The Autoimmune Epidemic: Bodies Gone Haywire in a World Out of Balance--and the Cutting-Edge Science that Promises Hope (No Series) (7 page)

THE POSTWAR CHEMICAL EXPLOSION: A NEW PLAGUE OF AUTOGENS

During the four or five decades that science lingered at the sidelines—at best, underinvestigating autoimmune disease, at worst, ignoring it—another cultural drama was unfolding in America, the portentous ramifications of which were also slipping under the national radar. Throughout the exact same decades that science was dismissing autoimmunity, the wheels of big industry were moving into high gear across the American landscape, augmenting the greatest industrial growth spurt of all time.

All across America, production plants were starting to spring up in town after town, as corporations ramped up production of thousands of novel products manufactured through brilliantly efficient new chemical processes. New pesticides were being introduced to boost crop yields, prolong the shelf life of produce, keep lice, fleas, roaches, and termites out of the home, and zap dandelions from the lawn. Ingenious new chemicals were starting to be employed to help manufacture everything Americans demanded to make their lives easier, simpler, and more luxurious—from plastics to hair shampoo, detergents, brake linings, carpet pads, cold creams, dry cleaning fluid, foam cushions, paint strippers, household cleansers and bleaches, and bigger, grander cars. Almost overnight, Americans began to find themselves inundated with and clamoring for the suburban home products, packaged goods, and manufactured foods churned out by mega-industry. Over four short decades—between 1940 and 1980—factory plumes came to shroud small towns, fleets of trucks spewed diesel exhaust as they transported a myriad of newly manufactured goods from coast to coast, and the ChemLawn truck began to circle the cul-de-sacs in neighborhood after neighborhood.

The coincidence in timing—between a medical community turning a blind eye to a mysterious, growing set of diseases with an unknown set of triggers and a society’s rapid swell in production of everything from SUVs to Teflon pans to furniture stuffed with flame-retardant foam—would turn out to be an ominous one, altering the well-being of millions of Americans.

Together, these two seemingly unrelated trends would set in place two of the key factors that would establish a “perfect storm” enabling an autoimmune epidemic to gather force and take hold. And both would go far in explaining not only why millions of autoimmune sufferers like Jan Pankey and Kathleen Arntsen would be underdiagnosed, undertreated, and marginalized once they did become ill, but why their bodies were so much more likely to turn against their own healthy tissue in an autoimmune reaction in the first place.

For nearly half a century, as big industry flourished, scientists sat idle in the lull of a gathering storm, not only missing today’s autoimmune disease epidemic in the making but blinded to its possible causes.

During these same decades, the idea that chemicals from our industrial age could trigger cancer would become so widely accepted that the term “carcinogens” would emerge as a household word by the 1970s. But science would be sluggish to accept the idea that chemicals could have similar effects on the human immune system. So slow that, even to this day, there still exists no comparable word to “carcinogens” in the world of immunology. The best we can do to describe the notion that environmental chemicals might be linked to autoimmunity is to use the clunky phrase “environmental autoimmune disease triggers,” which is analogous to saying “environmental cancer disease triggers” instead of, simply, “carcinogens.” The term “autogen,” I believe, might prove useful for this purpose, and I will use that term to describe chemical triggers to autoimmune disease throughout the remainder of this book.

It would, in fact, be 2005 before the head of one of the most prestigious research institutes in the country would herald the call, stating that the link between autoimmune disease and environmental contaminants from our manufacturing age had become “the next tobacco and cancer.” Research results would begin to mount, showing that it is the very chemical by-products of the goods we demand to live more convenient lives that are sabotaging the blueprint of how our bodies are meant to interact with Mother Nature. But getting this claim to be taken seriously was going to prove a very tough sell.

A
light is going on in the upstairs bedroom window of a small yellow Cape Cod on Pine Street in the suburbs of Richmond, Virginia. Becky Sandler’s
*
newborn, Zachary, is awake again, his high-decibel cry filling the house. Becky rolls over and lifts him from his bassinet to nurse, and Zachary’s wails subside as he moves toward total satiation, suckling in the healthiest food source on the planet.

