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(RW) Environmental Health: Aly Cohen
23 Plays16 days ago
(REWIND) Season 2, Episode 10: Dr. Aly Cohen is an integrative rheumatologist and environmental health expert in Princeton, NJ. Listen to Aly discuss the regulation of chemicals in consumer products, the effects of these chemicals on our health, and her experiences navigating the healthcare payment structure. Check out Dr. Cohen's environmental health initiative, The Smart Human, here.
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Transcript
Introduction to The Wound Dresser Podcast
00:00:09
Speaker
You're listening to The Wound Dresser, a podcast that uncovers the human side of healthcare. I'm your host, John Neary.
Meet Dr. Ailee Cohen: A Journey into Environmental Health
00:00:22
Speaker
My guest today is Dr. Ailee Cohen. Dr. Cohen is a practicing rheumatologist, internist, and integrative physician in Princeton, New Jersey. She is also an environmental health expert and co-author of Non-Toxic, Guide to Living Healthy in the Chemical World.
00:00:37
Speaker
In 2015, she created thesmarthuman.com to share information and media such as podcasts and videos regarding environmental health. Ailee, welcome to the show. Thank you so much for having me.
00:00:49
Speaker
So I would like to start ah by discussing your work in environmental health. I had the pleasure of recently watching a TEDx talk you gave ah titled, How to Protect Your Kids from Toxic Chemicals.
The Eye-Opening Journey: Unregulated Chemicals in Daily Life
00:01:00
Speaker
Can you tell our listeners how you got started in environmental health and what issues you seek to tackle? Yeah. Well, you know, i I really just got into it really haphazardly, a little bit of heartbreak too, which can always push you towards, you know, a passion. What happened was when I was a really, you know, I was a practicing physician. i was a newly out of training. i had two young kids and a golden retriever who was literally gorgeous.
00:01:23
Speaker
And um he got sick. The dog got sick. And he was four and a half years old. um And we just kind of assume he's, you know, swallowed a sock or something that, you know, Goldens always do. um But it turned out when we brought him to the vet that he had literally been living with autoimmune hepatitis. And his liver at the time was the size of like, ah you know, i would say golf ball. and obviously not sustainable. And we didn't know why he had this diagnosis of autoimmune hepatitis. It's very, very rare in dogs, let alone this breed, as we found out with our veterinarian. um
00:02:01
Speaker
And really it was pretty shocking. And so because he was my baby, of course, and i was so heartbroken, I started to try to figure out why this was happening.
Teaching the Impact of Chemicals: Water and Food Concerns
00:02:10
Speaker
I was looking at you know the things that might have affected his body, his immune system. such as drinking water, or perhaps it was the air quality. We live on a farm in New Jersey. Maybe it was his dog food was contaminated or his flea and tick um you know medication that I applied behind his neck, or even the red toy he sucked on all the time, literally like all the time, this plastic thing.
00:02:32
Speaker
And, you know, i'm and i'm an autoimmune disease doctor as a rheumatologist. So this irony was really pretty deep. But, you know, what I discovered by looking into his world and his exposures really just opened a Pandora's box of what human beings are being exposed to without any regulation. And I could not figure this out. I kept on thinking there's something wrong here, because up to that point, even as a physician,
00:02:57
Speaker
I really just assumed that every product that we put on our you our bodies from the shelves in the store were somehow vetted for safety. um And that is absolutely not true. And not only that, I found out you know water in our country is very limited. it has very limited regulation in terms of oversight for very many chemicals that get into our drinking water systems. um I learned about air quality and how that, too, is becoming a problem for human health. So it basically the story of my dog, who unfortunately did pass away, he was really sort of the start of my whole you know career in this educational world of of teaching people how environment directly and indirectly affects human health.
00:03:40
Speaker
Yeah, i was I was checking out your website, actually, the Smart Human. um And I think you have up there that there are around 90,000 chemicals available for commercial use in the US, but only about 300 have
Regulating Chemicals: Focus on High-Yield Exposure Points
00:03:52
Speaker
been tested. So that seems like a really ah daunting task to start, you know, um really just to regulate the use of those chemicals. So in your eyes, what are kind of the first steps to to tackling, you know, the regulation of those chemicals? Yeah.
00:04:07
Speaker
Yeah, I mean, the thing is, it's up to now 95,000. It's interesting you said that because it was probably about five or six years of that it was 90,000. So every year we have 95,000 on average right now that are in everything that we use from you know chemicals that we put on fabrics, like stain guarding chemicals to chemicals we put in our you know cookware to over 3,000 to 7,000 chemicals that are now in our food that's allowable as food chemicals. um You know, the list goes on and on plastic sizers, chemicals, industrial chemicals, pesticides, flame retardant chemicals. And, you know, so it's a pretty daunting, you know, vision of where we are are at and as humans. In fact, you know, we've been evolving for over 4.5 million years as human beings. The question is, how can we handle You know, just 75 years of over 95,000 chemicals that now surround us that are on our skin, that are in what we breathe and what we eat.
Water Safety and Solutions
00:05:05
Speaker
So it's pretty remarkable stuff. When I talk to my patients, when I talk to high school students, middle school students, college students, even my colleagues, I teach and write curriculum on environmental health for physician colleagues. What I really try to do is give them perspective.
00:05:21
Speaker
and really talk about what are the high yield changes we can all make without just you know getting so freaked out that we make no changes at all. Because it is quite an overwhelming topic, which is of course why myself and my co-author wrote a guidebook on this process, because it is a process, it's a journey for everybody. And what we talk about, or at least I emphasize, is really where is the high yield points of change?
