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The Exposome with Vanessa Hitch

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The Exposome with Vanessa Hitch

Why do some people become unwell from a given exposure whilst others carry on seemingly unaffected?

This is where understanding an individual's "exposome" comes into play. The exposome is the lifetime accumulation of toxic burden, spanning from conception to present day and takes into account your genetic and epigenetic makeup as well as your detoxification capabilities which handle this load.

Vanessa Hitch is a naturopath and has become an exposome detective uncovering the many sources of endocrine disruption and toxic burden in her patients.

In today's podcast, Vanessa discusses how she's identifying a client's toxic exposures, what the most common ones are and how she's minimising them. Vanessa will be teaching practitioners in greater-depth on this crucial topic in a forthcoming education event with The Australian Traditional Medicine Society (ATMS). 

Covered in this episode:

[00:30] Introducing Vanessa Hitch
[01:46] What is the "exposome?"
[05:24] The ripple effect of toxins and elimination
[07:04] The evolution of detoxification
[10:07] The everyday exposures that add up
[14:16] Exposome and Genes: a two-way street
[20:13] Where to begin?
[23:24] Gateway toxins
[24:59] Transgenerational impacts
[31:22] Misconceptions about the OCP
[34:19] Assessing chemical or toxin load
[39:54] Genomic analysis -worthwhile?
[43:37] Where to learn more about the exposome

Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook. Joining us on the line today is Vanessa Hitch, who has over 15 years experience as a naturopathic practitioner, international speaker and educator, and natural medicine formulator. Vanessa has also taught Clinical Nutrition at several complementary medicine colleges both in Australia and in New Zealand.  
As a clinician, Vanessa is experienced at getting to the heart of each person's health issues, connecting underlying imbalances, and restoring vitality by using individualised nutrition, herbal medicine, and many other natural medicine modalities. Vanessa has a passion for endocrine disruption and is driven by her curiosity for the differences in patient responses. Today, we're going to be talking about something that is quite alien to me, and that is, the “exposome”. Vanessa Hitch, welcome to FX Medicine. How are you? 
Vanessa: I'm really well, Andrew. Thank you for having me on your podcast and, yeah, thank you for the wonderful introduction. I'm really looking forward to chatting today about the exposome and, you know the toxin load that we and our clients carry around with us every day. And it's growing and growing, unfortunately. 
Andrew: Unfortunately. But, first off, what is the exposome? Because this was quite alien to me. 
Vanessa: Okay. So, the way we understand the exposome is that it is the sum total of our exposures from our environment. So, it's our external exposures, as opposed to maybe non-genetic types of bents or tendencies. So, it's really our external environmental exposures, from conception onwards, that may or may not create detoxification challenges.  
As opposed to, maybe, our genome, which is, really, the sum of our individual DNA which includes all of our, you know, gene mutations or gene variations like SNPs, which we call single nucleotide polymorphisms. 

So, it's really the external influence, our diet, our life style, the environmental input, if you will. That is the exposome. 
Andrew: So, forgive my pun here. But, to snip between, I couldn't help myself, to snip between birth and what might come from the mother i.e., that the load of the mother and the resultant effects on the foetus, where is the cutoff point here? 
Vanessa: Well, that's a really gray area. That is a very gray area. So, you know, if we were to look at some definitions of exposome, we might say conception onwards, and if we look at, you know, others, it might be birth onwards. But, really, it's very difficult to separate the exposome and the genome. I guess, there’s… and you know, it's quite a buzz, isn't it, to use naming this. There's some totality, if you will. We've got our microbiome as well.  
And so, the way I think about it, if we look at exposome. The way I think about it is, you know, we have two aspects to determine our health or disease state. The first one is the environmental input or our exposome, which is our air quality, our water, our lifestyle, our nutritional influences. So, do we have a nutritional excess or deficiency? What is our diet like? Even stresses and trauma, drugs, medicines, all those types of things.  
So, we've got all of this input but then, we've got to ask ourselves, "Well, how do we process all of this input? How do we excrete these wastes and toxins?" And that's probably where our genome comes into play a little bit more because, you know, it's our genes that really just encode for the production of cellular components, particularly enzymes. And I'm really interested in enzymes.  
So, I like to say the genetic conversation, or the genome conversation is really an enzyme conversation. Because the genome will, to some degree, not entirely, of course, but to some degree, govern our enzyme manufacture and function. And it's the enzymes that are going to process our wastes, our toxins, and detoxify. 