Becky considers trying to sleep for a few more seconds but the day has begun. Rising from the queen-size mattress with the “comfort sleep” foam padding on top that she and her husband purchased over the weekend, Becky gets up to face an array of domestic tasks. She is aided in these by a range of twenty-first-century products and conveniences that help to simplify her life.

This particular Tuesday is a fairly typical day for the Sandlers. Rick Sandler is traveling on business. Becky, on maternity leave, is home with the kids. She whips up pancakes on her nonstick Teflon griddle for her four-year-old daughter, Selena, then slices strawberries and cantaloupe on top and squeezes on a dollop of syrup. A piece of cantaloupe, she notes, has fallen from Selena’s plate to the tile floor, and a small line of ants—the same ants that have plagued her kitchen all summer—are veering in that direction. The house is sprayed yearly for termites, but she hasn’t yet called their pest-control company about the ants. Spraying means leaving the house with the kids for the day, to be on the safe side, and she can’t figure out when a good day for that might be.

A burning chemical smell suddenly assails her nostrils: the pancakes. A thin wisp of gray smoke rises up from the Teflon pan’s edges, emitting a chemical stench so intense that Becky throws open the kitchen window, batting the air with her hands.

Half an hour later they arrive at Selena’s preschool. Becky stands holding Selena’s hand, with Zach strapped to her chest in a baby carrier, at the crosswalk, waiting for the light to change. A bus pulls out in front of them, spewing a blast of diesel exhaust. A few seconds later a delivery truck rumbles by, letting out another diesel belch.

Inside the classroom, Becky waves as Selena races outside onto the playground, eager to clamber on a new wooden pirate ship climber that has just been built. On the way back out of the preschool, Zachary drops his pacifier and begins to fuss. An advocate of the five-second rule, Becky brushes it off on her shirt and gives it to him, hoping to stave off his hunger until she can breastfeed him again in the car.

After drop-off, there are errands to run, first to the dry cleaners, then to the mall to pick up Becky’s moisturizer, which she has been out of for days. Then to her hairdresser, to have her roots dyed auburn, as she does by rote every six weeks. On the way back to pick up Selena she stops to fill up the tank of her hybrid SUV, then on to McDonald’s to pick up a Happy Meal with the newest Happy Meal toy for Selena’s lunch. As she pulls into her driveway, the lawn company is pulling away, having just sprayed weed killer on the crabgrass and dandelions that threaten to ruin the lawn.

Later, after lunch, both children take a midday nap, Zach in his bassinet, Selena on Becky’s bed. The dry-cleaned garments hang on the bedroom closet door a few feet away, the cosmetics have been bought, and Becky’s roots are a sleek red-brown again. She has called the dentist because one of her mercury fillings has been aching whenever she drinks something cold or hot. And she has also managed to microwave a cup of noodle soup for her lunch in its disposable bowl, throw a load of baby clothes in the dryer, put tick and flea killer on the dog’s neck, and scour out the toilet and shower tiles with a foaming bathroom cleaner she doesn’t like to use when the children are up and about because the label carries a warning that reads “hazardous to humans and domestic animals” and the fumes make her feel woozy.

Next, she turns to stripping the paint off a child-sized chair and table she found in a thrift shop, which she is refinishing for her daughter’s birthday. When the job is done she takes advantage of the children’s nap to fix a broken plastic horse with a bottle of contact cement that boasts of being “the strongest glue on the planet.” Just as she is putting the horse’s leg back on, the children wake up. Becky sits down to feed Zach while Selena plays Reader Rabbit Preschool on the computer. Zach is cooing at the sounds emitting from the monitor, or maybe it’s the sight of the bottle of breast milk—which Becky pumped the night before in anticipation of a moment just like this, when her milk might run low, and then warmed up in the microwave—that’s making him so excited. It is, by and large, a happy scene. All in all, from Becky’s point of view, her Tuesday with her children has been pretty great.

