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Case Taking for Environmental Toxin Exposure with Nicole Bijlsma

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Case Taking for Environmental Toxin Exposure with Nicole Bijlsma

How do we identify when environmental toxins such as mould, allergens, and pesticides are contributing to our patient's ongoing health issues?

In this episode Dr Michelle Woolhouse is joined by building biologist and former naturopath Nicole Bijlsma, who emphasizes the importance of taking a comprehensive environmental exposure history can be for our patients. 

Nicole discusses how to identify patients who are highly sensitive to environmental toxins and introduces us to her handy acronym, “PHOLD,” which covers all the different areas that can easily be overlooked when discussing environmental exposures during our consults.

Covered in this episode

[00:09] Welcoming Nicole Bijlsma
[01:00] The harmful effects of pesticides
[04:55] Taking a comprehensive environmental history in consults using the “PHOLD” acronym
[07:56] P: Place history
[10:24] H: Hobbies
[11:54] Plastics
[13:53] O: Occupations with increased toxin exposure
[14:24] L: Lifestyle factors 
[24:48] D: Diet, Drugs & Dental History
[30:43] Conditions associated to environmental toxins
[33:17] Identifying patients with sensitivities 
[36:15] Examination signs 
[37:40] Calling in the experts
[39:48] Helping patients reduce the toxic load
[43:15] Thanking Nicole and final remarks

Michelle: Hi, and welcome to FX Medicine, where we bring you the latest in evidence-based, integrative, functional, and complementary medicine. I'm Dr Michelle Woolhouse, an integrative GP, and joining us today is Nicole Bijlsma

Many of us will know Nicole because she's been a guest several times with us on FX Medicine. Nicole is a former naturopath and acupuncturist with 15 years of clinical experience who changed her career path to become a building biologist after noticing a strong correlation with many of her patients' illnesses and the health hazards found in their home. Nicole is also the author of the bestselling book Healthy Home, Healthy Family, and is currently completing her Ph.D. 

Hi, Nicole. Thanks for joining us.

Nicole: Thank you for having me.

Michelle: So I just wanted to start off the conversation with a little bit of background in terms of the importance of environmental medicine, which I know is your super passion. 

So way back in 1962, a woman called Rachel Carson, who was a marine biologist, wrote a book called Silent Spring. Now, this book had the most profound influence in the world of science, but really arguably not enough impact in the world of medicine. 

So Rachel witnessed dramatic changes in the reproductive abilities and abnormalities in multiple species, including birds and amphibians, and she was one of the first and most instrumental people warning about the long-term consequences for the loss of wildlife populations because of pesticides and herbicides. Environmental medicine is so real, it is happening, it's been happening for a long time, it's accumulative, and it is often not discussed enough. 

So let's start with looking at the best way to take an environmental history. So, I mean, you're just such an expert in this field. Why is it important that we take an environmental history?

Nicole: Well, it's so important because most chemicals, many of the chemicals are associated with almost every chronic illness that you'll see in your clinical practice. And Rachel Carson is a great example because, as a result of her work, the EPA, Environmental Protection Agency, was formed in the U.S. So it had huge ramifications in a very positive way. 

But the interesting thing was her research was targeted at pesticides, and without doubt, in my research and published research, the chemical that comes up time and time again with almost every chronic disease is pesticides. Neurodevelopmental disorders like attention deficit hyperactivity disorder, autism, and right up to the other end, neurodegenerative disorders like Alzheimer's and Parkinson's disease. I mean, there's clusters of Parkinson's in farmers, I don't think that's a coincidence. 

Pesticides, without doubt, are my number one biggest toxicant because they're associated across the board with so many chronic illnesses. And I think part of the reason is because many of them are antibacterial, which means they're anti-human. A lot of these pesticides are used as preservatives in women's personal care products and in foods because they kill bacteria. And of course, as we know, our gut microbiome, our skin microbiome, our microbiome is such an important part of what it means to be healthy. And the quickest way to kill that off is to be exposed to pesticides as preservatives in personal care, as pesticides in food, which, of course, is where most of the toxicants are coming from, etc. 

So pesticides are my biggest one, and there's so much data on this and its ramifications on human health, etc. And the fact that many of these, the organochlorines, organophosphates, are lipophilic, they're being passed through the placenta and through the breast milk.

Michelle: And they also store within the liver, don't they? I mean, they really upset our ability to detoxify. So even if we take the gut biome out of it, it's our liver detoxification capacity that just doesn't seem to have enough...it doesn't have the ability to detoxify these chemicals.

Nicole: Yes, that's right. It has other downstream effects on the capacity to detox other chemicals. And I think a big reason this is is because they're antibacterial, and we've now realised our bacteria in our gut, on our skin, in our lungs actually are probably more effective at detoxifying chemicals than even the liver. We have over 850 bacteria that we know can metabolise chemicals, and this is probably far greater when we look at the microbiome across the entire body than even the liver at detoxifying chemicals.

