Common Agendas

Elise Miller, MEd
Director

We are pleased to announce that CHE will start hosting a new working group later this month — namely, the Initiative on Children’s Environmental Health. As many of you know, I served as Executive Director of the Institute for Children’s Environmental Health (ICEH) for 10 years before becoming Director of CHE this past January. After a great deal of discussion and reflection, ICEH’s staff and board decided that the most useful way ICEH could continue to contribute its decade of national leadership and expertise in this field would be to merge with Commonweal, CHE’s fiscal sponsor, and become a CHE Working Group. ICEH, in this new iteration, will use the same acronym, but become the Initiative on Children’s Environmental Health.

With an emphasis on science and precaution, CHE already focuses on the impact of environmental factors from conception through adolescence. Emerging science on environmental factors and children’s health, including the fetal origin of some adult diseases and disabilities, is evident in CHE’s array of white papers, consensus statements, workshops, working groups and calls. Having a specific working group focused on children, however, will augment the resources we provide you in this area and help ensure children’s health is prioritized in all of our efforts to promote public health research and policy. 

As a CHE working group, ICEH plans to launch its newly revamped website, including its rich database of searchable articles and other resources, under CHE’s website later this month (look for the official announcement). ICEH will also continue to offer biweekly ebulletins and will soon feature web-based materials on climate change and children’s health. In addition, ICEH will feature the remarkable work of so many of your institutions and organizations — nationally and internationally — already dedicated to children’s health. We are in the process of considering other opportunities and activities that would be value-added in this field and welcome your suggestions.

Along these lines, I would like to bring your attention to an outstanding new report, “Towards Tomorrow: A Common Agenda for Health and the Environment,” published earlier this week by the Lowell Center for Sustainable Production, a CHE organizational Partner, in collaboration with over 100 leaders representing diverse sectors, including many other CHE Partners. This report emphasizes generational goal-setting and prioritizes action steps — steps I would recommend we all consider taking to ensure the health and well-being of current and future generations.

Is the Environment Making Us Fat and Sick?

‘Obesogens’, other environmental factors contribute to metabolic syndrome

Based upon the May 7 CHE Partnership Call

Conventional wisdom says that the meteoric rise in obesity and related health conditions – the early stages of which are now called metabolic syndrome – is due to the West having a bad case of “couch potato syndrome.” That is, over the past few decades, we have been eating too much and not exercising enough.

While poor diet and inactivity play an undeniable role in fostering metabolic syndrome, that’s not the whole story. Clinical and epidemiological evidence increasingly implicates another culprit: the environment.

An insufficient explanation

Some scientists suspect that a combination of environmental factors, including a group of chemicals called obesogens, share the blame for the explosion of metabolic syndrome and its later stages: diabetes, obesity, cardiovascular disease, and even Alzheimer’s.    

“Despite what we’ve heard,” said Dr. Bruce Blumberg, Professor of Developmental and Cell Biology and Pharmaceutical Sciences at the Univeristy of California, Irvine, “diet and exercise alone are insufficient to explain the obesity epidemic.”   

A May 7 teleconference presented by the nonprofit Collaborative on Health and the Environment explored this urgent and compelling topic. This article is based upon that teleconference.
   
Metabolic syndrome is estimated to affect more than one-third of U.S. adults, 60% of them under 65 years old.

When environment collides with human biology

Speaker Dr. David Jacobs, Professor of Public Health at the University of Minnesota, a chronic-disease epidemiologist, defined metabolic syndrome as “a constellation of related metabolic abnormalities (body fatness, blood fat handling, insulin, glucose).”
   
Environmental factors suspected to contribute to metabolic syndrome include the food system, the transportation system, the built environment, air pollution, obesogens, other environmental contaminants, and socioeconomic stress.
   
These stressors alter pathways in the body, causing inflammation, oxidative stress, and disrupted insulin signaling. Altered pathways can, in turn, lead to diabetes, obesity, cardiovascular disease, and abnormal lipids (tied to dementia and Alzheimer’s).
   
You can think of metabolic syndrome as a crossroads, said speaker Dr. Jill Stein, co-founder of the Massachusetts Coalition for Healthy Communities, board member of Greater Boston Physicians for Social Responsibility, and co-author of the recent report Environmental Threats to Healthy Aging.
   
“This is where the environment meets human biology in the early stages of the disease process. You can think of environmental factors as kind of colliding with human biology here.” 
    

Chemical culprits

The obesity epidemic, as Dr. Bruce Blumberg pointed out, roughly correlates with the rise in the use of industrial chemicals (plastics, pesticides, etc.) in the years since World War Two.

Though, he reminded listeners, “correlation is not causation.”
   