So, we've got our input, which is our exposome, and then we've got, "Well, how does the body output it? How does the body excrete all this?" And I think these are two really important areas. It's one thing for us to try and reduce our toxicity in our diet and lifestyle and environment, which is to reduce our exposome, that is critical, of course. But we also have to have a look at, "Well, how are we processing these toxins?" So, it is...and what's coming out? And I actually think what's coming out is just as important as what's being put in. 
Andrew: Is it the case that sometimes, not necessarily the toxin itself, but other toxins might have an impact in how other toxins are excreted? 
Vanessa: Yeah, absolutely. So, if for instance, you know, you mentioned it in your introduction that I really like treating endocrine disorders in my clinic, which is thyroid, hormonal, and adrenal. So, I see a lot of women, in my practice, who have, you know, estrogen metabolism issues. And so, if some of their cytochrome P450 enzymes, or even if their phase two detoxification enzymes are being used up with toxins… by trying to metabolise a toxin mode, then it's going to be less available for the effective detoxification of some of our estrogen metabolites. 

For instance… and that could be, you know, that could be even things as simple as inflammation. We know that inflammation actually up-regulates estradiol, we know that cortisone up-regulates estradiol, and we know that certain toxins can shift around the way some of these phase one CYP enzymes actually break down things like estrogen. 

So, that's probably a particular interest to me. But, yes. So, if you're having a lot of coffee and alcohol, for instance, there's going to be less available detoxification enzymes to break down really valuable processes of breakdowns for these toxins and chemicals that we experience in our everyday world. 
Andrew: When we're talking historically, just how much has this changed over the last one, two generations? I was reminded of something from...we're talking the industrial revolution with regard to lead levels, and it was just exploded. As soon as we had petrochemicals, lead was in our bodies to a far higher level than previously exposed. 

Even in, what is it now? Probably, is it 50 years since we've had the OCP? The oral contraceptive pill. So, now we've got women exposed to, you know, huge amounts of estrogens. 
Vanessa: Absolutely. You know, even a very low dose of contraceptive pill may have up to 20 times a woman's natural estrogen levels. And that's going to very clearly affect their estrogen metabolism. That's going to mean there's going to be a big burden placed on the body to try and effectively excrete that. And therefore, we won't be having that resource available to excrete some of the toxins we're exposed to. 
But from a historical perspective, Andrew, I always like to take a really big picture approach and have a look at the evolution of detoxification. And I use the analogy that, you know, if we evolved over, you know, 100,000 plus generations based on, you know, what kind of evidence you're looking at. And so, we're talking about 100,000 plus generations where we evolved to cope only with the level of toxin exposure of our pre-industrial ancestors for a millennia. 
And yet, in the last two, three, maybe four generations, we're seeing these unprecedented levels of toxic exposure from industry, and that includes heavy metals. So, for those people who will say, "Well, look, heavy metals have always been with us in the ground, you know, even 1,000 years ago." And that's absolutely true but they are being dug up at this huge exponential rate for uses in industrial and sometimes even domestic purposes. 