Michelle: So where do we start? How do we approach this? If we are thinking about practitioners, how do we broach this with people?

Nicole: Well, taking a history, that history is the most important, and this is a question I asked when I developed that qualitative research and interviewed the top 17 environmental doctors in Australia and New Zealand and asked them, "How do you help patients with chemical sensitivities and chemical exposures? What's the best test?" I just wanted to know, which test by which lab, which one is it? And in the end, they couldn't agree on anything except one, and that is that the environmental exposure history is the most important clinical tool that a clinician has. And none of them were trained how to do it. And I interviewed the top occupational environmental physicians and integrative clinicians, and they all agreed that they had to create their own environmental exposure history because they were not trained in their undergraduate or postgraduate courses to do this.

So the place to start is with the grandmother. That's where our preconception care starts, with your grandmother. Tell me about where she was born, what she was exposed to, what was going on in her life at the time. And then you look on Google Maps what proximity, is it near military bases, is it near farms, for example, and you look at the exposure zones of what's close by. 

Certainly, your mother's history, because we know a lot of lead is being passed into children in the placenta from the mother to the child. So they can be born with all these toxic metal loads and have no chance from the time they're born. So taking a history of the grandmother, the mother, and of course, the child itself and where they've grown up is important. Gone are the days, when I did naturopathy, we said start preconception care six months before you want to try have a kid. Now, we know it starts with the grandparents.

Michelle: Ouch. I'm thinking about my grandmother's health, and that's a little bit scary. But asking about things like whether your parents renovated their house, what age the house was when they renovated? Where did they get their food supply from? Did they eat organic foods? These kind of questions, how close did they live to a freeway, particularly back, prior to the '70s, we had lead. When was lead in our petrol, until 1982 or something, was it?

Nicole: Yes, that's right.

Michelle: Yeah. So we had...if you were living by a major road, you had lead fumes just through the cars. And these are the kind of questions that we can kind of dig down into. And of course, there's things like your dental exposure through mercury and, I guess, fish. I mean, if you've got grandparents that are Norwegian or Swedish, I mean, they're eating fish three times a day.

Nicole: Yes.

Michelle: And these are the kind of questions that we can start to have a conversation about.

Nicole: Definitely. And I use a mnemonic PHOLD, P-H-O-L-D, to the power of three. So P is place history.

Michelle: Yeah.

Nicole: So where were you born? Where did you grow up? What was the house like? Were there any signs of visible mould or damp, musty odours? Because we know they're important markers for water-damaged buildings and, therefore, asthma, allergies, and fatiguing syndromes. And proximity to all those things you mentioned. Traffic-related air pollution is a big one for respiratory and cardiovascular disorders. A significant proportion of cardiovascular disorder is due to toxic metals like lead, for example. 

And of course, your house. The houses you lived in. You mentioned lead. If the house was built prior to 1986, then, of course, lead and asbestos could be issues if you renovated. Of course, if they're not disturbed, then they're not considered to be a risk. So prior to 1996, certainly 1965, that's when they legislated from 50% lead content to 1%, and then they dropped it in '97 to 0.1%. 
So the big problem now, of course, is we have new brass taps. Most of the brass taps in houses in the last 10 years have lead valves and faucets, in their faucets, the taps.

Michelle: Oh, what?

Nicole: So the government announced three months ago $2 billion into replacing the brass taps, because they're loaded with up to 6% lead content. And you could have a water filter, but if it goes through a brass tap, then it could be contaminated with lead. The children's hospital in Perth was recently, only about four years ago, had high levels of lead in their water in their new children's hospital because of the brass fittings in the taps.

Michelle: And I know they had a big issue with lead in water tanks at primary schools.

Nicole: Oh, yeah, that's still a big problem because of lead flashing, so you've got all the water on the roofs, if you've got lead flashing, which, of course, most of it was up until about the '80s, then you just assume that it's going to have some degree of lead. 

Also, the PVC downpipes. PVC or polyvinyl chloride is common pipes we use for sewerage but also downpipes between the roof catchment area and the tanks. They use lead stabilisers within the plastic. So you've got lead exposure. So that's why, in my book, I really talk about the different sources of your water and what water filters you should consider to make sure you're not exposed to those.

Michelle: So we're going to talk about some really simple things towards the end, but even just staying with this environmental history taking, because there's just so many...I mean, even just the conversation we've just had, but... So go back to your PHOLD.

Nicole: H is for hobbies. People often have hobbies that can really expose them to toxicants, heavy metals. Painting, lead lighting, fishing, all of those things, and there are many, hairdressing from home, all that stuff that could expose them to high levels of toxicants. 