00:05:45
Speaker
So for instance, you know you can start with, say, drinking water. Drinking water has become my biggest topic, my biggest beef, so to speak, because we have such really you know kind of dirty water, considering that our drinking system, which we have 160,000 wastewater treatment plants in the U.S. that serve 86% of the population, really follows only one law from 1974 called the Safe Drinking Water Act, that only looks for, monitors, and remediates 91 chemicals nationally.
00:06:17
Speaker
So when you go from 95,000 that can get into our water system and only 91 are legally being monitored and managed and remediated, you can see that's a lot of chemicals that are actually making their way through the water system, the water treatment plants, into our in our drinking glasses. so What I emphasize is what are the high yield exposures? Well, certainly water. And we should try to you know consider ways to filter our water because there's many, many ways and many inexpensive ideas in how to do this, which of course we talk about in the book and and I talk about in community lectures. The next thing would be food, our food quality. you know We think about a lot of times about how much fat should we need and how much protein and we have all these dietary
00:07:00
Speaker
you know, fads and, you know, you know, people jump on the bandwagon for different keto diet and paleo, vegan, Mediterranean. And what I want really people to think about, it's great to think about, you know, how much plant-based do you want to be or how much, you know, meat or or dairy, but you really want to think about the quality of your food because the quality, which is the chemicals that are used in the processing of that food, even if it's considered really healthy food, really needs to be considered because the quality makes a big difference in terms of the biochemical effects in our body from those chemicals.
Understanding Chemical Toxicity
00:07:35
Speaker
Can you, ah I guess just to clarify, when we when we talk about something being toxic, right, um are are are all chemicals necessarily toxic? Is anything that's man-made ah you know definitely going to be toxic? Or is is is there a certain percentage, ah a small percentage of those, like you said, 95,000 chemicals that you kind of label in your head as as toxic per se? Yeah.
00:07:58
Speaker
Yeah, it's a great question. You know, not every chemical is has been found. i mean, there's a difference between thinking it's safe and also having the tests behind it, which is very expensive to run, you know, important safety tests. Manufacturing companies are not required to do any testing on safety or toxicity.
00:08:17
Speaker
on there is those chemical ingredients in their products before those products go to market. That's pretty astounding. um And the chemicals that are used could be completely harmless, but they could also be incredibly toxic, but no one knows yet, right? Because no one's really spending the money and they're not required to. before those chemicals actually go into our market and then onto our bodies and the bodies of our children. So, you know, the idea is that there are chemicals that we know are pretty safe, you know, some, you know, acetic acid, right? It sounds horrible, but it's vinegar.
00:08:49
Speaker
Isopropyl alcohol, it sounds horrible as a name, but it's actually rubbing alcohol, right? It's great on COVID, you know, for COVID, and you don't need any other chemicals besides rubbing alcohol, 70% concentration or above. which gets into why are they marketing literally thousands of new chemical cleaners that many of them are known to be toxic just because of COVID when we can get safer, cheaper, options that are less toic toxic. So to your point, there are chemicals that we now know are are pretty harmless to the human body. The problem is, is that we don't know about all of them. And 95,000 is an enormous amount of number of chemicals to tackle in terms of studying them when they're really studied through third party academic centers and international academic centers. So what we do know is that there's over 800 to a thousand chemicals that are now known to be through academic testing and third-party testing to be endocrine disrupting chemicals, which means these chemicals do in fact have the ability to mimic human hormones, uh, like similar to the hormones in the endocrine system, the human endocrine system is a series of, you know, um, you know, a bunch of organs that we have thyroid ovaries, adrenal gland, um, that really secrete hormones at very, very low levels.
00:10:09
Speaker
And those hormones are messaging signals and messengers that go to different parts of the body to create an enormous amount of change only off of a very little bit ah of hormone. And what these chemicals are capable of doing, and this was really discovered was they can work at very, very low levels, similar to hormones and disrupt those normal pathways.
00:10:29
Speaker
So you can have disruption of thyroid hormone, you can have disruption of um of fertility, you know hormones that are sensitive to for fertility and you know for reproduction. You can have chemicals that are disrupted, the hormones naturally for growth and development or brain development in utero.
00:10:48
Speaker
Insulin is a hormone. So there are there are effects from these chemicals that can affect um insulin production and also breakdown in muscle tissue. So you name the hormone and there has been found to be chemicals called endocrine disruptors that can, in fact, have effects on certain hormones within the body.
00:11:05
Speaker
You mentioned, ah you know, that manufacturers are kind of ah responsible for putting a lot of these chemicals into our environment. Can you just give our listeners a better idea of ah perhaps like who is, you know,
00:11:19
Speaker
who are or what is is ah allowing these chemicals to be ah put into our environment? And like, perhaps why are, what are some of the reasons that they're not being tested? Is it more kind of like on an economic grounds where where people, ah you know, it affects the bottom line if they do a lot of testing or is there perhaps other reasons why these these chemicals aren't being regulated as much as they should?
The Historical Path to Chemical Ubiquity
00:11:42
Speaker
Yeah. I mean, I guess it comes back down to the history of of plastics and chemicals in the United States. You know, early on, um you know, we didn't have these chemicals. And so no one assumed that anything that was coming from the chemical industry would be harmful.
00:11:55
Speaker
um When 1940s and 50s was one of the biggest booms of, ah you know, chemical industrial innovation, if you want to call it, because we had different world wars, World War I and II, that really started to look for different ah compounds that could take the place. of um you know wood and things that were natural resources. They also were looking for pesticides to develop and in order to protect soldiers that were overseas, in woods, in sand environments where where you know infection could you know run rampant. um So chemicals came in the form of plexiglass or nylon or rayon or naugahyde or formica. And, you know, some of these names are familiar to some of your listeners.