If you were to view Becky Sandler’s life from the vantage point of the cells of her immune system, however, which are working diligently to distinguish Becky from everything “not-Becky” in order to protect her against foreign invaders and infections, her Tuesday with her children would not appear so idyllic. From the perspective of Becky’s immune cells, it is one more day of bombardment by chemical and industrial agents, forcing her immune system to stay poised on high alert. Each time Becky came into contact with a new irritant, her body engaged in an exquisite chain reaction of cellular events, making split-second decisions as to whether it needed to fight these foreign invaders or not. Throughout this Tuesday, like every day, Becky’s body labored to keep her tissue and organs from being adversely affected by all the external substances that she came into contact with.

Becky and Rick are more environmentally minded than most—they recycle, drive a hybrid, and avoid fumigating for pests around their children. They are also healthier than most, except perhaps for the fact that Becky has Raynaud’s disease, a quite mild autoimmune disorder that causes her fingers to turn white and cold from lack of circulation. But Raynaud’s does not affect her except when she’s exposed to sudden changes in temperature or to emotional stress. Selena, like nearly a fifth of her preschool class, has eczema and food allergies (dairy and tree nuts), but other than that, the Sandlers are all quite healthy.

Becky would no doubt be surprised, then, to learn how many noxious, invisible chemicals are quietly entering her family’s bloodstreams every day, silently lodging in their cells, fat tissue, and, in Becky’s case, her breast milk. Many of these contaminants—the by-products of our modern manufacturing chemical age—are familiar to immunotoxicologists, who study the effects of chemicals on the immune system, and are known to interfere with the intricately calibrated workings of our immune cells.

THE BURDEN OF CHEMICALS WE ALL CARRY IN OUR BODIES

For decades, scientists have been studying pollutants in the air, water, and on land. But over the past five years, they have begun studying pollution in people, and the findings are causing many researchers to reevaluate their assumptions about how successfully our bodies interface with the chemical-laden world in which we live. The most telling work detailing what contaminants are entering our bodies and how much toxicity accumulates in our cells and bloodstreams over time comes from a 2003 study by the Mount Sinai School of Medicine in New York City, in collaboration with the Environmental Working Group (EWG), an advocacy organization in Washington, D.C. Their findings reveal the “body burden” of environmental chemicals and heavy metals carried by the average American. After testing the blood and urine of nine representative Americans from around the country for 210 substances (sample groups are small as these tests are prohibitively expensive), these scientists discovered that each volunteer carried an average of 91 industrial compounds, pollutants, and other chemicals—including PCBs, commonly used insecticides, dioxin, mercury, cadmium, and benzene, to name just a few. This plethora of chemicals had accumulated in these individuals through the common and minute exposures that we all experience in our daily lives. None of the test participants had worked with chemicals on the job; none had lived near an industrial facility. Yet the average participant had detectable levels of 53 known immune system–suppressing chemicals in their bloodstreams and in their urine.

In 2004, the Centers for Disease Control and Prevention (CDC) in Atlanta conducted a similar study testing blood and urine samples of 2,500 people across the country. The CDC found traces of all 116 chemicals they looked for. Then, in 2005, a set of findings emerged that shocked toxicologists around the world. Researchers working through two major laboratories found an alarming cocktail of 287 industrial chemicals and pollutants in the fetal cord blood of ten newborn infants from around the country, in samples taken by the American Red Cross. These chemicals included pesticides, phthalates, dioxins, flame retardants, and breakdown chemicals of Teflon, among other chemicals known to damage the immune system. Shortly after, investigators in the Netherlands turned up similar findings: they discovered an array of chemicals commonly found in household cleaners, cosmetics, and furniture in the cord blood of thirty newborns.

OUR AUTOGEN-FILLED WORLD: HOW DID WE BECOME SO CONTAMINATED?