Gardening, for example. Many of my patients with chronic inflammatory response from mould get better, and suddenly, they start mulching, and now they set their health back two months because of using mushroom mulch, which they're allergic to. So, and pesticides. These, again, pesticides are my biggest concern in terms of chemicals in the house and, of course, outside. And I'm always amazed, not anymore, but the amount of people who have organic food, and go to naturopaths, and are very health conscious, but they live within two kms of a golf course, and now they have high levels of pesticides in their blood. It's very common. And contacting them and saying, "Can I have the safety data sheet for the chemicals you're using?" because they're often spraying them in the middle of the night when everyone's in bed. And I don't think it's a coincidence, and I don't mean to be the bearer of bad news, but golf superintendents and turf specialists have double the incidence of non-Hodgkin's lymphoma.

Michelle: These are all the things that we really need to take a look at and keep asking questions, because it's not only just these heavy metals and pesticides. But let's talk about plastics. I know that's a favourite of yours.

Nicole: Yes. Well, now, it's in our fish, in our food supply, so that's bad, isn't it? But, yes, plastics, of course. We want to make sure that we reduce our use of plastics, and I don't want everyone to throw out plastics. In fact, I'll prefer they keep them and use them to keep their tools and their sewing implements and use them as storage containers. But don't freeze or heat food in plastics. All plastics tend to leach when they're frozen and also when they're heated. 

Some plastics, of course, are notorious for containing hormone-disrupting chemicals like PVC, polystyrene, and the biphenyls, which is your number 7 plastics and number 3 plastics. So if you're going to use plastics for drinking from, I would say try and avoid it. Use glass instead. Use stainless steel, 304-grade stainless steel instead, if you can, especially with the kids. And just stop buying stuff in plastics. I think it's great we've moved away from plastic bags and have to bring our plastics to the supermarket now. It'd be good to get little hessian bags to put your fruit and veggies in, so you don't have to buy plastic bags for those.

Michelle: Yeah. And the other thing that I think is really useful is just material, like wrapping your vegetables...

Nicole: Wax-wraps.

Michelle: ...up in material. Yeah. That is fantastic.

Nicole: Wax-wraps are fantastic. 

Yeah. So PHOLD. Place, history, sorry, hobbies, and then occupations. And occupational history is so important part of any history, as I'm sure you would know. Painters, spray painters, people in the automotive industry, people in the military, engineers, aviation engineers, notorious for post-traumatic stress disorder and multiple chemical sensitivities, and gardeners, and landscapers, and fishermen, and hairdressers.

Michelle: Hairdressers.

Nicole: I mean, it's huge. It's just huge. I mean, they have high rates of miscarriage. If you look at the data on different occupations, it's actually like, "Oh, my god."

Michelle: Yeah.

Nicole: It's really an important part of a history taking to see where they could be exposed, or just ask the client, "Have you ever been involved in an occupation where you're exposed to potential chemicals, electromagnetic fields, toxic metals, all these sort of things, or microbes if you're a restorer or a remediator, you're exposed to water-damaged buildings? These are important questions to ask.

Michelle: So, okay. So we've got to O. And then we've got L.

Nicole: L, PHOLD. So L is for lifestyle. I want to know what you do for your lifestyle. So tell me about your exercise routine. Because a lot of people, they start exercising, and they go overboard, and they stress their heart out and weaken their heart by overdoing it. They start marathon running, and it's not balanced anymore, and they start running in polluted areas next to traffic, high levels of traffic, which sort of defeats the purpose of being healthy...

Michelle: Yeah.

Nicole: ...or areas where they're exposed to other toxins. That's not good. 

So the lifestyle is important. Their sleep is a very big one. Most people with chronic illnesses have some degree of sleep disorders, sleep disturbances. In fact, it's sort of almost synonymous with chronic illnesses. And I think one of the most important things you've got to do as a clinician is get that patient to sleep as fast as possible to get their circadian rhythm back in line, because it's almost impossible to get them to a state of wellbeing whilst their sleep is disturbed.

Michelle: A hundred per cent.

Nicole: And for me, as a building biologist, that would be looking in their bedroom and making sure there's nothing that we know can impact their sleep like any Wi-Fi-enabled device will emit radiation or radio frequencies, that we know impacts non-REM sleep, that we know suppresses melatonin. And as you know, I'm about to publish a study on the impact of a baby monitor on healthy adult sleep, and it was statistically significant. It impacted the delta and theta waves during non-REM sleep, and it impacted clinically their sleep diaries, so even though it was double-blind, randomised, controlled, crossover pilot study, and in healthy adults. So what is a baby monitor doing to your kids?

Michelle: That's right. I'll often get my patients to actually draw a picture of their bed and draw where it is in the house, what sits behind the bed, if it's the outside world or if there's an en suite backing to the head of the bed. And trying to get them to draw it because it gets them to think about where all of those electricity cables are coming in, if they've got a clock radio that's emitting EMF next to their bed. And depending on how sensitive people are as well. We're going to talk a little bit about sensitivity and susceptibility later on, so.

Nicole: And theyr’e great questions, especially, you don't want, on the opposite side of or adjacent to your bed head, you don't want a fridge because their motor’s going on and off.

Michelle: Yes. Trying to conserve.