00:12:45
Speaker
Well, these chemicals never existed until about the 1950s. And in fact, Monsanto, you know, created almost, you know, their own exhibit at the world the World Fair. And it was called, you know, they talked about, ah um what is it? ah the miracle of chemicals. And really it was just this astounding explosion of chemicals onto the market.
00:13:08
Speaker
you know, they marketed to homemakers in terms of, you know, not being able to break your your dishes if you were to drop them because now there's plastic ones. So it was out of convenience. It was out of a surge of chemical kind of know how.
00:13:22
Speaker
And the only thing that was the problem is no one really at the time considered how these chemicals would break down. No one really considered that they could make their way into the human body and have health effects.
00:13:34
Speaker
And so it was an explosion without looking at sort of the repercussions and the potential problems that could happen downstream. um There were certain laws that were developed. In 1958, there was the Food Additives Amendment.
00:13:46
Speaker
There was the you know Food, Drug, and Cosmetic Act of 1938, when some chemicals in makeup react actually reacted to people's eyelids in terms of lash lore and some of these companies that were putting really toxic dyes into cosmetics and causing blindness. And I talk about this in the book because I want people to have a perspective of where we've come from. Unfortunately, um the intentions of some of the earlier acts did not follow through and were not really held to any strong standard. And so what happened is as as the chemicals came out, they came out too fast for any repercussions to really be visible at the time. And so really never got a handle on the laws regulating the manufacturing safety and requirements that needed to be done. So now we have, you know, grandfathered in over 62,000 chemicals, um even since 1976, when initial laws called TSCA were developed, um Toxic Substance Control Act of 1976. And since that time, we've actually never had more than five chemicals removed from the U.S. market. It's unheard of. In Europe, we have over 1,200 chemicals that have been removed because they have a much more rigorous process for vetting these chemicals for safety before they go into products.
00:15:05
Speaker
And so again, we sort of let the horse out of the stable and no one's been able to rein in very powerful, very costly testing that should be required before any product containing any new chemicals or any previous chemicals that have not been tested go onto the market.
00:15:23
Speaker
Yeah, I think a lot of what you're alluding to, right, is that we sort of have this, ah you know, and the the Industrial Revolution was ah what brought about a lot of these chemicals. And I guess even even further after, as you were saying, into the 50s, 60s, and so on. But um when when you think about industrialization, right, ah we have the introduction of fossil fuels and plastics and so forth. And On one hand, it's like they've introduced a lot of toxic chemicals into environment, but at the same time, it's they they probably also greatly increased health outcomes. So how do you kind of think about like moving forward ah a world where we can take you know the best of industrialization, but also kind of reach back to ah to to the pre-industrial world in terms of balancing you know the use of chemicals and and also getting like the best health health outcomes possible?
Protecting Against Chemical Exposure: Practical Solutions
00:16:09
Speaker
Yeah, I mean, I think what I've decided is because the topic is so big between sustainability, which is certainly, you know, the cycle between, you know, affecting our planets our planet, which is, you know, affecting waterways that become our drinking water, right? You know, we think farming and agriculture and manufacturing and all the leaks from from any of these processes, even sewage getting into our water system doesn't exist, but it's very cyclical. What we do to the planet always comes back into our body. And what, you know, what goes on in our body tends to go out into, you know, the the planet. So we are cyclically, you know, interlocked with, you know, our environments that we walk through. That being said, you know, we we use plastic, you know, single use plastics, obviously everywhere. And yet we can still get chemicals from those plastics into the food and drink that they carry. So not only are we creating a mess for the environment with the plastic overload, but also the chemicals that are come from that matrix, that very soft matrix. get into our body and can affect the health of you know our bodies. So really the issue is going to be is how do we start to create products from the start? And that's called green by design or green chemistry.
00:17:20
Speaker
And actually that's really an important process. If we can create products from the very start that are sustainable and break down over time on the earth and have a very short half-life for disposal, then we can assume that they're not going to make their way to some degree into the water systems, into our food system, our food you know um you know growth and development of agriculture. And so when you ask a question like that, my feeling is that we want to, you know at least with the work I'm doing, is really trying to work with people that do the green design. But my my passion is really how do we protect our bodies here and now? And that was the the idea behind the book, Non-Toxic Guide to Living Healthy in a Chemical World, is to really give individuals you know who can't wait, like myself, can't wait for legislation to change because it hasn't in 50 years. It's not likely to change dramatically over the next 50, is really how do we as individuals protect our own bodies, our bodies of our children and our pets from these chemicals that have been found to cause potential harm.
00:18:25
Speaker
And, you know, it's very simple to some degree. I mean, I tried to really look at this, not in terms of, um you know, heavy economic costs to make these changes. It's more about how do we make smarter decisions about what we put in on and around our bodies. And and I think we laid that out pretty nicely in this book so that people could dive in at their own speed um with any topic, for instance, like drinking water is a whole chapter um with solutions. I want solutions, always solutions, even when I post on my platform, The Smart Human on Facebook, Twitter, Instagram, and the podcast that I have, The Smart Human. It's all about simple solutions that don't cost a lot of money. It's more about removing them from your home and your life by not buying them to begin with.
00:19:09
Speaker
And it's about simple swaps so that people can do a lot of this very easily and avoid and reduce as much exposure to harmful chemicals and radiation as possible.
Consumer Power and Market Change
00:19:20
Speaker
Yeah, a couple of follow ups to that. So when you when you think about incentivizing incentivizing ah green by design, um it sounds like legislation you know may not be the best route for that. You think it's ultimately just the consumers that are going to win out, that their purchasing power is going to you know push companies to to make greener decisions when it comes to designing products?
