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Ep. 466 How Toxins Impact Women’s Health at Every Age with Dr. Aly Cohen

  • Team Cynthia
  • 21 hours ago
  • 37 min read

I am honored to connect with Dr. Aly Cohen today. She is a board-certified rheumatologist, an integrative medicine physician, and one of the country's leading medical and legal experts in environmental health. 


We began our conversation today exploring the role of federal agencies, including the EPA and FDA, in regulating environmental toxins and their impact on public safety. Dr. Cohen discusses her rheumatology training and explains how our environments affect our immune systems, clarifying why tap water is problematic, how water treatment plants fail to filter out most contaminants, and how pregnancy, childhood, teen years, perimenopause, and menopause are critical stages for toxin exposure. She reveals how many of the laws for processed foods are outdated and ineffective, and how the concept of GRAS (generally regarded as safe) has no real value, and also dives into changes in nutritional value and soil quality, how medications impact our gut microbiome and disease susceptibility, why iodine is essential for detoxifying the lymphatic and glymphatic systems, and how noise pollution affects our health. 


This conversation with Dr. Aly Cohen is invaluable, and her book, resources, and works are particularly significant for this community.


IN THIS EPISODE, YOU WILL LEARN:

  • How the gaps in federal protections outweigh the measures currently in place

  • The cumulative effects of toxin exposure on the immune system, particularly for women in perimenopause and menopause

  • Why tap water is unsafe for drinking

  • Why reverse osmosis filtration is the best option 

  • Why young people should learn about toxin exposure before becoming pregnant

  • How estrogen loss during menopause impacts the immune system 

  • The poor nutritional value of processed foods and the lack of effective regulation surrounding them

  • How medications affect the gut microbiome and immune function

  • The benefits of iodine for detoxification and thyroid health

  • Why noise pollution is problematic for our mental health

“Water is probably the most unrecognized contributor to prominent chronic and acute health issues.”


-Dr. Aly Cohen

Connect with Cynthia Thurlow  


Connect with Dr. Aly Cohen 


Transcript:

Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness Podcast. I'm your host Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.


[00:00:29] Today, I had the honor of connecting with Aly Cohen, who is a board-certified rheumatologist and integrative medicine physician and one of the country's leading medical and legal experts in environmental health. 


[00:00:41] Today, we initiated the conversation on the impact of federal agencies, including the EPA and FDA, and their impact on the safety of toxins we are exposed to in our environment, the impact of her rheumatology training and the role of our environment on our immune system, why tap water is so problematic? And how water treatment plants don't filter out most contaminants, including glyphosate, BPA and drugs? What are critical areas of exposure including pregnancy, childhood, teen years and perimenopause and menopause? Why many of the laws for processed foods are outdated and effective? And the concept of grass generally regarded as safe designation is not particularly of great value? As well as the changes in nutritional value and soil quality, the impact of medications on not only our gut microbiome but also our susceptibility to disease, why iodine is so integral to detoxifying our bodies? The role of detoxification in terms of liver lymphatic system and glymphatic system, and lastly, the impact of noise pollution as well as the impact on our health.


[00:01:54] This is truly an invaluable conversation. I think Dr. Cohen's work is of particular significance and her resources and book and works are one that we should all be leaning into. 


[00:02:10] Dr. Cohen, such a pleasure to connect with you. I was mentioning before we started recording, I read your book now twice. I think it's a really important book and a discussion that needs to be had more often. 

Dr. Aly Cohen: [00:02:22] Well, thank you for having me on. It takes a village, so when you recognize the importance, it makes me feel like my mission is on the right track. And we're colleagues in this mission as well. 


Cynthia Thurlow: [00:02:31] Absolutely. And to give listeners some context, let's give them some perspective about two big organizations that on paper are designed to help protect consumers, but really speaks to the fact that there is a lot of special interests that influence policy that does ultimately impact consumers, our health, our exposure toxins, etc. 


Dr. Aly Cohen: [00:02:56] So, well, we can start with what are the protections that we do have in place, because there's more that we don't have than we do, [Cynthia laughs] so let's start right there. So, when I talk to folks and get into the history of how we got into this pickle, of having over 100,000 chemicals that are human made in the products that we love, literally in the products we love. I love cosmetics, personal care products on textiles, like stain guard, chemicals in building materials, that are in our drinking water just because of how they get in there. 


[00:03:30] If you think about that number of chemicals and how recently in human history, human literally history, meaning in the last 100 years that most of these chemicals have really skyrocketed in terms of their development, mostly after World War II, because that was when there was a lot of wartime need for changes in how we store and send food overseas. Pesticides for pestilence and preventing our soldiers overseas from getting ill with malaria and various other infections. So, there was a huge number of chemicals that really developed out of what you would consider a need. A need for protection, a need for reducing use of resources that are natural. And also because of convenience. I'm not going to discount convenience. It's a constant component of our lives. 


[00:04:20] And unfortunately, the laws that were set up back even in 1938 under the Federal Food, Drug, and Cosmetics Act was really the starting point of some type of oversight with [unintelligible 00:04:33]. So, we had this question of “How do we protect people from chemicals?” And it actually started from a company called Lash Lore that was making mascara and made a lot of women blind. And the daughter of one of the victims actually wrote to the president at the time, and it really put it in motion to say, “Hey, listen, maybe we should be thinking about what we put in our cosmetics, maybe even our food.” 