Nicole: You don't want a smart bed or a meter panel. You don't want a router extender/booster, anything with a pump, like a pool pump. Inverters are really bad in terms of magnetic fields from solar panels. So these are the things that you don't want in close proximity within a room or two away from your bedroom. And no mobile phones in the bedroom and no Wi-Fi-enabled devices.

Michelle: I mean, that's an easy thing to ask for. So with lifestyle, is there anything else that you want to hone in on?

Nicole: Let me see. So exercise and sleep are the big ones. I'm sure there's more that I've completely forgotten about. 

Maybe in terms of their holidays, where they go to, and sun exposure, of course, is still important. Skin melanoma is still a big killer here in this country. So you'd ask them about that, and their sunscreen use and how they protect themselves from midday sunlight, but more importantly, making sure they get enough because we're all vitamin D deficient, which, of course, is precursors for infections. 

So it's getting that balance. That's what's really important, is being able to establish what's healthy for that person with that genotype is critical.

Michelle: Yeah, that's right.

Nicole: Can you think of any other lifestyle factors that I've missed?

Michelle: Well, I mean, obviously, with most of the practitioners, they'll be asking about food and alcohol, and things related to that. I guess the question that I've often asked is also how much toxic exposure do we get from partners? 

For example, if your partner has an occupation that brings home lead dust, for example, or mould spores...

Nicole: Asbestos.

Michelle: ...in their clothes, or asbestos. Then the partner, you may not ask that in the occupational history for that particular person, but it could be that. I remember, when the COVID-19 pandemic came in, and there was talk about coming directly into a different place of the house and washing the clothes, etc. And that was the first sort of time of, “Wow, we've really got impact in terms of what we're bringing into that house and how much that can impact the rest of the family.”

Nicole: Absolutely. So industries where that could be an issue would be building and construction, restoration, and mould remediation, because they literally could have high levels of, as you said, lead dust or asbestos on their clothing, so they should don off or have personal protective equipment that's disposable, like Tyvek suits, etc., and gloves that are disposable, and don at the site, as opposed to coming home with their clothes and then tramping all over the house and release it. Because, of course, there were women, wives who died from asbestos exposure because they're all cleaning their husband's clothes. 

Other ones are dentists. They're bringing home the towels and they've got mercury on them, etc., or other forms of toxic metals, and the nurses or whoever is doing that could be exposed to high levels of toxic metals or other type of chemicals, definitely.

Michelle: This is an absolute minefield, isn't it? This is just such a minefield.

Nicole: It is. And that's why Professor Marc Cohen and I are developing an app on getting the patient to go through this environmental exposure history, lifestyle history, and health history, and just build up their logarithms to see if there are connections once we get big datasets. 

Because to take this takes 90 minutes, and that's what these doctors were saying that I interviewed. It takes a good 90 minutes in the first consultation to take your history, and even then, you're not going to get it all. It needs to be done in some patients who have chronic fatigue syndrome. You just can only do...they can only take a small amount at a time. So you need lots of small consultations to help these patients who also have emotional traumas that they're bringing into their consultation.

Michelle: That's right.

Nicole: And then these patients have these histories.

Michelle: Yeah. And it's overwhelming.

Nicole: Yeah.

Michelle: It's overwhelming for people. So it takes...I mean, not only are we asking these questions, and they might be revealing these answers, and then watching their practitioner's eyes go, "Okay. Well, this could be something that we need to consider." And then it's, "Wow, I have to start to reshape and redesign how I live my life to such details." It takes a long time for us to renormalise that without the anxiety and the fear and feeling a sense of empowerment with this information, because it's really important that we empower patients with this information so slowly. The app sounds fantastic, so they can actually navigate those changes without feeling overwhelmed.

Nicole: Yes. And because, for clinicians who take these questions, there's no point asking the questions if you don't know what to do with the answers. You need to have an understanding. It just reminds me of a recent event where I went with a professional organiser, who was a declutterer, to see how she goes about the process. And she had spent three hours in one little laundry, decluttering this woman's house who was a hoarder. And she had four big containers of naphthalene mothballs, right?

Michelle: Right.

Nicole: And I was quite quiet. I just watched the process, and I didn't interrupt much. I was just observing how she worked as a professional organiser. And first, I was shocked. Firstly, she's got 10 staff, and they all take antihistamines before they go to a job. That's how toxic that job is. Now, that's another one of the occupations. Are you a declutterer? Because you're exposed to high levels of mould, lead, asbestos, cockroaches, pests. Far out, oh, my god, I just walked in and went, ding, ding, ding, ding, ding, and they had no idea. I'm speaking at their conferences, and they're going, "We're all sick." I'm going, "Oh, well, that's because you're doing this and this and going where..." There's no formal training.