00:19:40
Speaker
Absolutely. Your point is taken. So, you know, when we also try to give people ideas on how to move the market, but when you purchase cleaner, better products that work hard to make them safer for human beings, not just safer for the environment, you're moving the market. I teach high school students and college students. um I write curriculum for schools. And what I try to emphasize with these young people is that they have every bit of potential to move this market in a better direction. not only because teenagers are very vulnerable to the effects of endocrine disrupting chemicals being teenagers and hormonally active, of course, as we all know, but they also wear and use the most daily personal care products than any other demographic.
00:20:23
Speaker
And so that's really important because they have this really great opportunity to purchase and move the market in a way that's going to help all of us, even though they themselves use the most products. and may have you know increased risk due to their developmental stage, among you know along with children and pregnant women, of course. But it's a really great opportunity for us to share that what you purchase every day adds up.
00:20:45
Speaker
And you know we see this with the boom of you know clean beauty that's really jumped onto the market people are really striving in these companies to reduce all the toxic players that we now know exist. And I think that's going to keep moving. Same with organic food and agriculture. that's organic, I think we're starting to demand better and cleaner food. And even the big box you know shopping stores across the country, big ones, have their own lines of organic food because they knew that it was going to be lucrative for them and safer for the environment, hopefully.
00:21:20
Speaker
I mean, for humans, really. i'm I'm sure with a lot of your your patients and people are interested in reducing the the environmental chemicals they're exposed to, it it can be very anxiety provoking. and And I'm sure it's easy to kind of go down the rabbit hole of, you know, reading the fine print and seeing what, what you know, may affect your health
Top Tips for Reducing Chemical Exposure
00:21:38
Speaker
or not. So what are what are some practical tips you have for your patients and I guess our listeners for, you know, reducing exposures to these these chemicals without kind of being overcome by but the fear of of the effects they could have on your health?
00:21:52
Speaker
Yeah, I would say the top five, and I have actually, believe it or not, in the book, a tear off you know refrigerator list because I really fought for that. And I thought, you know if people just want to hit like the biggies, then at least they could start with the big ones, which um you know take up like a page of this book in terms of just really simple ways to reduce exposure. So you know I'll give you five of them that I think are pretty important. Number one, as I mentioned, water is really underrated, under-emphasized when it comes to risks for human health conditions. And I really think everyone should be filtering their drinking water.
00:22:25
Speaker
And that's really kind of easy now. I mean, A lot of things have gotten so much cheaper. I mean, you could start with either a pitcher, which is a carbon filter, but you could also get more aggressive, which is what I recommend and moving towards something called a reverse osmosis water filter, which are now about $275. And it costs about 150 for a plumber to put it in in one hour and about $40 a year to change out the cartridges. So the upfront costs are definitely heavier than say a pitcher filter, but it's,
00:22:54
Speaker
It turns out that reverse osmosis can be far cheaper in the long run because you keep with it for a good couple, you know, 10 years with it. um So water filters are really great because, you know, even at the very basic level, they're going to take some degree of chemicals from municipal or well water, whatever you may have. And they're more accessible now price-wise. um I also think people shouldn't buy stuff that they don't need, like air fresheners and carpet powders and you know fabric softeners and things that have fragrance that contain phthalates. Phthalates are a group of pretty harmful endocrine disrupting chemicals that keep fragrance kind of lasting and ongoing and with longer shelf life. So anything with fragrance you want to avoid, but certainly any products in in general that that you you know that has color to it and has a strong odor typically are not, you know, I certainly are not regulated, but typically are not that healthy in terms of the ingredients. And they may not all be disclosed on the label. So going back to basics like, you know, white vinegar mixed with um warm water and some soap is a great surface cleaner. And we have do it yourself recipes for personal care products and cleaning products in the book.
00:24:02
Speaker
Or you could just go to the websites that we list in the book where you can actually vet out just a couple top, you know, cleaning product manufacturers and or, you know, cosmetics. And so if you don't bring this stuff into your home, And then you swap out what you need or even just make your own. It's very, very simple. And it's also much less expensive than than most of the stuff that's marketed to us that we need to buy. um Third thing is food quality. I mean, I think, again, we should start to think about the quality of our food and and buy organic whenever possible, um especially frozen organic foods tend to be incredibly nutritional, you know, because they are flash frozen. So they maintain all of the nutrients when it was picked.
00:24:42
Speaker
but you just transfer that organic produce into a glass container. And so frozen foods in general are much cheaper, more accessible, and they often have more nutrient value than even fresh organics because of the way they've traveled um as fresh foods. So, you know, I always say, you know, your quality is much better than even so much the macros your diet.
00:25:03
Speaker
And that's a really good way to stay away from processed foods, which often have chemicals stick with whole foods like whole fruits and vegetables, clean quality protein, healthy fats. um So quality of your food is really quite important. And you can also wash organic produce or so or soak it in baking soda and and water or white vinegar and water. And you can remove a lot of pesticides if you're not buying organic food or or can't have don't have access to organic produce. So there's always a solution no matter what the cost. um I also say get rid of plastics in your home. You don't want to store food.
00:25:38
Speaker
um and drinks in plastic, you want to stick to stainless steel and glass, which are materials that don't break down into the food that you're you're trying to store or carry, you know especially water bottles. I see lots of plastic water bottles, sports bottles, but you really want to get away from plastic because even if it says BPA-free, which is bisphenol A, a very you know well-known endocrine disruptor, my my co-author actually helped to get that off the market in baby bottles in 2012. He's my co-author, Fred Bomsal,
00:26:08
Speaker
But BPA-free doesn't mean anything in this country. It means that they've substituted potentially with BPS, BPS-IP, and a variety of other bisphenols that are considered just as toxic. So sticking with glass and stainless steel, even the mouthpiece is really smart, and you only need to get one or two and have them in your home.