[00:04:56] The unfortunate thing is nothing came of that 1938 legislation regarding ingredients. It was about a page and a half in the entire document of thousands of pages. To have some type of protections required testing of any kind. And it didn't happen really. Fast forward to 1958 and then you have something called, the Food Additives Amendment, which was really to manage the food ingredients, specifically, not cosmetics. Punchline “cosmetics have no required testing for safety or toxicity in those ingredients.” But you're talking about, in 1958, really, the Food Amendments Act, which was supposed to really jumpstart testing on our food chemicals. At the time, we had salt and vinegar. And so, it was like a real leap to think of anything that would be considered preservative or a coloring or genetically modified ingredients or chemicals that make things crunch for mouth feel. Just the list goes on and on, we have 12,000 of those now that are allowed in food. But that 1958 policy did not do anything. 


[00:06:00] Then you fast forward to 1976 and you have the Toxic Substance Control Act that didn't seem to put anything really tangible into place. You had more recommendations. You had more call out, but there was no absolute regulations in terms of required testing for safety or toxicity. And then again in 2016, there was another attempt to reinvigorate the Toxic Substance Control Act, and that failed because we had too much of a bipartisan or I should say a partisan sitting in our Congress and governing. So, we've really had multiple attempts and nothing really has come of it in any major way. We've had some wins. We've had regulations over time in terms of what's allowed in water. We've had DDT removed from pesticides. We've had-- asbestos has changed in terms of its regulation. But compared to anywhere else in the world, we've only had upwards of about 12 chemicals. 12 chemicals out of over 100,000 that have ever been regulated in some way in the US market compared to other countries that Europe has about 1200 they've removed, but we have 12, so, that's where we stand. 


Cynthia Thurlow: [00:07:06] It's really interesting because I know that, as you mentioned, the EU as an example has over like 2,000 banned toxins in comparison to what we have here. It really speaks to the impact of special interest groups and lobbying efforts here in the United States. And this is why I think these conversations are so important, to bring greater transparency so that consumers understand that we have to do the due diligence that we do not per se or should not per se presume that everything is safe.


[00:07:36] And I think over time, when I look at female patients in their 30s, 40s, 50s, and beyond, the net impact of a cumulative net effect of exposure to toxins throughout our lifetime, it's like the toxin bucket has just been overfilled. And this is where, I will see weight loss resistance and a lot of metabolic disease and challenges with hormones, especially for people that are in declining hormone levels as they're navigating late perimenopause into menopause. And so, I'm curious, as a rheumatologist, what are some of the trends that you have been privy to be able to witness over the last 15 or 20 years in clinical practice. I know for you, you have a very interesting story that kind of got you thinking differently about exposures to things, our environment, our personal care products as well. But as a clinician, what were some of the signs or the pieces that you were putting together clinically that were just starting to not make sense anymore? 


Dr. Aly Cohen: [00:08:34] So, I became a rheumatologist after internal medicine training about 18 years ago. And I was trained at really wonderful institutions, western-based institutions in the Northeast. And I had excellent training, but I did not learn throughout med school, throughout residency, throughout fellowship and fellowship is on the immune system. I'm a rheumatologist. Not one mention that environment or chemicals that were already-- The papers were already there, literally there is published peer reviewed studies at this time, but never had I been told that there was any kind of exposure-related connection to the immune system and how the immune system works. 


[00:09:18] And so fast forward to when I was a young mom and I had a dog. And of course this is what you're alluding to. my dog became very sick and I was just right out of fellowship training and here I was wondering why my dog had autoimmune hepatitis as a four-and-a-half-year-old puppy, Golden Retriever. And so, I started to explore out of heartbreak, his drinking water, his food quality, his toys that he-- plastic vinyl toys in his mouth, his flea and tick chemicals. I lived on a farm, still do, and I was worried about some of the pesticides exposures here as a young mom with two little kids running around. 


[00:09:51] And what I really realized at that time, and it started the process of this mission in my mind to figure out what the truth was, was that everything that could be affecting him certainly could be affecting humans because there was no regulation for pets, let alone for humans. And it was so mindboggling, it was so eye opening to me. I felt slighted and it was starting to correlate. Even as a young rheumatologist working at that time, it laid the foundation of how I would be asking patients questions moving forward, “What they ate, what they drank?” Trying to decide in my own world whether or not there were correlations. 


[00:10:31] And it turned out that the data that the epidemiology of environmental chemicals and their effects on not just the hormones, endocrine-disrupting chemicals, which I've written two books about, and there's more than enough information out there worldwide that it also these chemicals have effects on the immune system. And it started to dawn on me why I was seeing not just dogs at younger age getting strange autoimmune diseases, but human beings getting autoimmune diseases at younger ages that you might expect different from textbook assessments, and even with no family history. And I think what that really points to is there's such a strong environmental component to whether or not we develop autoimmune and immune disorders. And I was trying to figure out what chemicals did that? Which ones? What was the literature saying? And really framing my practice and my perspective around that issue. And then it became this book which really talks about the big picture here. 


Cynthia Thurlow: [00:11:30] Well, and I think that for listeners, there's really-- I mean, every specialty in medicine touches on the immune system, but nothing like rheumatology does. So, for me, the fact that you were making these connections over the course of the trajectory of your career is quite significant. And I think that a lot of people in traditional allopathic medicine, I always like to give credit. I am allopathic trained. I'm also functional integrative medicine trained. I would say there's a blessing to allopathic medicine. If you have an emergency or an urgency, that is where it really shines, but on a lot of prevention, chronic disease management, we don't per se look necessarily at the root cause. And that's why I think this conversation is certainly so important.


[00:12:16] You know, one thing that really stood out to me as I was going through your book was issues around tap water. It seems like such a benign kind of innocuous entity. And yet this is something that I think for everyone listening, all of us just getting more conscientious about how we consume water. Water is essential for life obviously. Being conscientious about municipal water, well water, the potential toxins we can be exposed to, I think that this would be a great way to pivot and talk a little bit about why is water so important in terms of our health and our exposure toxins. 