And so, on the one hand, we've got these, you know, incredible increase in the last few generations but what we lack is the evolutionary adaptivity to be able to cope with this level of toxicity. So, our detox ability has actually reduced. And, in fact, it's really interesting, in my clinic, I do, you know, genome profiling, and I've been really lucky now to do families where I've got, you know, a grandma, mum, and daughter, you know. So, three generations of families coming in. And, you know, every generation has more SNPs, more single nucleotide polymorphisms. And, you know, so genetically, from that perspective, we're actually getting more dysfunctional, particularly in the area of detoxification. 
Andrew: We think about these chemicals and we think about these molecules as, you know, vapors or pesticides, almost, dare I say the word, "giving it a liquid entity." One of the things I'm really learning about and fascinated isn't the right word, it's horrified, and that is these microplastics. What about them? 
Vanessa: Yeah. Yeah. So, this is a very real problem. And I would have to say that most of the clients coming into my clinic reached out to have a...we have to have a look at cleaning up their environment. So, this is their exposome. And part of that is going to be getting rid of plastics in their environment. Getting rid of, you know, all of those types of toxins and, you know, even mycotoxins can be such a huge problem causing blockages in detoxification, causing inflammation, causing all of these types of problems.  
And unfortunately, they seem to end up in the fatty tissue, in our fatty tissue. And so, you know, we see a lot of...well, I see a lot of women coming in with problems related to obesity, diabetes, not just their, you know, female hormones, but that's a huge, huge issue as well. And also, thyroid problems. So, the little old thyroid is really getting beaten up by some of these endocrine disrupting chemicals. 
And I probably would love to mention, Andrew, is that it's not just that PBAs and the PCBs and the pthalates, and all of those types of commonly known endocrine disruptive chemicals. But, endocrine disruptors include arsenic, cadmium, and lead, as you mentioned. And so, even the heavy metals can be endocrine disruptors. And it's a very real problem. 
Andrew: We're becoming familiar with the term nutrigenomics, it's only just settling in my brain, this one. And nutrients affect gene expression. Can we indeed change our reaction to pollutants? Or is it set in our genes, our constitution?  
Vanessa: Absolutely. Absolutely, it's not set. And I love that about epigenetics because it implies this plasticity. It implies that, you know, our genes are our tendency, not our destiny. And, in fact, I love the term nutrigenomics as well, which really is about how nutrition and, to some degree herbs, can affect genetic expressions for the health and wellbeing of our clients.  
And so, while there isn't, you know, a really big explosion in this kind of information coming out, information on nutrigenomics, information on epigenetics, information on, you know, methylation. One thing that I'm certain of, Andrew, is that we are only just at the beginning of this journey of understanding. Of the impact of our diet, lifestyle, and our exposome on our gene expression. 
And, look, there are much more learned people than I am, who are talking about maybe a 65%:35% sort of, ratio. That these are all hypothetical numbers where they're saying that perhaps it might be 30% to 35% our genes and maybe, you know, 65%, 70% our diet, lifestyle, stress, trauma, you know, even our emotions and our thoughts that are interacting and influencing.  
So, I think, in a way, that's really good news, isn't it? Because, no, it's not set in stone. Yes, we can do something about it, and it is just our tendency, it's not our destiny. We can really make a huge, huge difference and an impact. And I think that's something that has really sort of lightened the hearts of a lot of practitioners, knowing that that can actually make a really big difference rather than, "Oh, well. Your genes said that so, you know, goodbye. There's no point." 
Andrew: Now, this is, of course, personalised medicine. And you mentioned earlier that you are seeing more and more SNPs in subsequent generations. This is obviously a two-way street. the exposome is affecting gene expression and the gene expression is affecting the exposome. Have I got that right? 
Vanessa: You absolutely have. So, you know, as you mentioned, you might have a woman who gets pregnant, and at that time, she is exposed to a lot of, you know, stress and pollution. And so, what allelle of any type is she going to pass on to her child? Is it going to be a variant one or is it going to be a healthy or sort of wild-type one? And I guess I should probably explain myself a little bit better. 
If we think about it, that our DNA, as I mentioned earlier, is really just the instructions or the blueprint that we need to construct our cellular components, but our receptors as well and also our enzymes. So, if the gene sequence varies from the normal, healthy wild-type, as we call it, it's called a singular nucleotide polymorphism, which we call a SNP.  
And if there is that variant, we say gene mutation, I try not to use that term with my clients because it, you know, can make them feel like they're a mutant. And they're not because there's so many of us walking around with these variants. But, that means that the cellular components such as the enzyme won't be manufactured properly. It may have less than 100% functionality or it might even have more. So, this is particularly true for the genes that encode for the production of enzymes. And enzymes are really, really important when we talk about detoxification. Because all detoxification processes rely on enzymes. And so, we start to see that when there is this gene variation, we start to see a really big difference in the way people detoxify. 