00:26:28
Speaker
um And let me see, personal care products. You know, what I do with high school students and college students is i I have them look up, you know, on ewg.org slash skin deep. um Again, it's in my book, and it's also, I post on this on The Smart Human.
00:26:42
Speaker
People can look up their products, you know, their body sprays for the boys, you know, the the hair chemicals, shampoo conditioners, you know, hair relaxants, um you know, lotions, creams, skin tanners, you name the cosmetic lip balm, you know, anything. You can actually look those up and see how toxic they might be. and find really good substitutes that are really available everywhere. So, you know, those are my big heavy hitters. There's a lot more. um i also talk about radiation and how to manage radiation like our cell phones so that it doesn't hurt your body, such as, you know, taking them out of your pocket so they don't go near, you know, genitalia and affect sperm count for boys and certainly not in the bras of young women who carry them around in their bras, which can actually lead to lesions and potentially cancers underneath the radiation, the antenna of the phone. So I really want people to think about how to use cell phone technology and are all of our Wi-Fi technology safely. And I have a chapter on that in the book that's really kind of easy to understand and and certainly easy to implement.
00:27:45
Speaker
Yeah, got to check out the book. It sounds like there's a lot of ah lot of great tips and information. I'm curious to hear about your, um you you definitely have a unique background, as I mentioned in your intro, right? You you have training in rheumatology, integrative medicine, and environmental health. So how do you kind of infuse all these disciplines in your clinical practice?
00:28:06
Speaker
Yeah, you know, I think it's starting to come naturally, but I don't think that, say, five or 10 years ago, i knew how they all worked together. But it turns out, and as a rheumatologist, I've seen an enormous impact enormous almost epidemic growth. I mean, this is just not me. This is nationally, the stat statistics show this of autoimmune diseases and immune disease disorders, immune disorders, you know, from allergies to, you know, food to environmental allergies, um you know, to autoimmune diseases like MS and Crohn's and ulcerative colitis, rheumatoid lupus, um you know, to type one diabetes. um And, you know, since so many of these environmental chemicals
00:28:45
Speaker
can can affect the risk for developing many of these conditions, including metabolic disease like hypertension, which is high blood pressure, you know obesity, insulin resistance for type 2 diabetes.
00:28:59
Speaker
We really need to focus on how do we remove these chemicals so they don't contribute to this risk. and They can also contribute to the worsening of these conditions. um And it's been well studied, and we reference this all over the book as well, all these studies. So the idea is that You know, when I have a patient that comes in for a rheumatologic disease, there's no doubt that I can get in good information and a good environmental health history just by asking the right questions. Like, what do you drink?
00:29:26
Speaker
Where do you drink your water from? You know, where does it come from? do you filter? Here's a good idea on how to do that. um Do you, what kind of food do you eat? ah What's your occupation? Are you around, you know, are you in an auto body? center where you're breathing in perhaps air quality that may have you know toxic chemicals or even heavy metal exposure through skin. you know So what people do for a living and spendt where they spend time can really be part of this mystery and this detective work on figuring out why they're not feeling well for any number of reasons. And I think that's the problem in medicine is that this has never been addressed. medicines Medical schools do not teach this. They do not teach nutrition even now. Trust me, i've reached out to many of them and offered them the deans of medical schools free curriculum on diet, nutrition, environmental health, and they don't want it. And um that's really because they're teaching to board exams that have to do with symptoms and and treatments, medication medications. So the idea that we can help prevent people from getting sick in the first place is really what my whole medical practice is about as well. It's how do we get in there before the diseases start to evolve and how do we tame those diseases so they're not as, um you know, cause irreparable harm. And so that all comes together with an environmental history. It comes together with a background in internal medicine and rheumatology. Um, and of course I'm trained in integrative medicine for several years and board certified. So I can really give suggestions on evidence-based supplements, diet, nutrition, sleep hygiene, and discussing all the just different aspects of, of improving sleep quality and quantity, managing stress, which has enormous effects on the immune system and other parts of the body in terms of its ability to thrive. So yes, there's, there's a lot that comes together with having multiple specialty training.
00:31:22
Speaker
Yeah, I think, um yeah, one thing i've've I've heard reiterated on a number of occasions, like you said, is just like nutrition, especially in in medical school curriculums and and whatnot, is there there should definitely be more emphasis on that. So hopefully as providers and and patients like yourself, you know, begin to to show more interest that that ah our medical community will kind of respond to that. Yeah.
00:31:45
Speaker
I have a question, ah you know generally, wearing your your integrative physician cap, right? You you kind of ah look for the root cause of disease. So when you meet with your patients, how um you know can you walk us through the process of kind of considering whether you know a disease has ah an an origin, say, like ah a something that's like like genetic versus something? like How do you determine whether the the root cause of the disease is something genetic or like it's an exposure to a toxic chemical, or or could could it be even be both?
00:32:15
Speaker
Yeah, well, every disease that develops is really a dance between our genetics, our lifestyle and our environment. And so any one of those P3 pieces can contribute either a lot or a little. Now let's take, for example, breast cancer. Breast cancer has been discovered to be at about 90% of the cases are are based on environment. Only 10% of breast cancer at this point is considered to be genetically derived.
00:32:42
Speaker
And that's big deal because if we know that girls are going to develop breast cancer at a high rate as they get older, we really need to think about at what age we need to start telling girls about the chemicals that can contribute to that risk.