Also, many environmental contaminants affect the endocrine system, which plays a big part in determining weight by controlling the appetite and metabolism, fat cell development, and lipid balance. These basic facts, plus suggestive laboratory research, has led scientists to propose an additional label for certain chemicals: obesogen.
   
Some time ago, Dr. Blumberg and his colleagues proposed “the obesogen hypothesis,” which defined obesogens as “chemicals that inappropriately stimulate adipogenesis and fat storage, exist and contribute to the obesity epidemic.”
   
Varioius studies have found that pre- and post-natal exposure to obesogens reprograms the metabolism of exposed animals, predisposing them to obesity later in life.   
   
Dr. Pete Myers, founder, CEO, and chief scientist of Environmental Health Sciences, began the teleconference by describing one such study, by Soo Lim et al., published in the journal PLoS One in April 2009. You can access the study at www.plosone.org/article/info:doi/10.1371/journal.pone.0005186
   
The study involved chronic exposure of rats to low levels of the common herbicide atrazine. After five months of exposure, the rats showed descreased basal metabolic rate, increased body weight, increased intra-abdominal fat, and increased insulin resistance. The effects were even stronger when the rats were fed a high-fat diet.
   
The scientists concluded that long-term atrazine exposure could contribute to the development of insulin resistance and diabetes in people, especially where high-fat diets are prevalent.
   
“The exposures they used were well within the range that people are often exposed to, “ said Dr. Myers, “especially within corn-growing areas. I think we’ll be hearing more about this line of research in the future.”    

POPS, diabetes, and metabolic syndrome

When the CDC tested the blood of 2,016 adults for the presence of six POPS (Persistent Organic Pollutants) as part of the National Health and Nutrition Examination Surveys (NHANES, 1999-2002), they found that each of the POPS was related to increasing occurrence of diabetes. People with POPS levels in the top quarter had a risk of developing diabetes 38 times greater than those with bottom-quarter levels.
   
Among non-diabetics in NHANES, people with organochlorine pesticide levels in the top quarter had five times the risk of metabolic syndrome compared to those in the bottom quarter.
   
These pollutants, though mostly banned in the 1970s, still linger in our foods. They are also found in computers, refrigerators, flame retardants, and waste dumps.        

What you can do

As far as prevention goes, Dr. Stein said, there are three major things you can do as an individual to reduce your risk of metabolic syndrome.

“The route that you take depends on the particulars of your life and your community. There are many dietary interventions – I’ll just throw out the Mediterranean diet because there is very compelling data about its effect in reducing not only metabolic syndrome but all the other conditions we’ve been talking about, and others beyond that. Taking general steps to reduce chemical exposures. Exercise.”
   
The Mediterranean diet is one composed of mostly fruits and vegetables, with lots of whole grains, fish, and olive oil, and very little processed food or red meat.    

What we can do

When asked for his thoughts on prevention, Dr. Jacobs underscored the need to think on a macro level.
   
“We really need the political will to examine our society,” he said, “and make some changes in it. They’re not going to come overnight. If you’re talking about reengineering where sidewalks are to encourage more physical activity, that’s difficult. If we’re talking about having an entirely different way of delivering food to the people other than the food industry, that’s a massive change.
   
“If we’re talking about the chemicals – they’re in computers. I like computers. They’re in refrigerators… The cleverness is to figure out how to have the things we want to have in our lives from industry without disrupting health.”
   
A final point to consider reminds us that we are only beginning to understand the complex relationship between our health and our environment.
   
Dr. Blumberg brought up the emerging paradigm of developmental origins of adult disease.
   
“Many of the afflictions we have as adults arise during development and early childhood,” he explained, “as a result of the foods we eat, the chemicals we’re exposed to, a variety of factors. We need a lot more research in this area to help us prevent chronic disease in later life.”

Change Your Lifestyle, Change Your Genes

Shelby Gonzalez

Mind-body medicine pioneer, Dean Ornish, MD, explains surprising new research

Based on the March 26 CHE Partnership Call
Years ago, Dean Ornish, MD, brought a well-respected yoga teacher to speak at a medical school. The teacher made a remark along the lines of, “When you do yoga, even your genes can begin to change.”

Dr. Ornish winced internally, thinking, “I’m going to be the laughingstock of the medical school, because everybody knows you can’t change your genes.”

“Genetic nihilism”

While that was the prevailing thought at the time, current research shows that changing your lifestyle – which could include taking up yoga – may be able to reverse heart disease, stall the progression of early-stage prostate cancer, stimulate the growth of new brain neurons, and, yes, even change the way your genes behave.

Far from being a laughingstock, Dr. Ornish is now a renowned figure in the field of integrative medicine. He is the founder and president of the Preventive Medicine Research Institute, Clinical Professor of Medicine at the University of California, San Francisco, and author of six bestselling books, including The Spectrum (Ballantine, 2007).