Dr. Aly Cohen: [00:12:52] Yeah. And so, water is such a critical component of human health. In fact, I would venture to say and I say it throughout the book, it's probably the most unrecognized contributor to prominent chronic and acute health issues that no one pays attention to. We have thousands of books on diets and nutrition and we don't-- And we think about macros and fats and carbs and how much protein when you hit menopause. And there's a lot of talk about all that, but no one really talks about the fact that we need to drink water. We've been drinking water all our lives. We're made up of water, about 85% to 87%, every tissue in our body. And we take it for granted, kind of like sleep. 


[00:13:33] We take a little bit of it for granted, get away with it and we kind of can't see these toxins in our water. It's clear. We can't necessarily smell them, so it gets a pass. And my feeling was we need to just like really learn just the basics on water because when you know just the basics, it's not hard to motivate into some of the recommendations that I give in the book and really lay it out. And so just really quick basics is that we have a municipal water system in the United States which by the way is far better than any third world country. But it's certainly would be in my opinion enough for human health disease prevention, so that's why I'm sharing this. 


[00:14:14] But our municipal tap water, municipal tap, whatever you want to call it, we have about 160,000 more or less across the US-- scattered throughout the US, that service and give drinking water and send water to our homes to about 85% of the US population. So, it's the predominant way we get our drinking water. 


[00:14:35] Wells, on the other hand, service the other 15% of the US population. And that could be a personal well under your home if you're really rural, if it's a town, usually it's more rural and away from water lines. Either way, what we need to know is that it doesn't matter where your water comes from and I'll tell you why. Because you want to clean it when it hits your home, when it hits the point of use. And the reason being is that under the Safe Drinking Water Act for the municipal tap, the 160,000 wastewater treatment plants follow a law called the Safe Drinking Water Act that's dated back to 1974 and had very little change since that time in terms of its oversight of, get this, 91 chemicals. So, there are 91 chemicals that are required to be tested at these wastewater treatment plants. And if they hit a higher level than they're allowed, so it's their allowable-- designated by the EPA, allowable maximum concentration level or MCL for that chemical. And it's designed for a 200-pound man drinking 2L of water a day. So that doesn't really encompass everyone in the country and 91 chemicals since that time. 


[00:15:48] So, we're talking 50 years. As I mentioned earlier, the chemicals that exploded were in the 1940s and 1950s after the Safe Drinking Water Act. So, we now have this problem where we have all these wastewater treatment plants that are not equipped or capable, don't have the infrastructure to really clean water, given what we now know can get into our water systems from lakes, from streams, from sewage, from manufacturing runoff, from rainwater, it gets from air pollutants. So, there's a variety of ways water gets dirty and then it can't get cleaned before it comes to our home. 


[00:16:25] In addition, we add chlorinated chemicals to prevent pestilence and severe diseases. This is why we're not in the 1600s. But we also add detergents and those do not come off when the water leaves the wastewater treatment plants and then it travels through maybe several miles, 30 in my case. I've researched the facility, I've interviewed them. It goes through piping, PVC piping, if it's replacing lead piping. So again, all these maybe breaks in the system, it gets your home pretty dirty, pretty unfiltered, pretty contaminated. And when you get small loads of these contaminants, just like you would maybe from personal care or from air quality problems or even from your diet, you're adding up problems over time. And I think that's what people forget is that the littlest amounts actually can have big impact, not only from a chemistry perspective and how they work, which we now know, but also from overload from even just the dose makes the poison perspective as well.


Cynthia Thurlow: [00:17:22] Well, and I think you bring up so many good points, and one thing that I want listeners to think about is that our current water treatment facilities do not filter out hormones. So, if you are on the pill, if you are on HRT, etc., most drugs that are excreted renally that we're urinating, they get into the water supply. So, it's like this toxic stew. And I did actually ask a urologist who was a guest, I said, “Is there any way to filter out hormones, exposure to hormones?” And he said, “There's very few options at this point.” And that's not even counting for the microplastics, which I know really proliferate in our water supply. And this is why, sometimes when I travel, I have to kind of forget for a second the fact that I may have to buy bottled water in the airport because I can never-- I get dehydrated so easily, but this is what we're thinking about, [crosstalk]


Dr. Aly Cohen: [00:18:16] I have a fix for that. 


Cynthia Thurlow: [00:18:18] Okay, I want to hear it. Because I do a lot of travel and sometimes, they're not-- They give you those little water fountains, but you're like, “I don't know what's in there.” So sometimes that can be challenging in and of itself.


Dr. Aly Cohen: [00:18:28] Yeah. These are risk benefit tradeoffs. And it's interesting that you say that. I actually post on the Smart Human is my platform on Instagram and TikTok and Twitter and all that is videos when I'm traveling. Because I did do a lot of travel for this book promotion. And I was a big bottle person. I would go over to this big wall of bottles and turns out that each water bottle has an ingredients label which you would never even think to look at because water is water. Again, something we just overlook. But it turns out that ingredients label, that spot on the bottle will tell you how the water was cleaned, whether it was distilled, which is most popular in terms of sales.


[00:19:08] Believe it or not, the gall of having municipal tap I've seen on plastic water bottles. Okay, I could build it up in the sink in the bathroom. And then the third one is reverse osmosis, which I will tell your audience is the best choice because despite the fact that you can't get all the microplastics from the packaging out, okay, that's the risk-benefit ratio. You're still going to have water that if it's true that's how they cleaned it, that way will be more aggressively cleaned and distilled in general. So reverse osmosis is something you can get in your home as a filter, but it's also something you can look for in plastic bottles. 


