Endocrine Disrupting Chemicals and COVID-19

Linda S. Birnbaum, Ph.D., D.A.B.T., A.T.S., is the former Director of the National Institute of Environmental Health Sciences (NIEHS) of the National Institutes of Health, and the National Toxicology Program (NTP). As a retiree, she was granted scientist emeritus status. As a board-certified toxicologist, Birnbaum served as a federal scientist for 40 years. Prior to her appointment as NIEHS and NTP Director in 2009, she spent 19 years at the U.S. Environmental Protection Agency (EPA), where she directed the largest division focusing on environmental health research.

Birnbaum has received many awards and recognitions. In 2016, she was awarded the North Carolina Award in Science. She was elected to the Institute of Medicine of the National Academies, one of the highest honors in the fields of medicine and health. She was also elected to the Collegium Ramazzini, an independent, international academy comprised of internationally renowned experts in the fields of occupational and environmental health and received an honorary Doctor of Science from the University of Rochester and a Distinguished Alumna Award from the University of Illinois. She has also received Honorary Doctorates from Ben-Gurion University, Israel, Amity University, India, Tulane University, and the University of Rhode Island; the Surgeon General's Medallion 2014; and 14 Scientific and Technological Achievement Awards, which reflect the recommendations of EPA's external Science Advisory Board, for specific publications.

Birnbaum is an active member of the scientific community. She was vice president of the International Union of Toxicology, the umbrella organization for toxicology societies in more than 50 countries, and former president of the Society of Toxicology, the largest professional organization of toxicologists in the world. She is the author of more than 800 peer-reviewed publications, book chapters, and reports. Birnbaum's own research focuses on the pharmacokinetic behavior of environmental chemicals, mechanisms of action of toxicants including endocrine disruption, and linking of real-world exposures to health effects. She is an adjunct professor in the Gillings School of Global Public Health, the Curriculum in Toxicology, and the Department of Environmental Sciences and Engineering at the University of North Carolina at Chapel Hill, as well as in the Integrated Toxicology and Environmental Health Program at Duke University where she is also a Scholar in Residence.

A native of New Jersey, Birnbaum received her M.S. and Ph.D. in microbiology from the University of Illinois at Urbana-Champaign.

Aly Cohen MD, FACR, FABoIM, is a board certified rheumatologist and integrative medicine specialist, and founder of Integrative Rheumatology Associates. She is a Jones/Lovell Fellow from Andrew Weil Center for Integrative Medicine, and is on faculty of the Academy of Integrative Health and Medicine (AIHM), where she created and oversees the environmental health curricula for the program. She received her BA from the university of Pennsylvania and her medical degree from Hahnemann-MCP School of Medicine (currently Drexel University). She completed her residency in internal medicine at Beth Israel Hospital, NY and her fellowship training in rheumatology at Montefiore-Albert Einstein Medical Center in the Bronx, NY.

In 2015, she created TheSmartHuman.com to share environmental health and prevention information with the public. She lectures nationally on 'environmental health' topics for elementary/high schools, colleges/universities, medical schools, and physician training programs. In 2015 she received the NJ Healthcare Heroes Award in Education for The Smart Human educational platform and she was awarded the 2016 Burton L. Eichler Award for humanitarianism.

In 2017 she co-edited the textbook, “Integrative Environmental Medicine”, Oxford University Press, along with Dr. Frederick vom Saal. Their consumer book, "Non-Toxic: Guide to Living Healthy in a Chemical World", will be released in 2020. Her TED talk, "How to Protect Your Kids from Toxic Chemicals" can be found on YouTube, and you can follow her health tips and recommendations on Facebook: The Smart Human, Twitter and Instagram: @thesmarthuman and read her blog and posts at TheSmartHuman.com!

John Peterson “Pete” Myers, PhD, is founder and Chief Scientist of Environmental Health Sciences, a not-for-profit organization that promotes public understanding of advances in scientific research on links between the environment, including climate, and human health (www.EnvironmentalHealthNews.org).

For a dozen years beginning in 1990, Dr. Myers served as Director of the W. Alton Jones Foundation in Charlottesville, Virginia. Along with co-authors Dr. Theo Colborn and Dianne Dumanoski, Myers wrote “Our Stolen Future,” a book (1996) that explores the scientific basis of concern for how contamination threatens fetal development. Vice-President Al Gore wrote the foreword.

Dr. Myers is actively involved in primary research on the impacts of endocrine disruption on human health. He is on the boards of the Science Communication Network and the Jenifer Altman Foundation. He has also served as board chair of the National Environmental Trust and the H. John Heinz Center for Science, Economics and the Environment. He is an Adjunct Professor of Chemistry at Carnegie Mellon University.

