Q&A: Exploring the Link Between Environmental Toxins and Autoimmune Disease

Environmental toxins play a key role in human health, and to prevent disease, it’s essential that integrative practitioners address them with their patients, according to Aly Cohen, MD, FACR.

Cohen is an environmental health expert who practices rheumatology, internal medicine, and integrative medicine in Princeton, New Jersey, and her latest research explores the connection between environmental toxins and autoimmune disease. In her presentation at the Institute for Functional Medicine Annual International Conference in Orlando, Florida, Cohen discussed her findings along with functional and integrative approaches to reduce toxic exposures. 

After her session, we spoke with Cohen about key takeaways from her talk and how to tailor environmental medicine to each practice.

Integrative Practitioner: To what extent do you think environmental toxins contribute to autoimmune disease?

Aly Cohen: I want to say a very large amount. Having less sleep and being stressed are absolutely strong components, but these chemicals are physically in our bodies. We are absorbing them through all different means, and we're not getting rid of them because we’re constantly being exposed to them. It's an ongoing blast, and the immune system doesn’t know what to do with it because we haven't evolved fast enough to manage many of these chemicals.

What we're seeing in the numbers just has to correlate with the mass production of synthetic chemicals. I wouldn't have said that 15 or 20 years ago, but now that I've been doing medicine and rheumatology for so long, I have a different vantage point. I see patients getting sicker and sicker at younger ages with autoimmune issues but with no family history. I'm feeling it in my practice, and then I'm looking at the data and seeing it correlate with what I'm saying.

Integrative Practitioner: How do you go about translating this information to patients?

Aly Cohen: You want to hone in on what each patient's lifestyle looks like so the information becomes meaningful to them. I try to tell young people with a new onset diagnosis of autoimmune that there's always an opportunity to take those triggers and try to reduce them. I try to meet them where they're at and find out about past or current exposures without freaking them out. I don't like scaring people. Instead, I want to give them practical solutions.

All health, all wellness, and all risk for disease is personalized. There's just no one human that matches another. Even in two identical twins with the same exact genetics, we see a much lower concordance rate in autoimmune disease than you would expect. That has to be influenced by the environment, which includes everything from diet and nutrition to light pollution, noise pollution, chemical exposure, and water. You can't fix it all in a day, but you can start to be more cognizant of those exposures and try to make simple, practical changes over time.

Integrative Practitioner: When it comes to avoiding environmental toxins, what are the basics that everyone should know about?

Aly Cohen: The first thing I think of is water. Water has become the most underrated and under-discussed component of contaminant exposure, but it’s also one of the easiest things to fix for a lot of people because the solutions are now much cheaper than they've ever been.

People need to understand that clean water is important for preventing chemicals from getting into our bodies but also for clearing chemicals out of our bodies. Clean water is crucial, and having any filter is a good start because that means you’re conscious of the water you’re drinking, but I’m trying to nudge people into this world where you can do better at a reasonable cost. 

So, I always start by talking with my patients about water, and then I discuss food. We have tons of options that are United States Department of Agriculture (USDA) organic. I'm very much a promoter of the USDA organic certification because otherwise, we have no regulation in food. It's the only thing we have, so we should take advantage of it.

Integrative Practitioners: What are the three key takeaways from your talk, and how can providers implement them into their patient practices?

Aly Cohen: People should walk away from the talk knowing that chemicals and the environment play a key role in human health. Many people don't even know that, and there's a lot of assumed oversight, but there's really very little regulation. I want people to know that exposure can and often does lead to a variety of health issues, from metabolic to immune to endocrine problems. And then, I want them to know they have a real and powerful influence on their patients and they can empower them to improve their health outcomes with a few simple strategies.

It's important that practitioners are knowledgeable about the suggestions they're making; you don't want to share things you can't explain or answer questions about. I want clinicians to feel empowered and dive into topics pertinent to them or their location. For instance, there are certain clustered areas of toxic environments downstream for manufacturing, and in those areas, there can be clinics that manage a lot of kids with asthma. So, there are a lot of different, very specific needs for each community. Practitioners should focus on where toxins affect their patients and themselves because that's usually when they have the most passion and influence on their patients.

To hear more from Cohen on how the environment influences human health and what you can do about it, you can visit her website, The Smart Human.

Editor's note: This interview was edited and condensed. This article is part of our live coverage of the 2023 Institute for Functional Medicine Annual International Conference. Click here for a list of full coverage.