[00:19:39] And I've actually since made a change to just bring my stainless steel. I don't promote brands, but stainless-steel container without a plastic lid or flip top, I use -- And I actually now bring it every time I travel because it's thermal and you can get hot coffee and tea. But you can also fill up with carbon block, which is what most institutions have is a big carbon block, which is not as great as reverse osmosis, but then you save water-- I mean money. You save also microplastics, likely in terms of your contamination. So, everything in life's a risk-benefit ratio. And I just like to throw that in the book because I want people to know we have lots of options. Whatever's right for you is the choice. It's not so much what I tell you to do, it's not perfection. I'm not even,100%. I'm an 80:20 kind of gal. My hair's colored. My kids play lacrosse on toxic turf pretty much every day. So, we're working through life in a very reasonable way here but this is not about judgment or regret. 


Cynthia Thurlow: [00:20:37] Do you have recommendation in terms of-- Do you think that there's value in testing your home's water? And the reason why I'm asking is that what may be in my water in Virginia may be very different than Florida, California, etc. And so, we actually had our water tested and then ensure that the filtration system that we have for the house actually can filter out the things that we're greatest-- We have the greatest concerns about Cadmium, for whatever reason, is more prevalent in our area. So that was something that we wanted to be conscientious about filtering out.


Dr. Aly Cohen: [00:21:10] That's a great question. So, I started doing a lot of testing in my own home out of my own curiosity for the recommendations of filters that I give to my patients. I didn't want to give them a recommendation that actually wasn't working, so I started doing testing. There are third party testing companies I do not-- And they're in the book, all the recommendations, I promise, are in the book. One of them is Tap Score. I do not have any endorsements or brand affiliations with anything because of the work I do with schools and high schools and curriculum. 


[00:21:40] But I will say I do also really think about people's financial situations, especially people who are searching for answers, spending a lot of money maybe on supplements that they may or may not need to take or should take, maybe on doctors, maybe any number of things people are spending money on, it's limited. So, when I think about our bodies, like I think about our water, I think instead of testing, just know that it's dirty. Our bodies are contaminated, our water is contaminated. Spend that money, that's about 300 bucks for a water testing kit, and put it to buying a $300 reverse osmosis water filter under your sink or on top of your sink. A plumber putting it in is 150 for one hour. $400 up front, you've got this system that you don't even have to fill up. 


[00:22:26] if you're busy, like I'm telling you, I've tried all these filters. They send them to me and once you're done filling it up, you got to sit there for ten minutes filling it up again. So, I think convenience plays into your choices, but also the type of filtration, the cost, even comparing in the book, I compared to the drop in filters that are carbon block, they can add up. So, I just want people to think about all the different options. 


[00:22:51] So testing, back to your question, to me is great if you're interested and great if you want to find out. But it is at that moment, it's kind of like blood testing. At that moment is what we're getting a snapshot of. But if you have a flood or tornado or it's seasonal and you're in the Corn Belt and you're getting sprayed with pesticides, you're in the Northeast like I am, and you're getting sprayed with glyphosate or what have you, that water quality is going to change. Arsenic levels, cadmium, heavy metals, chlorine levels, all of these things will vary at a moment-to-moment basis. You can also check-- I even have a resource where you can check by zip code what your most recent testing could have been, but it might be a year old. But at least it gives you an indication and supports the fact that there's contamination, because I don't think there's a zip code in the US that is not contaminated, so-- 


Cynthia Thurlow: [00:23:41] And it's such a good point, I think for people that are listening, that feel a sense of overwhelm and dread, like they love these conversations, but then they dread these conversations. It sounds like there's-- And I know there's so many good resources, objective resources- 


Dr. Aly Cohen: [00:23:55] Yeah. 


Cynthia Thurlow: [00:23:56] -for options depending on someone's budget, their comfort level. I usually say, like pick one thing at a time. Don't feel like you have to make all the changes all at once. In terms of kind of looking comprehensively at vulnerable periods in our lives when individuals, you mentioned that you talk to schools, you've got teenagers at home, as do I. When are the vulnerable periods? If people are listening, they can kind of be attuned. Obviously small people growing are going to be more susceptible to toxins than an adult. But we know that there are certain stages in our lives when we can be more susceptible to chronic accumulation/exposure to toxins. Where would be the areas that you would suggest our community really leaning into? 


Dr. Aly Cohen: [00:24:42] So I would say starting with-- And listen, all periods of human exposure, of development and exposure is a potential harm, but it is true that we are vulnerable at certain periods of human development more so than others. And so, for instance, during pregnancy, and I say this not to blame moms or dads, not to blame anyone who didn't know better, because as I talk about in the book, I was rolling up to Mickey D's every morning with my oldest son and having a full-on egg pancake breakfast while pregnant. Not worrying about the hot plastics, not worrying about the synthetic maple syrup, not worrying, I'll probably get sued here, but I was not worrying about anything at that time because I did not know better. 


[00:25:23] But when you know better, you can start to do better and it's not about judgment, it’s a journey for everybody. But I would say during the-- If we can get information, and this is why I speak to high schools and I'm so adamant about getting this into schools nationally, if we can get to people younger before they may choose one day to have children, if they choose to get their bodies cleaner to make choices that are safer for their bodies on a regular basis, even as teenagers. That's a particularly-- Pregnancy is a very particularly worrisome component to this topic because we know the placenta does not really protect against the vast majority of these chemicals. 