So, I did a lot of genome profiling, not on everybody but, you know, there's a lot more people interested in it now. And we might find that they need more support, based on the results, we might find they need more support in the area of phase one detoxification. Perhaps, they have certain CYP enzymes that are, in fact, making it really difficult for them to break down some of the endocrine disrupting chemicals. Or they might find that some of these variations in their production of their CYP enzymes means that they are actually producing more harmful estrogens instead of beneficial estrogens when they break down estradiol.  
So, in those cases, I am always really wanting to focus on antioxidant support because any kind of dysfunction with phase one detoxification, I find, you know, I can't go wrong with really nice antioxidant support. But also, then I might need to add in natural medicines that are really specific for changing the metabolism of estradiol into more beneficial forms of estrogen metabolites.  
If, on the other hand, they may have come back and they may have a lot of gene variants or gene mutations in the area of, you know, their glutathionylation or glutathione conjugation of some of their toxins. In which case, I'll need to provide glutathione support or even the poor sulfation of toxins. So, there's so much that we need to have a look at.  
And the very popular gene variant that people talk about a lot is MTHFR. For me, MTHFR is the gene that encode for the production of the enzyme methyl-tetrahydrofolate reductase. And really, you know, that is part of the equation but certainly not the whole picture. But it does influence the methylation in their detoxification, in their phase two detoxification of certain endocrine-disrupting chemicals, certainly lots of heavy metals.  
And so, this is where personalised medicine comes into play. I certainly always look at, you know, a multi-system medicine approach. Where there are some things that we do for all our clients, which is clean up their diets, clean up their lifestyle, reduce their exposome as much as possible. And those things are always going to benefit everyone. But then we get into this really interesting area of personalising their medicine and providing really specific support in the area of detoxification that they need. And I really find that it works far better than, sort of, just a... 
Andrew: A protocol? 
Vanessa: Yeah, just a protocol. 
Andrew: I hate protocols. 
Vanessa: A single protocol that you tell them, with everybody. Yeah, absolutely. So, this is where it starts to get really exciting. But, as I said, Andrew, I really feel that we, and certainly, myself, we're only just at the beginning of our learning in this. And I think that, you know, what we know is five years from now, we'll look back and go, "Wow." 
Andrew: Yeah. If you've got such a load on our bodies, we've got thousands of… I think I read once, years ago, was it something like 40,000 chemicals since World War II? Is that right? 
Vanessa: Yeah. Well, I was just looking at some data that mentions, I think, 70,000? 
Andrew: 70, 000. These are new chemicals, these weren't here before. These are new things. Is that right? 
Vanessa: Yeah, that's right. They were never around in, you know, until about two, three generations. And, you know, some of them haven't even been registered for safety. So, it's a very real problem, I think. 
Andrew: So, when you've got these multitude of chemicals from all sorts of issues, from people heating up plastics. From people, you know, drinking out of their water bottle that's been sitting in the car for five days. From makeup, from, you know, foods in the environment, from, as you say, poor dietary choices.  
In fact, I remember Joe Pizzorno talking about even salt was a toxin, that it could affect our detoxification. So, there's this huge array of assaults on us. How do you go, "That's the one I'm going to pick." Do you focus first on getting them functioning and then saying, "Okay, I'll look down the track, we'll look at cleaning up your exposome." Or do you say, "We need to do the exposome first or else we're never going to get anywhere"? 
Vanessa: Yeah. I think, you know, we go to that concept of the bucket theory of toxicity where it might only be "Drip. Drip," Then, you know. So, those of us who've had a leaky roof, you know, one drip isn't a problem, two drips isn't a problem. But, it's drip, drip, drip, drip over time, over years. And sure enough, that bucket's going to get full.  
So, then, we have to ask ourselves, "Well, you know, how do we get the toxins out of the bucket? How big is the hole in the bucket? How can we get it out?" And so, for me, as a practitioner, we have to clean up the exposome. We absolutely have to do that. And, at the same time, support the detoxification. So, I don't do one before the other because, as you mentioned earlier, Andrew, that they're so connected it's really difficult to distinguish them. 
And I tend not to focus on one particular toxin or, you know, I focus on the person's total exposome, their total load, if you will. And so, for me, in my clinic, because I see a lot of women with thyroid issues, with hormonal issues, I'm looking at a lot of, you know, estrogen excess conditions.  
So, how do I know when we need to do detoxification and clean up? There's a few red flags. And one of them is, you know, women coming in with those estrogen dominant, sort of, conditions. You know, like endometriosis, fibrocystic breast problems, PMS, you know, weight gain, and things like that.  
I'm pretty clear now that almost everybody coming into my practice needs cleaning up and, at the very least, if I'm not encouraging their detoxification processes through a specific personalised medicine, I'm, at the very least, reducing their exposome. So looking at their personal products and their cleaning products. 
Looking, you know, women, particularly, have a much higher susceptibility, Andrew, because we have a much higher fat to muscle ratio and all of these endocrine-disrupting chemicals, they just love to sit and get stored in the fat. And also, we are the highest users of personal care products. So, it is estimated, now, that women are using up to about 15 personal care products a day. That's a lot of steps, you know. It's a lot of steps in that. 
Andrew: And then, you've got all of these other sources of endocrine disrupting chemicals, EDCs, from such a multitude of sources. It just becomes a minefield. 
Vanessa: And some of them are really sort of gateway toxins. You know, that… like triclosan and some of the phthalates that sort of… what they do is they allow the other chemicals to get in and get absorbed much better. 