But I was at this place, and she had this amazing personality, this declutterer. Her name was Amy. And we came across these jars, these big bottles of naphthalene mothballs, and I said to the lady, it's one of the few times I spoke in the three hours, I said, "Are you aware that these are known carcinogens, that they can affect your immune system and increase your risk of cancer?" And she looked at me, and she said, "Oh, okay. Well, I'll get rid of two, but I want to keep one." And I said, "When you look at this jar, what memories does it bring up for you?" And she said, "It reminds me, when I was young, mum used to get these naphthalene flakes mothballs and spread them throughout the house, because she was protecting us from the pests." 

So she associated that with a positive memory of her mother protecting her children even though her mother didn't realise what she was doing was actually increasing their toxicity, but thought that this was, by getting rid of moths and getting rid of insects and spiders, she was protecting her children. She could not let go of that last bottle because she associated it with a positive memory even though I told her it could increase her risk for cancer. That's what you're dealing with.

Michelle: I mean, it takes a long time for us to kind of almost embody this information, I think, and it's really important as we're taking our patients through that to be, I guess, cognizant of the emotionality and the convenience. And I guess it's a lot to take in. So in some ways, we have to normalise our toxicity or our environmental toxicity because, once we unravel it, it can be very emotional. 

But I wanted to go back into sort of things like taking this... Have we done D? We haven't done D.

Nicole: No. We've got three Ds. We got D to the power of three. Diet. So I've put diet separate to lifestyle, and without doubt, your diet, you're going to bring in over 20 tons of food through your gut over a lifetime. That's where most of the toxicity is going to happen. That's why the immune system, the Peyer's patches, etc., 70% of your immune response is in the gut, for that reason. 

So you know, as you said, fish is a big one, and not just for lead now, for microplastics, PCBs. and other things like that. That's why, in the '80s, the Danish actually had a marketing campaign to all of the obstetric clinics, warning women not to use perfume and plastics and to also avoid more than one fish meal a month if they're a woman of reproductive age because of the toxicity. Even then they were onto it.

Michelle: Yeah, unbelievable. They were onto it early. When I was in Norway, they had a mass amalgam removal program, didn't they, for the whole country because they knew that fish was such an important kind of...I mean, it's the national food really.

Nicole: Yeah.

Michelle: And so they had to minimise the risks in other areas of industry, I guess.

Nicole: Yeah. And that's a conundrum. Patients with sensitivity, you get their amalgams removed, some go backwards a year or two in their health, it's so bad. It's difficult, even if it's done properly, with oxygen, and rubber dams, and propolis, and charcoal, etc., it still can be very...the nervous system might not cope when they remove those amalgams...

Michelle: Yeah, it's got to be done properly.

Nicole: ...in highly sensitive patients. But it needs to be done. I mean, you don't want it in your mouth, especially with electromagnetic fields. It acts as an antenna and accelerates that. So it's a catch-22. I laugh about it, but I've had 20 years of coming to terms with corporate corruption, exposure standards are not based on public health, and I see hundreds and hundreds of my students go through the course going, "Oh my god. Oh my god." I go, "Yes, I know. I know." Let's deal with what we've got and just educate people from the ground up a bit at a time. That's why I think most people read my book and go, "I can only do a couple of patches at a time," because it's really confronting.

Michelle: It is. And it's a book, though, that you sort of...I mean, there's no other book I know that's like it. So it's like having a little bible for that particular area of your life. And so if we're looking at changing houses or building something, or whatever, you get it out, and you make sure that you never get your way through whatever particular process that you're going through. So it's such a fantastic resource to have.

Nicole: Yeah, thank you. Look, I wrote it because I hated writing reports for my clients. I'll start over saying the same thing over and over and over again. So just read the book. I'm going to give you the book. Don't ask me questions. It's all on there. Look at page 5.

Michelle: I have a gift. This is the book. So, okay. So D is food.

Nicole: D is diet.

Michelle: Or diet, sorry, yeah.

Nicole: And the other D is drugs, pharmaceutical drugs. The first...in the end, before I stopped practising as a clinician, naturopath, acupuncturist, the first thing I would do is go, "Okay, tell me what medication you're on." And the older they are, the more the polypharmacy is common, right?

Michelle: Correct.

Nicole: I would just literally read out all the side effects of every drug they'll take in a day, and I say, "This is what you're here for, right?" "Yeah. Exactly." 

So there's the root cause. So what can we do to manage this? How can we...some of these drugs, can we work with your clinician and go, "Which drug can we look at weaning you off and starting to bring other things in to manage it better or reduce the side effects?" Because root cause is really important.

Michelle: Yeah. I've had so many successes just with changing diet. I mean, a lot of the practitioners who listen to this will be nodding in agreeance, but... And so, then, all of a sudden, those medications are just simply no longer needed again.

Nicole: Yes.

Michelle: So I had a man who was on a PPI for, obviously, reflux, but because his reflux was so bad, he had a bowl of grapes next to his bed, and he was eating one every hour. And so his digestive system never ever got a rest. We took the grapes away, and his reflux fixed itself effectively. And we could take him off those medications. So as a GP, deprescribing is such a craft as well. So prescribing...

Nicole: Yes.