00:32:56
Speaker
And again, that's why I speak to as many high school schools as I can i can come up with, middle school, because the earlier these young girls um And boys can learn about what they put in on and around their bodies, the more likely they are going to either avoid those illnesses potentially, even if they have a genetic, you know, predisposition. That's called your epigenetics, the ability to change your potential risk of developing a disease that you have a gene for.
00:33:25
Speaker
by your environment quieting it down or not letting it be be expressed. And so our epigenetics, the the kind of the the proteins that allow or not allow diseases to come through clinically is what you can modify with lifestyle and environment.
00:33:41
Speaker
can't always change your genes, but you can certainly change your and but your environment and your lifestyle, which includes diet, nutrition, stress, sleep, et So when I have a patient coming in, first, I got to know who I'm dealing with. I got to know what do they eat? What do they drink? What's their occupation? What's their stress level? What's their family history, of course? But that has learned, I've learned that it's really contributes far less than what they're currently doing and living, um ah you know, with in terms of behavior. So there are only very few genetic conditions that are literally almost one-to-one that if your parent or your grandparent had it. you're gonna get it as well in terms of a disease. Only very few of those. The rest are modifiable or pleomorphic, meaning there's multiple genes involved and that you're not necessarily going to get that disease um just because you have a gene mutation. There's multiple genes that surround that gene and they can contribute good or bad to that disease development. So my goal is always let's focus what we can do.
00:34:41
Speaker
<unk> Let's focus on the low hanging fruit And let's stave off any potential risk for that disease to either get worse or develop in the first place. And that's just called epigenetics. And that discussion is really trying to get people motivated to know that they can make a difference in their in the health of their own body's future.
00:35:00
Speaker
Can you talk about, um alongside a lot of the you know conventional Western medicine that you have in your practice, can you talk about some of the common integrative modalities you use ah
Integrating Medicine: Treating Autoimmune Conditions
00:35:10
Speaker
to treat autoimmune conditions?
00:35:13
Speaker
Yeah. I mean, one of the things is that, you know, some people think that because I'm trained in integrative medicine and environmental health and I'm anti-medication. So I want to say, you know, I have a whole chapter on this book on common medications and what are some of the problems because those common medications are typically over-prescribed and could very well be substituted with very safe alternatives. And that's what I talk about in terms of, you know, statins, and proton pump inhibitors for reflux disease, which is you know acid reflux. So there's a lot of things that we take thinking that they're harmless, which can eventually cause harm. And there's so many integrative approaches to not having acid reflux and to using you know not just dietary changes and behavioral changes, but also evidence-based supplements that are absolutely safe. So integrative medicine really adds this set of tools that are not taught in medical school. that give people choices other than medication alone.
00:36:13
Speaker
Medications can be amazing. And I use them all the time. I have patients that have rheumatoid and lupus and they all, you know, may have, you know, some of them may have medications on board. Some of them may not because they don't need it. But the idea is usually you need some other tool and whether that tool is good dietary changes, um you know, like the anti-inflammatory type diet, which are foods that really do contribute to lowering the inflammation in the body. whether it's recommendations on fixing the gut microbiome and helping the gut, which is literally 24 feet of bowel in the human body and making sure that the gut is the healthiest it can be, since that's the largest you know organ that's in an immune system organ in the body.
00:36:53
Speaker
And so we work on the gut. We we talk about you know environmental exposures that can be modified, such as water, such as stress, such as occupational exposures. And then we work on what you build into the body to make it thrive.
00:37:07
Speaker
such as certain specific vitamins. Certain brands need to be considered, considering there's so much junk out there. And so it's not just a matter of removing all of these chemicals and exposures. You have to add in things that help the body have nutrition to ward off changes from these environmental exposures. And, you know, it's a process and I try to meet the patient where they're at because everyone comes to this discussion at a different stage. I have patients that can school me on everything you can think of in terms of diet, nutrition and supplements. And I have patients that have never seen a vegetable or at least don't eat them regularly. So, you know, really it's a matter of gauging, you know, your clientele, figuring out where their needs are, what they're there for, and really working to give solutions both, you know, so here and now and into the future.
00:37:56
Speaker
I want to take a second actually to talk about ah insurance and and payment structure. um With the interactions I've had with integrated providers, it seems like a lot of them are put in a tough spot where they want to spend that you know hour long initial consultation plus 30 to 45 minute follow ups. And and it it it it works out that it's the way our payment structure is set up, ah that it's very hard to do um and that a lot of them are forced to go out
The Challenges of Integrative Medicine in the U.S. Healthcare System
00:38:23
Speaker
of network. So can you talk about sort of the the challenges of being an integrated physician, you know, wanting to take time with your patients in our current U.S. healthcare system?
00:38:33
Speaker
Yeah, absolutely. um You know, I am not ashamed to say that our system is broken. And, you know, I was, you know, a rheumatologist in a busy insurance-based practice for many years. Then I went on my own to do the same thing on my own, to be insurance-based practice as a single practitioner. And that was just unsustainable. I mean, I could not see patients for more than 15 minutes if I wanted to pay for my overhead, which was my you know secretary and my, if I had a nurse or if my rent, my electronic you know my electronic medical records cost money every year, the lighting, the you know my supplies, my medications. So a single practitioner,
00:39:12
Speaker
in an insurance based setup is really almost unheard of. it's It's just a shame because this is the way my father, who's a physician, he's a nephrologist, used to practice for 50 years and they had autonomy and they could make decisions. They got paid appropriately for each patient they saw from an insurance company. Nowadays, you get paid so little for each patient that you have to have volume of patients just to be able to make the overhead.