But, you know, there is...I don't want to make out that it's a lost cause because there are also some fantastic, you know, organic, chemical-free products that we can choose. So, you know, women don't have to...I don't think they have to, you know, I'm a fan of not necessarily having to compromise everything but we need to make those choices. And I'm a big fan of, if 80% to 90% of our choices are really good if our everyday choices are not to use a chemical hairspray, use a natural one, you know, not…ought to use all organic makeup and chemical-free products. 
Then, you know, if we are exposed then a little bit, from time to time, then that's okay. If our detoxification processes are working well. 

So, it's not, I mean, it's very easy to get into the doom and gloom, isn't it, of it? And to just get completely overwhelmed by it. But, there are solutions out there and I think that's what I'm trying to achieve in practice. 
Andrew: Apart from the people that are canaries in the mine. Do you find that most people, of reasonable health, can have a lot of leeway in what they can handle as per the assault on their exposome? And therefore, they can, let's say, be a little bit bad or continue on as life as normal? I guess where I'm going with this is, how quickly do you think they can recover if they run into a situation? 
Vanessa: I guess I used to think that, Andrew. I, you know, you do hear those people that are, you know, 93 and still smoking and drinking. And I think one of the world's oldest woman died at 123, and she had a glass of champagne nearly every day of her life. 
Andrew: Good on her. 
Vanessa: I know, right? She used to say, "Everything in moderation including moderation," was a Frenchwoman, I can't recall her name. But, I used to believe that. I have to say that given the information that I'm looking at in the genome profiles of the mothers and children, as opposed to the grandmothers coming in, it's less and less so that they've got this enormous leeway.  
I think, even if you are healthy, that's fantastic, you should still go all organic, you should still, you know, reduce your, you know, purify your water. You should still really try and strive to, you know, to really reduce that exposome because it's not going away. And it will affect the endocrine function. 
Like, we know that the endocrine disrupting chemicals affect, you know, the insulin and obesity. We know that they affect both and female reproduction, we know that they affect the thyroid and also neurodevelopment and all of the neuroendocrine systems. And we also know, and this is probably the most important point, that these chemicals are causing epigenetic changes.  
So, that means that even if the person is, sort of, strong as an ox from a genetic perspective and, you know, doesn't look after themselves at all, their offspring will be significantly, you know, paying the price, if you will. And so, no, I'm a huge fan of cleaning up as much as possible.  
That being said, if 80% to 90% of the time we're great and then we go out and we have a, you know, a glass of wine that's not organic and it's not sulfite free, and, you know, all of that. Well, do you know, we also have to live and that's why part of what I'm looking at, my multisystem medicine approache is, part of that, yes, detoxification's absolutely critical. Yes, getting their nutrients corrected and their pH correct is critical. But also, improving their adaptive resilience.  
Because I think we need to future-proof ourselves from whatever life throws at us. We don't know what the exposome is going to be in a day, a year, or even, you know, up the road next week. We just don't know what we're going to be exposed to. All we can do is reduce it to the best of our knowledge and then improve our adaptive resilience, improve our detoxification, and hope for the best for us and our children. 
Andrew: So, block up as many holes in the bucket as you possibly can. I have to make a comment. When a friend and colleague was out here a Dr Lise Alschuler, she had these...it was like a swizzle stick that she waived around the red wine to absorb the sulfites and… to reduce the histamine response. 
Vanessa: There are, always, sort of, lotions, and portions, and workarounds to get around our sort of toxin exposure. And for me, in clinic, you know, and a dysfunctional histamine response is often tied to estrogen excess. So, for me, I have to go back to, "Okay, what is their estrogen metabolism doing? And why have they got way too much histamine? Why are they coming out with these types of effects?"  And often, you know, we see it associated with migraine pre-menstrually, and things like that. 