Michelle: ...we spend all of our time learning how to prescribe medications, and I don't think we had one single lecture in medical school on deprescribing.

Nicole: What a great subject.

Michelle: I remember a time when I had an elderly person, I wanted to take them off, and then I actually had to seek further advice of, "Can I just stop this? She's 84. Can I just stop this cholesterol-lowering medication?" or whatever it was. I can't really remember. But I felt nervous about stopping it. That's how kind of entrained we were to prescribe and not to stop. So at this time, this could be just a fabulous opportunity for naturopaths to re-refer back to their GP to discuss whether deprescribing some of these medications is appropriate.

Nicole: Absolutely. And on top of that, that combination of herbs, and supplements, and pharmaceutical drugs, the book Herbs and Natural Supplements by Lesley Braun and Marc Cohen, that's a great one looking at the combinations there, because sometimes people can get that. There are some that you cannot actually take, where there are some massive contraindications.

Michelle: Oh, yeah.

Nicole: Because all of that has to be sorted out very early on in your consultation with the patient before you even look down the track for the other, the diet, the lifestyle. You've got to look at the big fish first, the biggest risks.

Michelle: Yeah.

Nicole: You've got to get on to in the first consultation, in the first three, try and deal with that before you get into the more, okay, lifestyle, diet, all that other stuff, for sure.

Michelle: So.

Nicole: And the last one is dental history.

Michelle: Yes.

Nicole: Big one. That is probably one of the largest sources of toxicity apart from the diet. Place, medicine, dental history, and pharmaceutical drugs, and diet, sorry. Yeah.

Michelle: Yeah. So I mean, it's a big, long history, and your app sounds fantastic in which to sort of navigate people through this but also to get people to think about it before a consultation can sometimes be really useful for an environmental history beyond any other history taking because there's such a longitudinal factor. You're talking to grandparents, parents, etc. about kind of getting all of this information, which could be very, very new for people, really.

Nicole: Yes.

Michelle: So just going through, I mean, we've sort of touched on the fact that pretty much any chronic disease can have an environmental, or there's an impact from our environment in pretty much any condition that we're looking at. But is there ones that are standouts for you? So for example, if we're new to this environmental history taking, is it things like neurological or neurodevelopmental issues or infertility? What are the standout ones that you kind of must, must deal with it?

Nicole: Yeah. 

Michelle: Or you really won't get anywhere.

Nicole: All right. Asthma and allergies, that's number one, for sure, because what you're breathing in is often the problem with the allergies or what you're putting in your mouth, for sure. They're the big ones. Asthma, allergies, and fatiguing syndromes. 

So any autoimmune disorder associated with long-term fatigue is a big one for mould, for sure, but also other allergens in the environment. So, your pests, your pet dander. A lot of people have allergies and don't even know. Even just your normal IgE-mediated allergies, they don't know they're allergic. And they've been allergic to dust mites all their life and sneezed all their life and had antihistamines all their life and not realised that, by having a cover over their bed and their pillow, that could stop all of that. It's incredible.

Michelle: So that's great. So we've got asthma. We've got allergies. We've got the fatiguing syndrome.

Nicole: Yeah. So mould is a big one there and allergens in the home, for example. Like I said, dust mite is the most common allergen in the world, affects 21% of the world's population. And it's marked by allergy symptoms all year round as opposed to pollens, which are seasonal-related, for example. 

Sleep disturbances. If it's not due to stress or massive change in their life, the obvious cause then, always think electromagnetic fields. So if you've done everything else to help someone who's not sleeping well, and obviously, they haven't had a history of night shift working, which, of course, works as a pilot or a nurse, and their circadian rhythm is out, that's hard to treat. 

If it's not due to an obvious thing like that, then think electromagnetic fields. I find, as a building biologist, that's a common cause of sleep disturbances. And it's so insidious, it happens so gradually, whilst they're sleeping near the meter panel or had a router in their room that they never make that connection. So that's a big one for me, which is why I ended up doing that study, because it's so common.

Michelle: Yeah. Gosh, there's so much for us to think about. 

I guess, one of the things that have often struck me in clinic is that, when do we decide to focus just on toxin burden alone, versus that kind of holistic sort of principles of mind, body, soul? Because they're so concrete and externalised to us. Are there people that are more susceptible to toxic load? And how do we look out for those people, and how do we support them?

Nicole: Well, they'll often tell you that they're sensitive. They can't wear perfume. They react to the newspaper. Often, they may not come to you if you work in an inner-city area because they're reacting to even the traffic-related fumes. Most of these people have an idea that they're chemically sensitive already. So they'll often give you that idea. 

In terms of a history, they'll nearly always have a history of atopy. So anyone who had food allergies, or environmental allergies, or hay fever, or asthma, they're a big marker for environmental sensitivities. Absolutely huge. So that's the first thing I'll look at is a history of allergies, especially in childhood or food allergies, because then you know they're going to be more susceptible to the environment. 