[00:26:05] There was a 2005 study that everyone talks about, no one really needs to even repeat, to be honest. From the environmental working group that I talk about in the book and others that, essentially, they took the blood, the cord blood from 10, they called it average Americans. So, a little bit of this and a little bit of that Americans, and they looked at the cord blood from newborn babies that were born to these women and they found over 200 industrial chemicals and this was 2005. And these are moms that range from really conscientious, really thinking about what they do with their bodies to people who were really less aware, not interested, wasn't their thing. And it just goes to show how, believe it or not, you know this is what makes humans. We can all be exposed no matter what our product choices, no matter what our socioeconomic background, no matter how fancy our lipstick and expensive, it doesn't mean it's safer from chemicals. It may be that it's a better brand for other reasons that they, but it does not in any way mean that there's safer chemicals because it's true that across the board these regulations apply or lack thereof. 


[00:27:14] So, pregnancy, thinking about that population getting to younger people before they become pregnant to be prepared. Young children, once they pop out, we've got underdeveloped detoxification pathways. We've got narrow choices in food, which again, in this book I talk about how food is medicine and so powerful to offset some of the harm, even the epigenetic harm that comes from exposures to chemicals so that we have an effect on our genes and successive generations, believe it or not, their foods are narrow in terms of what they eat. My kids don't eat anything that I want them to eat most of the time. But as a toddler, it's even more narrow. And also hand-mouth behavior, so they're touching dust and they're putting things in their mouths. And so that developmental period is pretty vulnerable. 


[00:28:05] And then we have my favorite group here because of my kids, teenagers. So, by definition, teenagers, I mean literally by definition, their hormones are teeming. They're creating and breaking down hormones so much from growth and development. And we see that throughout development. But certainly, in the teenage years, they happen to also use the most personal, the most number of personal care products in a 24-hour period than any other demographic. And so, they are more exposed to many of the chemicals that can affect fertility and can affect growth and development, that can affect hormone sensitive cancers potentially down the line and heart disease with phthalate exposures down the line. And so, we have all the data to show this. The question is, how do we get these kids to care? And I've been working on that. And they're very open to this material, by the way. 


[00:28:53] And then we have even menopause, like people-- We discount menopause as a time period where it's not a big deal. You lose some of your estrogen, ah, big whoop. You get some pains and aches and what and it goes away and you're fine, hot flash is done. But it turns out that that period of again, flux of hormones is also a very vulnerable period for exposures. And when I talk about in the book endocrine-disrupting chemicals as they affect hormones, they're also immune-disrupting chemicals as well. And so, I talk about how they're very-- These systems in our bodies interconnect and communicate, so it's not like they're separate. They actually work in concert together.


Cynthia Thurlow: [00:29:30] Well, and it's interesting because you talk in the book about toxin exposure may also cause earlier onset of menopause. We know the average age here in the United States is 51. I see plenty of women going in their early 40s, mid-40s, late 40s, way before that kind of 51 mark. And the other thing that I think is really interesting, and I just finished my second book, talking about the gut microbiome and the interrelationship between estrogen and immune function is absolutely fascinating. That loss of estrogen has such a profound impact on not just susceptibility to infections, but rise in autoimmunity. And so, I know for you, because this is your area of expertise, I think, that there's not enough discussion about the immune-modulating properties of estrogen and why it's so important. We think about it for so many other things. And yes, bone protection, heart protection, cognition, but also the immune system.


Dr. Aly Cohen: [00:30:25] No, for sure. And this is why men and women are different creatures when it comes to all of our physiology. I mean this is why I think we're getting a lot of attention now with the whole menopause movement. There's a zillion books coming out and people are really paying attention and not letting doctors who may discount certain things off the hook because they're trying to figure out answers. That's all people want is answers. So, for sure, at the time of this publication, which is now, we are now seeing so much more investigation into why, for instance, more autoimmune diseases predominate amongst women than men.


[00:31:00] Literally, it's not-- There are some that are equal, like for instance, psoriatic arthritis and inflammatory bowel disease can affect women and men pretty equally in terms of the predominance in our demographics. But we have some that are more male dominant, like ankylosing spondylitis. But we have majority of them rheumatoid, lupus, MS, even Guillain-Barre syndrome, they tend to be more female dominant. And the question is why? And why is it also during certain periods like rheumatoid is more pronounced or the instance is higher during the years of fertility. So, like 20 to 40, so to speak, in the textbooks. 


[00:31:39] I'm seeing these issues happening younger. And so does the data support this, that's one of the reasons why I was so urgently called, I think, to this mission and this book. The idea that estrogen receptors-- it's one of the most ancient hormones of human evolution and existence, it's on every-- There's receptors for estrogen androgens and a lot of other hormones on every immune system cell in the body. And now we know that there's-- At the time of this publication, there's even gene findings called the Xist gene, which we now know is a way anthropology to knock off some of the gene material to create male versus female that might be dysfunctional. And so, there's a lot more science ahead, a lot more to be had, because we want to figure this out. 


[00:32:30] In the meantime, we need to do something about exposures, because we know that that can contribute, as you mentioned earlier menopause back to teenagers, we now see puberty happening at such a young age, as early as seven, eight, nine years of age, when 200 years ago, two centuries ago, it was at 16 and 17 was the average. And we're seeing this for both males and females going through puberty. So, we have a shift from all of this mimicking of these chemicals, mimicking various hormones, including estrogen and androgens, that are really implicated in why we're seeing a shift in

puberty, earlier menopause, and of course, I'll say I'll speak to the immune disorders. 


Cynthia Thurlow: [00:33:11] Yeah. And I think for a lot of individuals, certainly in my generation, I grew up in the 1970s and 1980s, I don't think I got my period until I was 14 or 15. And when I hear about these poor young women at seven and eight years old, I'm like, that is a burden for young people to be dealing with at such a young age because maturation-- they may be sexually mature, but they may not be emotionally mature to be able to navigate decisions and things that they need to do differently to have this longer trajectory of fertility, which has other implications.