So, all of those red flags. And, you know, we have to ask ourselves, if we are using those types of, you know, cheeky workarounds, it could be that the person has an underlying susceptibility that needs to be addressed as well. 
Andrew: Yeah, that's actually a really salient point, you know. You're just really putting a Band-Aid on a broken leg, you're not fixing the broken leg. 
Vanessa: Yeah, that's it. That's it. And, you know, we do know, for example, alcohol...look, Andrew, I love a good pinot noir, don't get me wrong. However, we do know that alcohol does inhibit some of the COMT, which is, you know, the stage two detoxification processes that help detoxify estrogen.  
So, when we're looking at women with estrogen excess issues, we really have to have a look at, "Well, how much alcohol are they drinking? How much coffee are they drinking?" You know, "What are the factors that are really causing them to have this unhealthy estrogen metabolism? And what can we do to help it?"  
For example, we know that glutathione, N-acetyl cysteine, Milk Thistle, resveratrol, all of those beautiful natural medicines are really good at helping the body to detoxify some of the more harmful estrogen metabolites like the four hydroxy estrogens into the four methoxyestrone, which are relatively inert.  
So, yeah, you're absolutely right, Andrew. We can't just, sort of, give everyone a swizzle stick or Milk thistle and say, "Good luck. Don't worry about your exposome." We need to individualise it, we need to find out what's happening with our clients. And then, look at the underlying cause. "Why? Why is there so much unhealthy estrogen metabolism? Yeah, and endocrine disrupting chemicals is a really huge one. And also, the oral contraceptive pill, I'm really not a fan of the oral contraceptive pill. 
Andrew: Yeah. And, of course, I omitted a very potent drug in the OCP, just talking about estrogens. But what about progestogens and their issues with insulin resistance and stuff like that? 
Vanessa: Yeah. Yeah. So, that's interesting because, you know, you do get clients coming in and saying, "Oh, you don't need to worry because I'm on the mini pill, and it's progesterone only." And I always say to them, "Look, there's a really big difference between a synthetic progestin, which is what you're taking, which is associated, in fact, with high risk of anxiety, depression, heart risk, hair loss, breast cancer," you know, as well as what you outlined. Those synthetic progestin versus progesterone, natural progesterone. Which we know is calming, you know, reduces cardiovascular disease risk, reduces breast cancer risk, improves hair growth, those types of...and is actually a little bit thermogenic.  
So, yeah, so it's an education process, I think, of their hormonal health. And also, not to forget, the little old thyroid, which is very, very sensitive. I was just looking at some research recently, where they were looking at this total load, if you will, and how it can affect cellular T3, you know, cellular thyroid hormone levels. And so, they talking about things like stress, things like inflammation, things like, you know, aging, insulin-resistance. All of those factors will actually cause a low peripheral and cellular T3.  And even when the gland itself, before the gland itself is even affected. 

What we know about endocrine disrupting chemicals in terms of their effect on thyroid hormone production, we know that they have a disruptive effect TSH, T3, T4. They actually affect receptor sensitivity, they definitely affect the peripheral deidoidinases, which convert, you know, the thyroid hormone T4 thyroxin into T3. And so, I'm now having a huge focus with my thyroid clients on the endocrine disrupting chemicals, specifically, some of the research is that the polychlorinated biphenyls or the PCBs. 
Andrew: Absolutely, yes. 
Vanessa: And, yeah, and the PBDEs as well, are specifically known now, to disrupt thyroid hormone signaling. 

So, whenever I get a woman coming in with, you know, low temperature, even if she's got normal thyroid blood work. Well optimal/normal. You know, it could, in fact, be that she's got that chemical load that we need to get rid of. 
Andrew: Do you measure these chemicals? The dioxin-like compounds and things like that? Like, you know, we see the measures in fish oil, for instance, PCDEs as a maximum amount. So, therefore, it cannot go over that amount or else it's tainted, it won't be put onto the market. Which I think is a fantastic thing because we sure as heck don't get that from fish. But, you know, is it something that you can measure readily? Or is it something that you really need like a research facility to be able to access the machinery to the instrumentation to measure? 
Vanessa: Yes. I have to say, Andrew, that there needs to be more in this area. This is a really big issue for a lot of practitioners is, measuring in their clinic, just how toxic their clients are. 

So, my first line is, you know, a very comprehensive questionnaire on their exposome, what they've been exposed to. But you can't, you know, think of every scenario, you know. They’ll always say, in that questionnaire, "Please outline if you have worked for five years spraying strawberries with pesticides," for example. You can't account for all of that. That's why I think that some of the work of the people like Nicole Bijlsma, with the Building Biology is so really important. 

Andrew: Oh yeah. 

Vanessa: But, yeah, absolutely. In my practice, I use a questionnaire.  
You can get… there are a lot of fantastic functional pathology companies out there, so you can get an environmental pollutants panel. And that's something that, you know, a business could be even look into. 