00:39:38
Speaker
And um that really just took a toll on me. And I really felt that I was jeopardizing good medicine and what I wanted to share with patients and how much information I needed to get from them in terms of a good history of physical exam and how much time I had to really instruct them on you know proper or dietary habits and water filters and all of those things that contribute to human health. So it just kind of blew up and I knew that I could not manage a practice with seeing 10 patients a day.
00:40:06
Speaker
um with the reimbursements that I was receiving. And so I decided to go out on my own to you know, away from all insurances and set a price point that I thought was worthy of my time without being excessive, but would allow me to spend an hour with each initial visit and a half an hour with each follow-up and really give enough information and get enough information from patients to help solve their health needs, which you know, can be very, in rheumatology, can be very complicated. So I just knew I needed that time and and I knew i would have to get paid for what I thought was valuable to maintain my overhead and to keep a practice, you know, at 10 patients a day, 12 patients a day maximum.
00:40:49
Speaker
And it's worked out beautifully because I do feel that I'm, you know, and everyone has their own choices, but I wanted to set price points that I thought would not exclude the working class people, people who really are just you know desperate with health conditions and really could not find solutions, but really didn't want to break the bank by seeing me as a physician. So, you know, these are things that physicians are struggling with their price points, you know, what, what they can do to, to keep making a living as ah as a physician, but also serving the public in a way that, that, you know, feels good and feels that we're in the right field for the right reason.
00:41:28
Speaker
And um so it's worked out, but you know, you know, I hustle, I hustle to make sure that my patients are happy. My skin is in the game because it's one-to-one. It's not like I have a bunch of administrators that can block for me whenever there's a problem, I have to call patients back. You know, I have to connect with them. And I think it's just a level of connectivity. That's very positive for patients. That's what I've seen. Not a lot of aggravation and anger because people want to come to see me. They're not being forced.
00:41:57
Speaker
um And I think it's just a really good way to to to practice medicine. But it also, as a person who writes books and you know textbooks and teaches high school and does you know social media, the smart human, runs a podcast, you know and I'm trying to get in other education groups, um I really could not do that if I was fully insurance based. It would just be too much volume. So we're all going to have to figure out what works best for our medical practice. But this has certainly been very fulfilling. And I'll probably be the happiest doctor you've ever met, which is a a pretty unique thing.
00:42:32
Speaker
Yeah. and the In the broader scope of medicine, though, do you do you see any solutions between to kind of ah nurture a partnership more between this slower approach to medicine and ah payment methods? or Or do you think, you know, for the foreseeable future, people who who want to take more more more time are going to be kind of, ah you know, pushed out of network?
00:42:52
Speaker
Well, one of the things I think about is, you know, sort of like the water filter situation is that if you have upfront costs that are valuable, such as seeing someone who perhaps is out network, perhaps is cash based, maybe a little pricey, although of course I can't comment on on everyone's prices, because some of them are pretty outrageous that I even think so. um But if you if you put those upfront costs and to work and you really are changing through that that one to one relationship with that physician that you paid money for out of pocket, you know, and you can stave off some of the health issues, can get off medicines, polypharmacy, you know, get off some of these medicines that cause issues. you know, manage your sleep better, you know, get your disease in order, look at, you know, vetted supplements that are very, very effective in reducing inflammation and managing a whole host of conditions, you're probably, those upfront costs will stave off a lot of expenses down the line if you were in a conventional medical practice. Because conventional medical practices will often give you medications and will just see you back at intervals that you're still paying a copay.
00:43:53
Speaker
And so my feeling is you need to go upstream to the problem and try to sort out the problem and go to the root of the problem. And that way you may end up being much healthier down the line. And then of course, less costly to, to, you know, to stay healthy. So that's how I look at it is that you have to do the upfront costs. You have to do the upfront work.
00:44:12
Speaker
And often it changes people's lives so that they really do see route, you know, a road to health and and better, better health and wellness. just through that education early on with upfront costs.
00:44:24
Speaker
Yeah, I definitely, you know, salute a lot of the things you're you're trying to do. I'm sure it isn't easy at times. You probably feel ah in ways that you're getting, you know, resistance from the healthcare system. But, you know, thank you for for ah for for you know sticking to your guns and and, you know, what you're doing in your practice.
00:44:41
Speaker
um Last thing I want to just wrap up our discussion ah actually is is a more personal question about, I understand you live on a farm and can you can you tell our listeners how you know this contributes to your own ah health and wellbeing?
Life on the Farm: Health, Wellbeing, and Pesticides
00:44:56
Speaker
Yeah, well, when we moved in, I lived in New York City, that's where I trained at Beth Israel Hospital and Montefiore Hospital for Rheumatology and Autoimmune Diseases. So I came from a really, you know, the Bronx, New York City, Manhattan. And I also trained in Philadelphia where I went to college at Penn and then also med school, which was MCP Hahnemann, which is now Drexel University. School of Medicine. So, you know, I've been in cities for the better part of my young life. And then i met my husband and we moved to where I grew up outside of Princeton, New Jersey, and there's a lot of farmland.
00:45:28
Speaker
And we bought an old barn and we live on, you know, a couple acres of land. And I really thought, you know, since I grew up originally on a farm with my parents, just, you know, just in terms of land, not really animals, It was kind of coming home again. But it's interesting, as I became began to understand, you know, environmental health and obviously my dog, I started to realize that even in the most pristine settings, there are the it's the there's the potential for harm.