The reality is we are all susceptible. One of the most amazing quotes I had from a clinician as part of that research I published on environmental chemicals and how doctors deal with it is one doctor said to me, "I've been treating patients with chronic fatigue syndrome for 40 years." He said, "Nicole, you know how many patients I've had with chronic fatigue syndrome who have had cancer in 40 years? I've had four patients with cancer. Why do you think they don't get cancer, Nicole?" And I'm like, "I don't know. Why do you think?" He said, "Because they, in the olden days, in the tribes, they smelt the dinosaur meat and went, 'Guys, it's off.' And everyone goes, 'No, it's fine. We'll eat it.' And everyone gets gastro, but they don't. They're so finely tuned to the environmental stimuli around them. They saved the tribe. What we have done in our lifetime is we've put them with a psychiatric illness and a mental illness and said, 'You're not normal because you can't live in this toxic society, when, in fact, they're the markers to the rest of humanity. Go quick, run the other way, because...'"

Michelle: Yeah, the sensitive, anxious, cautious ones.

Nicole: Exactly, and we're the ones who get the cancers, and they don't. Now, I think that's very interesting as a comment, and there's certainly not any data on it. But it was his observation of working in that space for 40 years, why these patients aren't getting cancer. And it's because their body is so finely tuned when they walk past the David Jones perfume counter, and they start getting a migraine headache. They know to avoid it, whereas you and I stand there for god knows how long.

Michelle: Yeah, I don't get one. Yeah, that's right.

Nicole: Exactly.

Michelle: You're actually increasing your toxic load because it stays.

Nicole: Exactly right.

Michelle: So let's say we don't take an environmental history, because this is a new patient and we're not yet at that sense of rapport with our patient. Is there something about signs to look for or things in our examination that can create a little spark to sort of say, "Okay, well, this is something that, I might need to look at this next time?" So signs in examinations and little things that prick up your ears.

Nicole: Yeah. Well, when I asked these doctors this, they came up with a very interesting phenotype that many of them talked about, and that was a background from Welsh or the UK where they had fair skin, freckled, redhead. They were far more likely to have the gluten intolerances. 

If anyone's got gluten intolerance or Coeliac, they are highly likely to have environmental sensitivities to chemicals. And they have hyper flexibility. I don't know what that syndrome is called, but their joints are highly flexible. They're often like, "Oh, no, I can't cope with chemicals." You'll see it in history. It's like as I said, food allergies as a kid, environmental allergies, asthma and allergies as a child, atopic constitutions. They may have a background or gene type from the Welsh or Wales or those areas where they had more gluten intolerance. They are highly sensitive to the environment, generally.

Michelle: So, okay. So little things are sometimes, like genetic background is important as well, and just piecing it all together, I think keeping that environmental history in the back of our minds at all times is just such an important…

But for those that are the kind of new to this or that don't feel like they've got the experience to take people through not just a reduction of exposure, who do we refer to? Is there a group of people? 
You've been training up building biologists for the last 10 or 15 years or so. Is that a good option for people to actually reach out and find their local building biologist so that we can at least help with that education and reduction of load?

Nicole: Yeah, absolutely. Because the building biologist, it's a nationally accredited advanced diploma, building biology that I offer. And a big part of the course, in two years full-time, I get them to take an environmental exposure history, that's what they're trained to do, and then do a site inspection to look at if their house is making them sick and look for common hazards. 

Obviously, lead is a big one. Asbestos, we're not allowed to certify, because you have to be certified to do it, but you can base it on the age that it's potentially likely and then refer them. Mould is a big part of the work we do. So if they have asthma allergies or autoimmune-like disorders with fatiguing syndromes, then, definitely, you want to check mould. And the history of mould so ask, have you had water damage in your car? Have you had water damage in previous homes? Did you grow up in a mouldy home? It's very, very rare I get someone with chronic fatigue or CIRS that hasn't also grown up in a water-damaged environment or hasn't been exposed to other biotoxins like blue-green algae, so in lakes, contaminated lakes, or tick bites. By the time the body breaks down, it's been exposed to multiple either pesticide, spraying from sheep dipping on their farm, to living in farming communities, to having a tick bite. It's this multitude layer of multiple factors before, actually, their system breaks down and then they become chronically unwell.

Michelle: Amazing. And we're going to get you back to talk about mould because I think we could really do a deep dive into what to look for and how to diagnose that most effectively and what to do about it. 

But let's finish it off here, because often, sometimes, these conversations can be like, "Oh my gosh. What do I do?" So I know you've got some amazingly simple ways in which to reduce our burden.

Nicole: Right. So from a house perspective, so I'm not going to go through diet, because most of your listeners will know what to do with diet. In terms of the house, you want to make sure, if you get any water damage or water event where you flooded your bath, etc., you want to dry it within 48 hours. After 48 hours, it goes from a water drying event to a mould remediation job, which can go from a few hundred dollars to tens of thousands or hundreds of thousands. 