Andrew: Great. 

Vanessa: Yeah, I will often look at their estrogen metabolism so I would use the, you know, the dried urine testing of comprehensive hormones. Because I really like that because it gives me all of the different types of hormones and their cortisol. It's a really good look at their endocrine function on the whole.  
It also tells me how they're methylating, what their two hydroxy estrogen metabolism is like, which is the beneficial form of estrogen. And what their four hydroxy estrogen metabolism is like in their sixteen. So that we can know that they've got the right ratio of estrogen metabolites. 
Now, why I'm so interested in the four hydroxy estrogen metabolites, because they are known to be produced from endocrine disrupting chemicals, from these toxins. And they are, you know, very much chemical carcinogens. And they form these substances, it's called depurinating adducts which are biomarkers of cancer. And so, you know, the four hydroxy estrogen metabolites are one I pay a lot of attention to, and if that comes up in my testing, then I am going to really have to work on their estrogen metabolism. 

Because most of these endocrine disrupting chemicals, not all of them, obviously, but most of them, that's the activity that they have is that they increase these, you know, harmful estrogens that have a very highly proliferative effect. So, I measure that. And then, I also… because it's very hard to measure toxins and there's a lot of controversy., you know. People say, "Well, what about, you know, blood testing for heavy metals?" And I think, "Well, you know, that's only going to give us short term because the body will adapt and try and push the, you know, the toxins where it can sort of, you know, cope with them.” So you know, a lot of our endocrine disrupting chemicals, it pushes them into the fat.  Lead, will push into the bone, you know. Mercury loves the fatty tissue as well. So, we're really kind of at a loss of how to effectively measure these toxins.  
So, one of the things that I do have a quick look at often, is their porphyrin levels. Why? Because urinary porphyrins are oxidised intermediate metabolites of heme biosynthesis and they can serve as biomarkers for disorders in heme production. But, more than that, what we see is abnormal porphyrin profiles when there is a specific toxic or group of toxic chemicals or toxic metals in the body. 
So, for example, if you have a high, sort of, coproporphyrin 3, you can expect that that person has really high lead, and if they have a high, you know, uroporphyrin, I can expect that that person has high dioxin levels and, you know, some other, sort of chemical levels. And I think it's a sort of a nice sort of umbrella first line test to do for people when you're wondering about their toxin load. And if it comes up that they've got high porphyrins, you can bet that they're really highly toxic, not only in metals but also chemicals, pesticides, and other toxins. And then, I might go to, you know, a more in-depth profile, like an environmental pollutants panel because these functional tests, as you know, Andrew, they're not cheap. So, that's where I sort of sit in terms of testing for this.  
But I will admit that, you know, it's an area that we really need to improve on. I mean, even hair tissue mineral analysis, there's question marks around that. And I will often do a couple of tests at the same time just to sort of back up a hair tissue mineral analysis, for example.  
Andrew: And do you automatically do a genomic analysis as well? And tie that in with the potential for an issue and tied in with, you know, a more biochemical issue, so you can actually see, "Yes, there's an issue with that SNP or that, you know, part of the genetic framework that's being affected by the exposome?” 
Vanessa: If I can, absolutely. One thing I've noticed about my clients who are willing to invest in their own genome profile is that it makes my prescribing far more effective. And, you know, generally speaking, not only do I get better results but they're really happy because they're feeling fantastic and they feel like they've uncovered, you know, a lot of a-ha moments. 
So, when we go through that, I might say, "So, are you sensitive to this?" And they go, "Yes. Oh, my gosh, I've always wondered why that was happening to me." And so, I think it's a bit of a revelation for them and it certainly, certainly Andrew, it has really changed the way I prescribe. Definitely. 