Dr. Aly Cohen: [00:33:40] Implications of breast cancer. Implication, you know the longer women are exposed to exposed to many estrogens has been-- I'm not talking about hormone therapy. I'm not getting into that realm. But just really in general, the studies show that the longer you are exposed to estrogen, the higher your rate for breast cancer. I would like to also say that these chemicals have been found in breast tissue that Dr. Bill Goodson, who I interviewed for my podcast The Smart Human on breast cancer, he was doing fine needle biopsies voluntarily. Women were volunteering biopsies. They had no breast cancer history. They were family members that were very passionate about learning more information. 


[00:34:16] And he took 28 women and fine needle biopsies at the beginning of 28 days. And they all changed out their cosmetics and personal care products to safer versions, safer products. And then they voluntarily, all 28 came back for another biopsy at the end of 28 days. And it turns out that the signal for cancer was reduced after changing their cosmetics and personal care products just for 28 days, that's what they were looking at. And it made a lot of news for a very short period of time. But again, this is why we're out there trying to hustle this information because it's so good, it's so critical to our young people to make decisions young so that they don't end up with getting hormone-sensitive cancers and other immune issues. So, it's all about education as you know. 


Cynthia Thurlow: [00:35:03] Yeah, absolutely. And really speaking to the fact that those simple changes have a large impact that you know I think for a lot of people, they're like, “I'm overwhelmed with having to make so many changes.” Every change is going to have a positive net impact. That's the point of why I think this discussion is so important. Let's briefly talk about processed foods because I think people, again, they assume whatever's in the grocery store has been regulated, is safe to consume. And I think the more that we understand about just reading ingredient list, being conscientious about avoiding certain ingredients can be very, very helpful. I'm not suggesting that if the bulk of your diet is processed foods, that can slowly be improved upon, but in the interim, as you are navigating better choices, reading ingredient lists in and of itself can be very, very helpful. 


Dr. Aly Cohen: [00:35:52] For sure. I break that down in the book and I want people to know that our food system is really, it's unbelievably fraught with problems. It's not just eating processed and ultra-processed foods, which by the way, not only have thousands of untested, unregulated and grandfathered in ingredients because there was no oversight in these ingredients and they designated as generally recognized as safe, meaning it's voluntary safety information from manufacturers not required by third party testing. And so, when we think about the food industry, that's one aspect, but we should also be thinking, and I call attention to the nutritional value of our food now, not just the processed and ultra-processed foods, which we would certainly think, “If they're packaged, less likely to have nutrient value.” 


[00:36:40] But even our produce travels a very long distance before it gets into our supermarkets. Even our soil quality in terms of the nutrients that our plants and produce actually absorb is very limited. And packaging-- food packaging is an incredibly important route of contamination into the food and drinks that we drink. You could have organic canned foods and it will still have an epoxy plastic BPA lining. That's part of the food packaging regulation, not part of the food industry per se, separate issue. 


[00:37:11] And so, through the book, instead of overwhelming people, I want to get them right to the solutions. One of them is listen, frozen USDA Organics, which matters because USDA Organics is one of those few regulations that actually does work. But USDA organic foods are a great option because it reduces pesticides and fertilizer chemicals. It also does not allow for genetically modified ingredients. It also means that produce has been grown in soil that's organic as well. It also has a lot to do with how much spraying is done and by which types of chemicals. And it's not a perfect system, don't get me wrong, but it's the best thing we have. 


[00:37:50] But frozen USDA Organics, every big box store now has their own brand. So, you could be in Podunk or wherever, and you might actually have access to really great frozen USDA Organic produce because it has all the nutrient value, because it's flash frozen, they pick it and they run it to the freezer and they package it up. And so, it just really turns out to be a great option for people looking for cleaner quality and actually reasonable price points. 


[00:38:16] So, like I said, the food system, so many variables that we cannot control, but the ones that we can in terms of all of these choices, and what I really shoutout is that we can make so much of a difference not just in choosing what we put in on and around our bodies, but also how we maximize our detoxification process, how we implement sleep and quality sleep, and exercise, and sweating, we can get into that. But there's a two-pronged approach to this process, one is to really get rid of chemicals wherever we can or swap out to products that are safer. But then there's an addition to our bodies that matters so much to human health. 


Cynthia Thurlow: [00:38:54] Yeah, I love that you brought up the flash frozen fruits and vegetables because it's a very cost-effective way for people to continue enjoying the fruits and vegetables that they love. What I would say is before we talk about supporting detoxification, which is a big concept, I would love to at least briefly touch on some of the medications that we know impact the microbiome vis a vis, changes to again, immune signaling and endocrine-mimicking chemicals, because I do think this is important. I think for a lot of individuals, again we assume, with the exception of maybe antibiotics, which I think everyone understands, that does have a significant disruption to the microbiome. A lot of these other medications that seem benign and innocuous are actually not.


Dr. Aly Cohen: [00:39:35] Yeah, look, I am not anti-medication overall, but I mean I use them all. As I mentioned, as a rheumatologist, my patients will have major problems if they don't have medications, including the biologics and all the ones that were developed over the last 25 years since I was in training. They are mind blowing in many cases, but they don't always have to be used reflexively. I think that's the problem. We need more tools to try out prevention, root cause. Let's figure out the gut microbiome and how it plays out. Let's change our diet, our stress, all that, because that is ultimately what you want to solve upstream. You don't want to necessarily just go to the punchline and have to stay on the punchline even though it may work. So, I'm very-- It's just another tool in the toolbox. 