Over the last few years he has received 3 major national and international awards: the first “Champion of Environmental Health Research” award from the U.S. National Institutes of Health (of the 11 awardees in addition to Myers, 3 others were the current and former directors of the National Institute of Environmental Health Sciences); the Laureate Award for Outstanding Public Service from The Endocrine Society (the world’s largest association of medical and research professionals specializing in endocrinology); and the Distinguished Service Award from the Sierra Club.

Myers lives just outside White Hall, Virginia. As he was growing up he lived near Baltimore and in Mexico, Nicaragua, Colombia, Uruguay and Paraguay. Dr. Myers holds a doctorate in the biological sciences from the University of California, Berkeley and a BA from Reed College.

This webinar is one in a monthly series sponsored by the Collaborative on Health and the Environment’s EDC Strategies Partnership. The CHE EDC Strategies Partnership is chaired by Sharyle Patton (Commonweal Biomonitoring Resource Center), Jerry Heindel (Commonweal HEEDS, Healthy Environment and Endocrine Disruptor Strategies), and Genon Jensen (HEAL) and coordinated by Hannah Donart (Collaborative on Health and the Environment, a Commonweal program). To see a full list of past calls and webinars related to EDCs and listen to or view recordings, please visit our partnership page. 

This webinar was moderated by Jerry Heindel, PhD, founder and director of Commonweal's Healthy Environment and Endocrine Disruptor Strategies (HEEDS). 

Q&A we did not have time for during the live webinar:

Q - How can patients handle interactions with physicians who do not “believe” that the chemical exposure component has a real effect on overall health. Instead, they chose to treat a patient as crazy and want to put them on psychiatric drugs. This parlays into how society treats these patients, as well.

A - I totally agree, Michele, which is why I got into integrative medicine! I have more time to see patients and discuss their issues at length… Western medicine isn’t set up at this time to listen and truly get to the upstream causes of illness. It’s treatment based. I suggest you find a doctor that supports your needs… And if you have trouble finding an integrative medicine practitioner, go to Andrew Weil Center for integrative medicine and look for a practicing physician either by specialty or by location on their doctor finder link! You’ll be able to find a graduate from the program who may be able to help you! I am certainly able to see you as well… alycohenMD.com. Good luck!! 

Q - How can we start change within networks and hospital systems and hospitals are the most loaded with EDCs? How can we support and push for cleaner hospitals and offices? What resources or movements do you support?

A - It’s very difficult… I’ve lectured over 30 different hospital systems, speaking to many Neonatal intensive care unit (NICU) directors about changing out tubing for respiratory and intravenous fluids for DEHP-free and BPA-free materials…there was very little interest. I believe the change has to come from high-level physicians and medical directors talking to the administration. In addition, Healthcare Without Harm https://noharm.org/ is a wonderful organization that shares materials and support for these change-outs.

Q - Dr. Cohen, are you seeing any research on sulforaphane reducing IL-6? 

A - I did a search on pubmed.org… Many great articles on the anti-inflammatory effects of sulfurophane! https://pubmed.ncbi.nlm.nih.gov/?term=Sulfurophane+and+IL-6

Q - How does PNIS differ from HLH?

A - ... They both basically represent immune system’s that are out of control and not functioning properly… Very similar to COVID-19 during stage 3 with Cytokine storm...I can’t give you the specifics on how they differ because there are several types of HLH as well.

Q - Are patients with MGUS and high IGM protein more susceptible to COVID?

A -I have not seen an increased risk but new data is coming out every single day…

Q - Is taking 1-3 grams of Ester C a day and overall good health practice, along with a healthy diet of course? 

A -  I can’t attest to this brand of vitamin C… but Lipophilic ascorbic acid (vitamin C) can absorb more efficiently and there are better brands than Ester-C that do not have any added sugars, coloring and other synthetic food additives and are third party tested for quality and quantity of nutrients.

Q - Are male (testosterone) related comorbities with other underlying conditions more represented in severely ill COVID patients than those patients with only male (testosterone) related comorbidities?

A- I don’t believe this has been teased out yet…I follow closely Journal of American medical Association and New England Journal of Medicine for the most up-to-date information on COVID-19… You can certainly search pubmed.org for new medical publications. 

Q - Are male (testosterone) related comorbities with other underlying conditions more represented in severely ill COVID patients than those patients with only male (testosterone) related comorbidities?

A - I don’t believe this has been teased out yet…I follow the Journal of American Medical Association and New England Journal of Medicine closely for the most up-to-date information on COVID-19… You can certainly search pubmed.org for new medical publications. 