Andrew: Yeah. 
Vanessa: Because I can apply individualised support to different aspects, not only... I know, in this conversation, we're looking at detoxification, but certainly, you know, many, many other factors. Because the genome profile isn't just going to show us detoxification. It's going to show us, you know, neurotransmitter, you know, profile. It's going to show us methylation profile. It's going to show us, you know, what genes may be affecting even our microbiome. And also, our antioxidant status, which is something that I'm really big on right now is improving people's antioxidants status. Because when we start doing these genome profiles, we see, "Oh, my goodness. Their detoxification capacity, tendency, is so reduced." And then, you look at the gene variance for superoxide dismutase, glutathione, catalase, and they're really reduced as well. And I'm, you know, it's really a recipe for the perfect storm, isn't it? 
Andrew: Yeah. I might add the caveat, though, that any sort of genetic profiling with SNPs should be done by a responsibly-trained practitioner, and I would warn against people just doing the test for themselves because they might do their own ‘Dr Google’ and come out with something which might frighten them.  But, as you say, this is the potential. It's how that reacts with your environment, your exposome, and indeed, your constitution, that says, "This is how I handle that gene. This is how that gene expresses… you know, or can't express certain enzymes." 
Vanessa: That's exactly right, Andrew. You know, it's really interesting that you can get people that live a really, really wonderful life and they can have their genome profile if you didn't meet them and hear their signs and symptoms. And their genome profiles is, you know, it doesn't look too great, if I can be so blunt.  
But then, you meet them and they, you know, they've been a yoga instructor and eaten organic food for the last 15 years, and lots of sort of green, leafy organic vegetables or they grow their own food, and they meditate, and they, you know, do spa and sauna and, you know, detoxification programs. And they come in and they don't have the same symptoms… 
Andrew: No, they're glowing, yeah. 
Vanessa: … that you might expect. So, that's why you're absolutely right because, you know, it's not just what our profile says, our genome profile says. It's what we do with it that counts. 
Andrew: Can I just ask, as a last question, further information. Where can people learn more about the exposome? 
Vanessa: Oh, gosh. That's a really interesting question. You know, there are some really good seminars and webinars out there, on the exposome. I've already mentioned, you know, cleaning up the, you know, the home. And I love the work of Nicole Biljsma, that book is amazing and fantastic. And if you ever get it, the opportunity to do a podcast or listen to a podcast or do one of her seminars and webinars, that's fantastic. 
And, I guess, there's more information coming to light every day. So, I think it's just keeping our ears and eyes out. I do, you know, look at certain websites. You know, The Environmental Working Group, I know it's an American website, but they tend to have a lot of really good information about toxins. But also the Building Biology website is absolutely fantastic. 
And that sort of expands out some of what we've talked about today because we've really only talked about endocrine disrupting chemicals and how they can affect the estrogen metabolism and the endocrine system. However, you know, the Building Biology site, they're talking about, you know, Wi-Fi, and mould, and mycotoxins and, you know, it's a huge, huge area that's getting bigger and bigger every day. I think we're just at the beginning of our understanding of that as well. 

There's another really great paper on The Endocrine Society, Second Scientific Statement on Endocrine Disrupting Chemicals, and that was published in 2015. And that's got a huge amount of information on it. In terms of what to look for, what are they doing, and their impact. It's not going to help us in terms of what natural medicines do we use to help that. But certainly, if you want to know the impact of endocrine disrupting chemicals, that paper is a really nice one. 
Andrew: Great. We'll put that up on the FX Medicine website if we can. 
Vanessa: Great. 
Andrew: For our listeners. So, Vanessa, I understand you're talking about this subject, or at least, in part of it at an ATMS event. Is that correct? 
Vanessa: Yeah, that's correct, Andrew. So, on Sunday the 27th of May, I'll be doing a day-long seminar entitled Cellular Detox and our Exposome and How We Can Manage Modern Toxic Exposure. And that will be in Sydney. And for more details, you can go to the ATMS website
Andrew: Vanessa, thank you so much for taking us through the exposome today. Not the least of which you've opened me up to it's not just the burden of now or where we lived the last few years, but the total burden that we've to deal with our life and how that's responding to what we've been given from our parents. It's really enlightening what you've taken us through today. 

Thank you so much for joining us on FX Medicine. 
Vanessa: Oh, Thank you so much, Andrew. It's been wonderful to chat with you today. 
Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.

Additional Resources

Vanessa Hitch
EVENTS: Australian Traditional Medicine Society
Nicole Bijlsma: Building Biology
Environmental Working Group

Research explored in this podcast

Gore AC, Chappell VA, Fenton SE et al. EDC-2: The Endocrine Society's Second Scientific Statement on Endocrine-Disrupting Chemicals. Endocr Rev. 2015 Dec;36(6):E1-E150


The information provided on FX Medicine is for educational and informational purposes only. The information provided on this site is not, nor is it intended to be, a substitute for professional advice or care. Please seek the advice of a qualified health care professional in the event something you have read here raises questions or concerns regarding your health.



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