[00:40:15] Now there are certain medications that work against us and should only really be used, I believe in the science really pans out in short periods of time for specific goals. Watching for outcomes, managing side effects, and really communicating with your prescriber about whether or not you've achieved the goal. And are there alternatives? That kind of thing. They may not know alternatives because that tends to be extra training like integrative medicine or functional medicine. People are learning about licorice root, deglycyrrhizing licorice root that's safe and effective for reflux. Instead of taking a proton-pump inhibitor which turns off acid cells in the gut. 


[00:40:54] Unfortunately, unfortunately we've used that those cells for millions of years of human existence to turn them off for long periods of time may solve a short-term goal, which would be an ulcer or manage reflux and GI bleeding, they're used, and certainly that's important, but not necessarily staying on these drugs or that class of drug for example, long term, because acid is really critical to taking nutrients out of food. It also can affect and has been linked to higher levels of H. Pylori infection in the gut, higher levels of fracture because it decreases absorption of calcium and vitamin D into the body. Because you're changing the milieu, the environment of how our bodies work. And that's something you don't want to do long term. 


[00:41:40] Same with like melatonin. You want to really avoid too much melatonin because innately our bodies make melatonin. It's an incredibly important antioxidant. It's been linked to profound effects for cancer prevention. In fact, we know shift workers have higher rates of breast cancer. Females who are really messing with their light and darkness melatonin levels. It's not to say they're going to all get breast cancer. It means that you want to sort of have long periods of day work or long periods of night work and then really try to catch up on that sleep and have no light during the day when you're sleeping. So, there's fixes for all of this. You just want to be aware. 


[00:42:16] So, proton-pump inhibitors. Like typical medications for blood pressure actually. There was a Nature article from 2018 that I talk a lot about that when they looked at all these conventional drugs, not just antibiotics, that there was a mild to moderate change in the gut microbiome and the microbes that are considered healthy just by using them on a daily basis. And so, we just want to be thinking not so much get rid of meds, but let's just use them judiciously. The least amount dosing over the shortest period of time necessary to solve the problem that you're looking for and with real specific goals and monitoring. 


Cynthia Thurlow: [00:42:56] I think that message is so important. I'm not anti-medication and I don't laugh, but I think back to 16 years of clinical cardiology as an NP, everyone got Protonix when they hit the hospital and a lot of people were just given the Protonix during the duration of their hospitalization. But many people were continued on Protonix long term. And we know that being on an acid-suppressing agent more than 30 days has a significant and quite profound impact on things like pneumonia. You mentioned H. Pylori, but a lot of the-- We're inducing normal mechanisms in the body to not be able to do their jobs effectively and that can have a domino effect in the body. Let's talk about what detoxification is for maybe listeners that are not as familiarized with it and why minerals like iodine are so important for detoxification.


Dr. Aly Cohen: [00:43:44] Yeah, and I go off on iodine a lot in the book because it's one of the most-- I find it to be such the most interesting perspective on the combination of where we're at as human beings in modern day time. But in terms of detoxification, it's a really big one word. I think it's sometimes overused, just like inflammation is overused, just like toxins. Unfortunately, in order to sell a book and get this information into people's hands, you have to use the colloquial phrasing. But let's be clear, the human body has been remarkably capable of detoxifying itself and surviving for millions of years. The problem lies in the fact that we've come up to this point 75 years ago and all of a sudden, we're seeing a lot of change happening over a very, very short period of time. So, the body's going like “What? This is a lot of stuff to work on.” 


[00:44:30] That being said, we have pathways where the liver, of course you think liver detox, drinking alcohol, those things we think right to the liver. But the liver does a great job on a lot of these industrial chemicals. We've been finding that out. And that by supporting liver function by exercising and flooding the liver with lots of clean blood, by eating specific foods like cruciferous vegetables that are loaded with compounds that help that detoxification, it's called Stage 2 conjugation, has really helped to make the liver do its best. 


[00:45:06] By reducing alcohol, things that we have control over in terms of our choices is an option by reducing over-the-counter pain medicines on a daily basis or managing medications by managing stress in our gut. Our detoxification pathways go on in the gut as well because that's the entrance into the human body. Whatever crosses that tube of the gut into the bloodstream will either serve it well or piss it off and make the immune system react. So, there's a lot of different avenues by which we detox. We have a lymphatic system that we can keep moving. I talk about trampolining and how fun it is, but also how it's so beneficial to moving fluids and waste around the body. We have the glymphatic system around the brain and spinal cord, which is a drainage component for chemicals that we experience during the day. We wash out at night with sleep. So, it's a combination of lifestyle. And then feeding food is medicine into our body. And then I even talk about supplements and supplements being what I call human fertilizer. Anthropologically, I believe the human body is like a plant. If you give it what it needs, it will thrive. It'll do better than if it did not have those nutrients. 


[00:46:13] And iodine, back to your point about iodine is so interesting because it's one of many minerals and micronutrients that we're deficient in as modern-day humans because we're busy and our food access is different and variable and we don't always eat, I don't eat vegetables a day. I don't know if you do, but I don't. The idea that our lives are so crazy and busy and access to certain foods with nutrients is so limited or inconsistent, means that we probably do need, and I state this in the book, a certain couple of supplements, if they're chosen well, clean brands. And I go through how to know that, but every day we should be getting some of those. And one of them happens to be a multivitamin that has enough iodine because iodine, even though it sounds like, “Okay, what's that about?” Iodine, we don't make it as humans. We have to eat it from food or get it from supplements. It's cheap as rocks. It's almost-- You wouldn't even think about it, but it sits in the thyroid gland and protects it, it makes it function properly, but it also protects from chemicals that we now know are in everyday life, food washes, certain foods, even organics have some degree of these chemicals that can attach to thyroid gland and create the risk for Hashimoto's and other thyroid issues. But iodine can be gotten every day in the right amount.