Q - How do you suggest we clinicians deliver the message of the association between increased morbidity /mortality by SARS-CoV-2 and environmental exposures (particularly endocrine disruptors)/climate change? It seems that this is a critical time to have this conversation with families, communities and stakeholders.

A - I agree… There’s a lot to absorb at once right now… Most people are just trying to survive! We all feel much more vulnerable about the relationship between COVID-19 and climate change… As there will be increased risk for zoonotic infections as temperatures rise globally.

Q - Aside from the elderly, the biggest risk demographics for M&M are: 1) people of color; 2) obesity; 3) metabolic syndrome. The one item that ties these three together is processed food, working through 3 mechanisms. 1) ACE2 increases with insulin resistance; 2) hyperglycemia from diabetes increases ACE2 opening for RNA viral injection; and 3) lack of soluble fiber and reduction of butyrate leading to increased inflammation. In addition, the countries with the highest processed food consumption have the highest COVID rates. Would someone address processed food as an endocrine disruptor? 

A - Yes, all very important factors…processed foods are also consumed in poorer communities where air pollution is of concern, perhaps drinking water is unclean, people are working several jobs and can’t afford to eat well and exercise... and pharmaceuticals, with all of their side effects are pushed onto patients and preventive health services are not available. Definitely difficult to tease out...but no question processed foods are a key target to reducing death from Covid.

Q - Is there any correlation with COVD incidence and/or death in areas with existing areas with identified high burdens of environmental exposures?

A - Great question. I believe we’re gonna find out more about locations of environmental exposures and higher risk for hospitalization and death … Right now we know that air pollution is certainly correlated with increased risk of not only contracting  COVID-19, but also increased morbidity and mortality.(Harvard Chan School of public health). I believe there will also be a correlation at some point in the future between drinking water contamination and risk for Covid complications.

Q - For Dr Cohen: Can you comment on the higher incidence of COVID19 hospitalizations and deaths in men vs women, particularly since women have higher incidences of immune diseases, which seems counter-intuitive.

 A - Yes, this was quite surprising amongst rheumatologists worldwide… It turns out that  having a rheumatologic disease does not necessarily worsen risk for mortality… However contracting the virus may be elevated with use of 10 mg or more of prednisone daily. 

Q - As I mentioned in the talk, male androgens may predispose to viral entry into lung cells and increased replication of the virus… This will definitely need to be researched as we move forward.

Q - COVID-19 has further highlighted the significant health disparities and inequalities across low resource/access populations especially black americans. Dr. Birmbaum touched on some gender differences, how about impacts or effects across race/ethnicity. Does some of the data presented break down across race/ethnicity or is the research just too limited?

A - RESEARCH IS VERY LIMITED.  MANY DISADVANTAGEDCOMMUNITIESHAVE HIGHER EXPOSURE TO ENVIRONMENTAL CHEMICALS WHICH INCREASE THEIR RISK OF OBESITY, DIABETES, IMMUNE SUPPRESSION, ETC.

Q - What is the pathway to get affordable clinical laboratory testing for endocrine disruptors: bisphenols, phthalates, perfluorinates, pesticides, etc. How can we get high throughput time-of-flight mass spec testing available for clinical use? Who is doing the best research on this?

A - THE TESTING OF EDCs IS NOT SOMETHING DONE ROUTINELY N CLINICAL LABS.  MAINLY RESEARCH LABS OR PLACES SUCH AS THE CDC OR SOME STATE LABS.    A GOOD CONTACT RE TESTING OF EDCS AND CLINICAL LABS COULD BE DR ROY GERONA AT UNIVER. CALIFORNIA AT SAN FRANCISCO.

Q - Lots of studies are show EDCs as risk factors for fibroids & endometriosis, how do we get doctors to inform patients of these potential risks ie for chemical food additives, past DES use. there are many journal papers on it but doctors don’t tell patients? They keep saying it's unknown why it may occur.

A - THIS IS A HUGE FRUSTRATION.  THE AMERICAN CONGRESS OF OBSTETRICS AND GYNECOLOGY HAVE BEEN AMONG THE MOST ADVANCED MEDICAL GROUP, ALONG WITH THE AMERICAN PEDIATRICS GROUP, TO RECOGNIZE AND TALK ABOUT EDCS.  HOWEVER, THAT DOES NOT MEAN THAT ALL OF THEIR DOCTORS ARE INFORMED.  AND MOST OF THE OTHER MEDICAL SPECIALITIES PAY NO ATTENTION TO ENVIRONMENTAL EXPOSURES OTHER THAN SMOKING, SUGAR, ETC.