So mould is a big problem affecting at least 40% of the housing stock. Make sure you look after your house, that you clean the gutters on a regular basis, the drainage is good, there's no water pooling around the house, it's important. Because without fail, I find most of my patient's chemical sensitivity, most of them started in a mouldy house, because mould affects the detoxification pathways, which I can talk about next time. So mould and chemical sensitivity, I see as the same. So make sure any visible mould or damp odour, you need to get a building biologist to test to identify where it's coming from and get rid of it. That's number one.

Number two, take your shoes off. There's a reason why nature is kept at bay out there, and the council spreads thousands of tons of pesticides in order to keep nature at bay. So you want to take your shoes off so you're not tracking all those chemicals onto your carpets where the most vulnerable, like your children, are walking all over. It's in their breathing zone. That's problematic.
Third one is, when it comes to buying products, cleaning and personal care, really think about, do you really need it? You can clean your house very effectively with a vacuum cleaner fitted with a HEPA filter, because the most of the chemicals in the house is sitting in the household dust. So how you deal with the dust will determine the toxic load in the house. So you want a good vacuum cleaner with a HEPA filter, and you want microfibre cloths that are slightly damp, and that's how you're going to dust. So you wash the microfibre cloth's dust down the sink. That's important.

The last thing, because I've only got 4 options that you've given me, whereas I could talk about 20...

Michelle: I know. I have to rein you in.

Nicole: ...is to get a filter.

Michelle: Yeah.

Nicole: So filter. Get a water filter, get an air filter. If you don't get a filter, your body becomes the filter. So for me, I live in a bushy environment because the plants are filtering any air from the traffic-related air pollutants and stuff instead of my lungs and my kids'. So an air filter is really important. I just did an hour-and-a-half lecture, I've got free lectures on my college website, of why you need an air filter.

Michelle: Great.

Nicole: So that's important because now, with bush fires…

Michelle: And that's an easy. That's an easy. That's easy.

Nicole: It is easy. It's such a great banner. If you all live in a rental where there's mould and you can't do anything about it because it's a rental, get an air filter. And wherever you are in the house, have the air filter on. That will make huge differences to reducing your inhalation of particulates, fungal particulates.

Michelle: Amazing.

Nicole: And a water filter is important. You don't want chlorine, you don't want fluoride, etc., I mean, but that's a lecture in its own, right.

Michelle: Wow. Nicole, you are a wealth of knowledge in such a fascinating area. And as we know, it can be overwhelming, but just having those simple, easy, cost-effective ways that we can start the process, we're so lucky to have you really to consume this knowledge. 

So thank you so much for all you do in this space. It's such an honour to have such an intelligent discussion with such an amazing person.

Nicole: Thank you. I just forgot to mention the Association of Building Biologists. So to find a building biologist, it's asbb.org.au.

Michelle: Fabulous. And we'll have all of the show notes, transcripts, and resources that we mentioned today from today's episode on the FX Medicine website. Nicole Bijlsma, thank you so much for joining us today.

Nicole: Thank you.

Michelle: I'm Dr Michelle Woolhouse, and this is FX Medicine.

Resources discussed in this episode

Nicole Bijlsma
Building Biology
Book: Healthy Home, Healthy Family
Australian College of Environmental Studies
Association of Building Biologists
Book: Silent Spring
Environmental Protection Agency (EPA)
Book: Herbs and Natural Supplements: An Evidence-Based Guide
Research: Environmental Chemical Assessment in Clinical Practice: Unveiling the Elephant in the Room (Bijlsma & Cohen, 2016)
Research: Expert Clinician’s Perspectives on Environmental Medicine and Toxicant Assessment in Clinical Practice (Bijlsma & Cohen, 2018)
Nicole's Article on Water Filters

About Nicole Bijlsma

Nicole Bijlsma is a former naturopath and acupuncturist with 15 years of clinical experience (now no longer practising), building biologist, writer and author who lectures on health hazards in the built environment. Nicole experienced insomnia and ten miscarriages after moving into her home which she believed occurred because of sleeping in a high AC magnetic field from the meter panel, sleeping above geopathic stress and exposure to elevated traffic-related air pollutants. Apart from an Honours degree in Acupuncture, she completed further training in Guangzhou TCM hospital (China) and naturopathic qualifications in the early 1990s and has 30 years experience lecturing in Traditional Chinese Medicine, naturopathic philosophy, nutrition and environmental health-related topics at various universities and institutions in Australia. Nicole is the author of the bestseller - Healthy Home Healthy Family - which attracted numerous radio and television interviews in addition to numerous articles in print and online media, wrote the chapter on Environmental Medicine (Advanced Clinical Naturopathic Medicine textbook 2020), co-authored the RACV report on Mould in Australian Homes and has published papers in peer reviewed scientific journals. She lectures extensively at medical conferences both in Australia and internationally, and is regularly consulted by the media for her opinion on chemicals, mould and electromagnetic fields. She is currently completing her PhD investigating the impact of wireless technologies on brain, sleep and heart function.



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