[00:47:36] And it’s sort of this combination of nutritional deficiency and environmental chemicals that come together and create an epidemic of autoimmune thyroid disease. And it used to be added to our food system, and it was a public health measure when we now would-- When they knew back in the 20s and 30s that it was a problem developing goiter from not having enough iodine, they added it to bread. It was in table salt. Of course, people remember, like Morton's, but most people don't eat bread or a lot of people don't eat bread consistently or in the amounts they may not even iodine now, a lot of people don't have table salt anymore. We have Himalayan, Kosher, Celtic. So, none of that has iodine. And so, here's the argument. If you take these four nutrients and supplements in the way they should be taken with the right amounts, you're going to get something into your body every day that helps protect you against a world you may not be able to control.


Cynthia Thurlow: [00:48:30] I think that's a really important point and I feel like iodine is one of these minerals in the functional integrative medicine space that it's very-- It can be by itself, it can be super polarizing. Like there's the camp of they're very pro, just iodine supplementation, others are anti. So, I think the idea of taking it in a multivitamin is a great way to ensure that you're getting some, but not too little and not too much, and I think that that is certainly an important distinction. 


Dr. Aly Cohen: [00:48:30] And liquids are very variable. So, you have to be really thoughtful about how it's taken and not to do too much because you can end up having hyperthyroid. But it's in the book. I'm trying to just give people a framework by which to talk to their primary care or their health care provider and then take it from there.


Cynthia Thurlow: [00:49:13] Yeah, I think that again, it's such an important point and that's where the instance of taking a multivitamin, you're going to get a little bit, but not too little and not too much. I'd love to end the conversation today talking about something that was really not on my radar, but you bring up in the book talking about the role of noise pollution. You mentioned that According to the WHO 1.5 million years of healthy life are lost annually, in this case in Western Europe, but this could be extrapolated to all westernized countries because of traffic noise. 


Dr. Aly Cohen: [00:49:41] Yeah. 


Cynthia Thurlow: [00:49:42] So, let's briefly touch on noise pollution because again, this was not on my radar, but I read it in the book. I was like, “This makes so much sense. Why aren't we even addressing or discussing this?” 


Dr. Aly Cohen: [00:49:53] Yeah. And in my last book, Non-Toxic, I think I did a little bit more on this area. But even people who live near airports have higher rates of cardiovascular disease. Now, whether or not they teased out air pollution or not, who knows? But I know it was directed towards just the sheer amount of noise pollution. And again, my training in anthropology and my interest in anthropology has always led me to question, did we just land here with nice shoes and great cologne, [Cynthia laughs] or did we really have this history where there was no synthetic light and noise was just not omnipresent? And just sitting in silence is such a phenomenon. I find myself yearning for it but not always getting it. And it's, why do we need it only on vacation sometimes? Like we should really be infusing it into our lives. 


[00:50:39] So, the idea that we are such vulnerable creatures plays into the idea of exposures, it plays into the idea of such the hustle to survive. One of those components that messes with our mental health and our physical health can be noise. And so, it's just another moment to say “Let's sit back and figure out if we're doing, everything we can do in modern day times that really matches what our genetic template is really about.” And, so I just want people to just be aware and see how they can work that into their lives. 


Cynthia Thurlow: [00:51:14] And I think it's important I shared at the beginning of our discussion we met virtually that we relocated from a very large US city to a smaller US city. And I think one of the benefits that I hadn't really thought about until I read the book was its quieter here. It is so much quieter here and how that brings tremendous peace. And I feel like it lends itself to less stress. And if there's less stress, you're a little more easygoing, you're a little more relaxed, you're more engaged in the parasympathetic. So ultimately, I acknowledge that maybe not all listeners live in a part of the country where it's quiet per se, but finding your own peace within your lifestyle I think can be very beneficial. Dr. Cohen, I've so enjoyed this conversation. Please let listeners know how to connect with you, how to purchase your new book and your other books or learn more about you and your podcast. 


Dr. Aly Cohen: [00:52:02] Thank you first of all for having me, Cynthia, because just by reaching out, connecting, it's been a wonderful experience with people in my village, really getting what I'm trying to do here and supporting me. I am a practicing rheumatologist in Princeton, New Jersey. I'm here in the office. I do telemedicine if people are interested. I am still seeing patients. We'll see how long that goes on for new but certainly not giving up my practice. I love my patients. 


[00:52:25] And then certainly on social media, if you want to follow, I do post quite often it's called @thesmarthuman on TikTok, Twitter, Instagram, Facebook, LinkedIn, so I'm trying to get out there and let people have great information without having to buy a book if you want. 


[00:52:41] Also, I have small courses on thesmarthuman.com. I've been posting very small courses for different factions, on heavy metals is one, pesticides, EMF radiation, if you want to watch that with your kids and understand how cell phones work, actually it might be a little heady for kids, but you'll have to see. But anyway, the idea is that I want to make sure as many people get great information that's vetted, that science, backed and evidence based as possible. So really then there's the book. And the book is my baby. So, this is available on Amazon and ah, there we go, look at us. Amazon, Barnes & Noble, certainly local booksellers, wherever you find that you radiate to, but yeah, I hope people will check it out and share with their family and friends. 


Cynthia Thurlow: [00:53:26] Oh, it's a great resource. Thank you again for your time. 


Dr. Aly Cohen: [00:53:26] My pleasure. Thank you everybody. Thanks, Cynthia.


Cynthia Thurlow: [00:53:33] If you love this podcast episode, please leave a rating and review. Subscribe and tell a friend. 



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