How do these chemicals creep into our bodies? The process occurs through the simple exposures to contaminants in our world that most of us rarely think twice about. Consider the substances that Becky came into contact with in just one day.

Becky wakes up on her new mattress—with the luxurious foam pad on top—both of which have been manufactured, as have all U.S. bedding materials, with a flame-retardant known as polybrominated diphenyl ethers, or PBDEs. PBDEs are chemicals that manufacturers use to mix or coat almost every single product that surrounds you. Consider what you sit on throughout your day: your chairs, mattresses, pillows, the foam cushions in your cars and sofas. Airline seats and airplane plastic and fabric interiors are drenched in flame retardants to meet safety standards. Add to these exposures the ones from your footwear, the insulation in your walls, and the plastic in your computer, video monitor, BlackBerry, and TV. All these have been made with plastics or furniture parts soaked in and manufactured with PBDEs.

In the 1950s, during the heyday of the American industrial revolution, a singular new invention, polyurethane, began beefing up manufacturing profit margins as it scaled up the comfort level of the American home. Polyurethane, a thermoplastic polymer, was both inexpensive and malleable. It began to be used in novel ways in resins, coatings, insulation, adhesives, foams, and fibers—from refrigerator and wall insulation to upholstered foam chairs and sofas. But there was one drawback: it was also highly flammable. Starting in the 1970s, consumer protection laws were put in place to treat all polymer products with flame retardants. PBDEs began to be used liberally in manufactured goods as the chemical industry’s insurance policy that your furniture, bedding, pajamas, and carpet—all of which are highly flammable—would not go up in a burst of flame if there happened to be an electrical short while you slept or if you should mistakenly knock over a candle while doing your crossword puzzle in bed. But PBDEs had their own downside. They are not molecularly bound to anything in the products into which they’re manufactured. As a result, they continually leach out from the plastics that make up our computers, TVs, and wire insulation, the insides of our window frames, the upholstery, carpets, and clothing we buy, and the lint from the clothes dryer into the air around us. From there they do not waft away in the breeze or disappear; instead, they fall to the floor and attach to the minuscule bits of dust in our homes. One recent study found PBDEs in every single sample of dust evaluated from seventy homes across seven states from New York to California. A separate study of seventeen homes conducted by the National Institute of Standards and Technology found disturbingly high concentrations of PBDEs in household dust and dryer lint.

From our floors, this chemical-laden dust is then kicked up into the air, where it is inhaled into our bodies. Babies and toddlers, who have the highest levels of PBDEs, ingest even greater levels because they chew on plastic toys, drop them in that invisible household dust, and then pick them up and mouth on them again (think of Zachary’s dropped pacifier, and suddenly the five-second rule loses its appeal).

Thirty years ago, Swedish researchers decided to start testing nursing women to find out whether these ubiquitous chemicals could be found in women’s breast milk, and, if so, whether levels of flame retardants in breast milk were rising. They discovered, to their alarm, that levels of PBDEs in nursing moms have doubled every five years. In 2003, a study of twenty first-time American mothers found that PBDE levels in U.S. women are much higher than those found in Swedish women, indicating that Americans’ exposures to PBDEs may be particularly worrisome. Overall, levels of PBDEs in the general population of the United States are ten to one hundred times higher than levels found in individuals living in Europe. Other recent studies show that levels of PBDEs are rising in humans at an alarming rate, doubling every two to five years.

In 2004, U.S. manufacturers agreed with the Environmental Protection Agency to stop making and selling two potent forms of PBDEs known as penta-BDEs and octa-BDEs. However, these continue to leach out from goods manufactured prior to that time, as well as circulate into the air, soil, and sediment, which is why they continue to be commonly detected in our fruits, vegetables, meats, and dairy products. Deca-BDEs, the most commonly used subgroup of PBDEs, remain in wide use because they were thought to be less easily absorbed into the body. Recently, however, investigators have found that even deca-BDEs turn into the more easily absorbed and toxic penta-BDEs as they degrade in the environment around us.