He gave the keynote speech at the landmark Institute of Medicine Summit on Integrative Medicine and the Health of the Public, which took place in February 2009.

You can view the video recording of the summit at www.imsummitwebcast.org.

On March 26, he spoke on a teleconference presented by the nonprofit Collaborative on Health and the Environment. This article is based upon that teleconference.

Often, Dr. Ornish said, people attribute their health problems to “bad genes,” or figure that since they are genetically predisposed to, say, heart disease, they will get it no matter what they do, so they might as well continue leading unhealthy lifestyles.

“That’s what I call ‘genetic nihilism.’”

That mindset reflects a rigid and increasingly outmoded model of how genes and lifestyle determine health.

“Your brain can get measurably bigger”

As recently as ten years ago, he explained, “it was thought that you were born with a certain number of brain neurons. If you went out and had a binge, you lost a few thousand of those or more, and that was it. You wouldn’t get them back.”

These days, he continued, the new field of neuroplasticity is revealing that the brain is far less static than previously thought. Depression, for example, can shrink your brain, but treatment with cognitive behavioral therapy can return it to its previous size. And even if you’re not suffering from depression, getting more exercise can stimulate the growth of new brain neurons.

“Your brain can get measurably bigger,” Dr. Ornish said. “What I’m impressed by is how dynamic our bodies are. How quickly you can better – and how quickly you can get worse – in a number of different domains.”

More examples of the body’s responsiveness to lifestyle change come from research related to telomerase, which he defined as “an enzyme that repairs and lengthens damaged telomeres, which are the ends of our chromosomes that control how long we live.”

In 2004, Dr. Elizabeth Blackburn FRS, Professor of Biology and Physiology at the University of California, San Francisco, Fellow of the Royal Society, and the codiscoverer of telomerase, coauthored what Dr. Ornish described as a “pioneering study” that appeared in the Proceedings of the National Academy of Sciences. The study, which examined mothers of chronically ill children, found that the women with the highest perceived levels of emotional stress had lower levels of telomerase and shorter telomeres than the women with the lowest perceived levels of stress.

In fact, on average, the most-stressed women had the telomerase levels and telomere lengths of someone ten years older.

“Over five hundred genes were changed”

Conversely, a study published in The Lancet Oncology in September 2008 found that, after following the lifestyle plan outlined in The Spectrum for three months, the telomerase activity levels of men with early-stage prostate cancer increased by 30%. Dr. Ornish and Dr. Blackburn were among the study authors.

A longer follow-up study will determine whether there were corresponding increases in telomere lengths.

“We also found that over five hundred genes were changed,” said Dr. Ornish, “turning on or ‘upregulating’ the disease-preventing genes and turning off or ‘downregulating’ the genes that promote prostate cancer and breast cancer (a specific class of Ras oncogenes) as well as the genes that control inflammation and oxidative stress.”

Those results were published in the Proceedings of the National Academy of Sciences in June 2008.

Inflammation and oxidative stress are considered important underlying mechanisms for diabetes, coronary heart disease, and metabolic syndrome, among other conditions.
 
Technically, he acknowledged, you can’t change the genes themselves.

“But you can change how they’re expressed, by modifying the proteins that turn on or turn off these genes. If you can turn off a gene that’s disease-promoting, then effectively you’ve changed your genes – at least functionally, if not structurally.”

“The world is catching up with us”

The healthcare system in the United States has been slow to embrace lifestyle-change approaches to managing serious illness. But that is changing. Medicare now covers the Dr. Ornish Program for Reducing Heart Disease – a comprehensive lifestyle-change program shown in clinical research to reverse even severe heart disease without drugs or surgery.

“I’m cautiously optimistic that the world is catching up with us,” Dr. Ornish said. 

After giving the keynote speech at the Institute of Medicine summit, he testified before the Senate Health Reform committee about how preventative integrative-medicine practices, such as lifestyle change, could save the country billions of dollars in healthcare costs and help affordably extend healthcare coverage to more people.
   
Key among his recommendations were:

• Change the reimbursement system to pay for integrative-medicine practices that have been proven safe and effective
• Fund more scientific studies of integrative medicine
• Incentivize wellness in healthcare plans and on corporate worksites
• Serve healthy lunches in school cafeterias
• Change subsidies in the Farm Bill to make it cheaper to eat healthy foods than junk foods

You can access his full testimony and other resources at www.pmri.org/press.
   
Through the efforts of Dr. Ornish and others, awareness of the medical efficacy of lifestyle change is spreading through the public consciousness.
   
“For me,” he said, “awareness is always the first step in healing. Just knowing these changes can make a difference so quickly can empower people and … motivate them to make these changes.”