00:45:55
Speaker
You know, so there's no perfect place to live. which I've discovered in terms of even exposures in the most remote parts of the world. But I did find out that I had to manage some of the the pesticide spraying that was going on in literally 10 feet from our back, you know, our door where my kids sleep, even their windows. So I had to sort of embark on a journey of working with farmers that were spraying glyphosate twice a year for 10 years. and really get to know them and and you know bring over organic beers and chat it up and drop off articles. And I swear, and this is really the story of how I've been working with one of these local farmers that's so, you know and there's many of them, but one of them who sprays directly on our next door plot of land. And so you know it's one of those things where,
00:46:43
Speaker
Nothing is ever as pretty or i said I should say as perfect as pretty might might seem. But I still love where we live. I love the nature of the environment. I love my office is sort of in a nature environment. And I think, you know, what I post on Friday is Mental Health Friday is on Facebook, Twitter, Instagram. for the smart human is a lot about mental health. And I think especially about articles on nature and how well that supports our brain and our management of stress um and getting exercise where there's greenery, nature, forest bathing, all of those things I post. And I feel like I'm trying to live what I preach. And for that reason, that environment is just so extraordinary to wake up to, but it has its issues as well. So, you know, I manage them and I balance them, but um I feel very blessed to be living in a very natural environment.
00:47:34
Speaker
That's awesome. Yeah. um I live in the Princeton area myself and I definitely love a lot of the nature. So it's it's cool to hear that you're you're kind of integrating some of your your ah you know knowledge in environmental health with with where you live in the community you live in.
00:47:51
Speaker
um yeah So it's time for a lightning round, a series of fast paced questions that tell us more about you. um but So what's ah one chemical you can't live without?
00:48:03
Speaker
A chemical I can't live without. um i would say if it was a chemical, I would have to be maybe vinegar, you know, because I use it for so much stuff. White vinegargar vinegar for cleaning. I use vinegar in my salad dressing. I love It's really good for the gut microbiome. So just because it's on my brain and it's one chemical, I mean, water would have to be the second or first because, of course, I i really preach on drinking water quality. So water that's clean is really my number one go-to. But water Chemicals wise, vinegar is pretty all encompassing.
00:48:34
Speaker
What's your go-to self-care practice? I just put in a sauna that has no chemicals and we used a woodworking, you know, like ah a really master carpentry guy to do it with no chemicals, no glues, no epoxy resins, just plain cedar, no chemicals in the wood. And it's really tiny, but I have waited a very long time to have the resources to do this because I have two kids. And it's become my go-to one hour once a week that just I sweat it out naturally, and I can just get a little bit of quiet and peace once once a week. I also run a lot. So that's really been very good for my self-care.
00:49:18
Speaker
Yeah, my my gym, once COVID started, closed down the sauna, and i was I've been pretty disappointed. I really enjoyed that myself. Yeah. Yeah. What's your what was your covid binge watch?
00:49:30
Speaker
Gosh, what didn't I watch? In fact, I had like four streaming services and I still do. And I feel like I run out every two weeks. um You know, I gosh, what did I love? There was a couple couple movies I liked on Netflix that was really great. One was The Serpent. I found that really cool. um But I love right now, I love Yellowstone and I love 1883 kind of takes me back to the Wild West when everything was so pristine. There's something really lovely about all of the cinematography. I love it.
00:49:59
Speaker
What's your favorite restaurant Princeton? Ooh. Favorite restaurant, Princeton. um i happen to really like ah Effie's. I like Effie's Mediterranean because I love Middle Eastern food and hummus and really fresh baklava. And that's like my favorite thing in the world is baklava and, you know, shepherd salad and really healthy, non-carby type foods. um So, yeah, I'd have to say ethnic foods are my favorite. And that's that's probably one of them.
00:50:30
Speaker
Yeah. or Or if you want the ah the grease specialty, you can go across the street to Hoagie Haven, right? Yeah. right Well, that's that that's the classic staple. I grew up here and that was like everyone on a Haven run. Right. So but I was never into Hoagies. I don't know why, but I just never into them, even when I didn care about health and wellness back in high school. So ah last thing in the the spirit of hope to close this out, what's what's one thing that's working in our health care system?
Small Hospitals and COVID-19: Effective Healthcare Delivery
00:50:56
Speaker
One thing that's working in our health system, that's a positive question. um Well, I thought, you know, with COVID, you know, um i belong to a very small hospital system i have for 20 years and near freehold.
00:51:08
Speaker
And I just thought that the way they handled COVID was just astounding and and really knew who this, you know the the person who was in charge really bright guy and just how they rallied and the communication with staff, including myself, you know, and letting us know how many people were in the, you know, still to now we actually still have counts, but, you know, daily emails on ICU counts and, you know, kind of crowdsourcing the best ways to handle, you know, getting those plexiglass boxes for intubation. And I just found that, you know, small hospital systems, I'm not sure about big because I'm not experienced with huge systems, but small really,
00:51:46
Speaker
you know, they're community-based, they rock and roll, they they have their skin in the in the game. And I was just thinking that they did a beautiful job of really working through a really, you know, horrible situation. And I think they continue to do very good work on on COVID in terms of their their medications, therapies, recommendations. So I'm pretty impressed with that.
00:52:08
Speaker
Dr. Ailey Cohen, thanks so much for joining the show. Thank you so much. And please, John, let let everyone know about The Smart Human on Facebook, The Smart Human, and Instagram, Twitter, and thesmarthuman.com. And of course, the podcast, The Smart Human, because as much as I post really practical information on everything you can think of from nutrition, diet, breast cancer prevention, chemicals, sustainability, um all of those follows actually help me receive grants to teach. So I really hope that people will follow and share
00:52:38
Speaker
and i really take some this information in for, and I don't sell anything. So it's really legit. It's not, it's not political. It's not wacky. It's just really straight down the middle. Good practical health information. Yeah. You heard it here. Check out the smart human. We'll include ah some information in the info box for this episode.
00:53:07
Speaker
Thanks for listening to The Wound Dresser. Until next time, I'm your host, John Neary. Be well.