors, such as how complicated methylation can be, and how environmental toxicants can change the expression of those genes for methylation.

 

Gene testing provides information about rare but major defects, like Down’s syndrome, but more commonly identifies relatively minor, non-life threatening variations that very slightly alter how we make our brain chemicals and translate genes into proteins. Clinicians know the most about variations in the code for the enzyme methyltetrahydrofolate reductase (MTHFR). Some variations of the code for for MTHFR create a heightened risk of depression, cardiovascular disease, and cancers.

But the story only begins there: just because a gene exists does not mean its expression is predictable. In fact, researchers around the world are creating a body of studies of the “epigenome,” i.e., the influences that the translation of genetic code into enzymes and proteins. Among those influences: environmental exposures to metals and manufactured chemicals. Because I try to take a broad view of human health and the tools available, from medications and transcranial magnetic stimulation (TMS Therapy) to detoxification, I am trying to learn more about toxic effects on our genes, and have learned some facts with future implications.

As I said in my previous blog, although I am emphasizing the problems, some solutions are quite available, particularly eating a great diet that is low in pesticides, high in fiber and antioxidants (in other words, lots of colorful fruits and vegetables). We can choose products that minimize toxins (a great resources is the Environmental Working Group, http://www.ewg.org/ For those who are truly sick from pollution, a doctor will need to design a special detoxification plan. In the long run, though, to protect ourselves and our children we need to be sharing this information with others, especially manufacturers and regulators, so that individuals, companies, and governments can make better decisions about the production, distribution, and eventual clean-up of these substances.

Here are some examples of toxins and their genetic effects:

Metabolic system: Pollutants: PCBs, Chromium. Effects: Altered glucose and corticosteroid levels from prenatal exposures; altered thyroid hormones.

Central Nervous System: Pollutants: Mercury, Lead. Effects: Impaired learning, depression-like behaviors in rodent studies; seizures.

Immune System: Pollutant: PCBs; chlorine breakdown products, dioxin, air pollution. Effects: Auto-immune hepatitis, impaired immunity and increased rates of associated cancers (leukemia, lymphoma), asthma.

Reproductive System: Pollutant: PCBs, phthalates, BPA, benzene. Effects: Early puberty, altered development of reproductive organs (which can persist into future generations), reduced fertility.

Cancer:  Chromium, cadmium, arsenic, nickel, tungsten alloy, dioxin, PCBs, chlorine breakdown products, benzene,

Clinical Perspective – Putting information into Solutions

As a clinician I value scientific research, but recognize the limitations. As the field of functional medicine continues to gain knowledge and is applied to integrative Psychiatry, I ask myself the following when I put into practice what we are learning.

  • What is the value of animal studies to predict long-term low-dose human exposures?
  • How do different chemicals interact?
  • How can we better measure and monitor low-dose exposures?
  • How can I screen for and measure toxic exposures?
  • How can I help patients strengthen their own natural detoxification pathways?
  • How do I tell our patients what and how they can eliminate common exposures?

 

Scientists especially worry about the accumulation of pollutants in pregnant women, as most do pass through the placenta to the fetus. If they disrupt thyroid hormones they may also disrupt normal brain development. The thyroid gland plays a role in other areas as well: bone growth, female hormones, and even fat cells.

My job is to take a holistic view of health and therapies, and include all the tools available, from medications and transcranial magnetic stimulation (TMS Therapy) to detoxification. As an integrative psychiatrist I recognize that there are strong connections between thyroid problems and depression. This research suggests that environmental toxins may drive some of the thyroid problems we see. Although I am emphasizing the problems, some solutions are quite available, particularly eating a great diet that is low in pesticides, high in fiber and antioxidants (in other words, lots of colorful fruits and vegetables). We can choose products that minimize toxins (a great resources is the Environmental Working Group, http://www.ewg.org/ For those who are truly sick from pollution, a doctor will need to design a special detoxification plan. In the long run, though, to protect ourselves and our children we need to be sharing this information with others, especially manufacturers and regulators, so that individuals, companies, and governments can make better decisions about the production, distribution, and eventual clean-up of these substances.

Here are some examples of Toxins:

  • Thyroid: Pollutant: Phthalates; Polychloride biphenyls (PCB); metabolite; PCBs; Perchlorate; PBDE; DDT, aldrin, dieldren; PFCs; Organotins
  • Central Nervous System: Pollutant:
  • Skeletal System: Pollutant: PCBs; Pollutant: PFCs
  • Female Reproductive System: Pollutant: PCBs
  • Adipose Tissue (Fat Cells): Pollutants: Persistent organic pollutants

Click here to download this blog.  It includes more details about these toxins.

Clinical Perspective – Putting information into Solutions

As a clinician I value scientific research, but recognize the limitations. As the field of functional medicine continues to gain knowledge and is applied to integrative Psychiatry, I ask myself the following when I put into practice what we are learning.

  • What is the value of animal studies to predict long-term low-dose human exposures?
  • How do different chemical interact?
  • How can we better measure and monitor low-dose exposures?
  • How can I screen for and measure toxic exposures?
  • How can I help patients strengthen their own natural detoxification pathways?
  • How do I tell our patients what and how they can eliminate common exposures?

About Dr. Marilyn Vaché and Austin TMS Clinic for Depression

Dr. Vaché is the Medical Director of the Austin TMS Clinic, Medical Director of Austin Recovery and Chair of the Travis County Medical Society’s Physician Health committee. She is a graduate of the University Of Arizona College Of Medicine, and completed a psychiatry residency and substance abuse fellowship at Stanford. She is board-certified and licensed in Arizona, California and Texas. She is a strong advocate of TMS Therapy for the treatment of depression, and specializes in the treatment of addictions, anxiety disorders, bipolar disorder and other psychiatric illnesses.

Since 2009 she has been recognized twice by peers as an Austin Top Doc in Psychiatry. She and her staff have also received recognition from patients in on-line surveys: as one of the Top 10 Doctors in Psychiatry, as a Compassionate Doctor, and as an On-Time Doctor.

About TMS Therapy

TMS Therapy or Transcranial Magnetic Stimulation is a breakthrough treatment for depression in which an MRI-strength magnetic creates an electrical current directed over the areas of the brain affected by depression. It is performed in our office under the guidance of Dr. Vaché. Results have been excellent: Two thirds of our patients have had significant improvement in their depression and over half have had complete remission. Side-effects are essentially nonexistent. The typical initial treatment course consists of at least 5 treatments per week over a 4-6 week period, for an average of 20-30 total treatments. Each treatment session lasts approximately 40 minutes.

Benefits of TMS Therapy

  • Non-invasive, meaning that it does not involve surgery. It does not require any anesthesia or sedation, as the patient remains awake and alert during the treatment
  • Non-systemic, meaning that it is not taken by mouth and does not circulate in the blood stream throughout the body. TMS does not have the risk of side effects commonly seen with medications such as weight gain, sexual dysfunction, tiredness, or nausea.

Who Can Transcranial Magnetic Stimulation Help? 

  • If antidepressants are not working to provide FULL relief of symptoms
  • If too many medication are causing side effects – limiting quality of life
    • Sexual dysfunction
    • Weight gain Dry mouth
    • Confused thinking
  • Pregnant or nursing females
  • Non-mental health medications that conflict with antidepressants

We are one of the few centers, www.austintmsclinic.com  in the US to have recorded and published our success rates with TMS Therapy since its introduction in 2008.

Marilyn Vaché, MD
TMS Clinic for Depression, Medical Director
3724 Jefferson Street, Austin, Texas 78731
512.458.1000
www.austintmsclinic.com

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