Plastic Food Container Safety.

Plastic containers are a huge part of modern life. Perhaps their use is nowhere more significant than in the storage of foods. Stored food comes in contact with plastics, plasticizers, intentional additives, and inadvertent contaminants. Plastic food containers are asserted to be safe, and the resin used in their manufacture is assigned a number to help understand their recyclability. These containers are not totally inert and leach varying levels of metals and chemicals into the foods they store-especially if subjected to elevated temperatures. The safest containers appear to be those made from resins with the ID numbers 2, 4 (except food wraps), and 5. This editorial looks at the various types of plastics used in the manufacture of food containers, their typical contaminants, their toxicity, and the median amount of migration of contaminants into food.

Time to Recognize and Address the Serious Arsenic Problem.

Chronic low-level exposure to arsenic has a dose-dependent relationship with many chronic diseases. However, the typical arsenic safety standards used by governmental entities and laboratories appear inconsistent with current research. This editorial reviews the research and suggests that the random first-morning-urine total arsenic threshold for increased disease risk should be 5.0 µg/g creatinine or lower.

Fluorocarbons (PFAS)-The Forever Chemicals.

Fluorocarbons are fluorinated organic molecules widely used in industry and commerce. Nomenclature has changed over the years, with PFAS becoming the accepted umbrella term. The environment is heavily polluted with these toxins. Worldwide research shows that they contribute to almost every chronic disease. The primary source of human contamination is food packaging. There are significant concerns that the available research has not adequately addressed ultrashort-chain PFAS, which are breakdown products of longer-chain versions and accumulate in the environment at almost 100 times higher concentrations than the longer-chain versions.

"Food faddists and pseudoscientists!": Reflections on the history of resistance to ultra-processed foods.

The term 'ultra-processed food' emerged in the 1980s, mostly used in reference to highly-processed convenience foods and snacks, often energy-dense, poor in nutrients, and inclusive of various synthetic additives such as emulsifiers, colors, artificial sweeteners, and/or flavor enhancers. Concern over such foods was part of the growing holistic and environmental health movements of the 1970-80s; yet, those who raised alarm about the encroachment of ultra-processed foods were often labeled, especially by industry and their powerful allies, as 'food faddists' and 'pseudoscientists'. Today, the topic of ultra-processed foods is generating massive personal, public, and planetary health interest. However, other than discussing the history of the NOVA food classification system, a useful tool that has allowed researchers to more accurately separate foods based on processing, most lay media and academic articles are ahistorical. That is, there is a tendency to present the term ultra-processed food(s) as a relatively new entrance into the lexicon, and by default, the idea that health-related pushback on ultra-processed foods is a relatively new phenomenon. This omission overlooks decades of determined advocacy and clinical work, much of it by pioneers within the holistic medicine (now integrative, functional, and lifestyle medicine) movement. Here in this reflection paper, the authors will use historical research and reporting to fill in the historical gap and articulate the saliency of why it matters.

Thinking About Berberine.

The alkaloid berberine is a constituent of several medicinal herbs with centuries of use. Emerging research is documenting many effective clinical applications. It has been shown to improve blood sugar control, lower cholesterol, inhibit infectious microorganisms, decrease inflammation, ameliorate inflammatory bowel disease, lower blood pressure, facilitate weight loss, and even inhibit cancer cells. However, it is important to recognize that relying solely on berberine as a treatment because it is a natural molecule ignores the need to address causes of the diseases and dysfunctions the patient is suffering.

Unimportant Molecules and Medical Philosophy.

In Parts 1 and 2 of my editorials on "Unimportant Molecules," I reviewed the research on how modern agriculture has seriously distorted the food supply. In this editorial I showed how this oversimplification and lack of recognition of the importance of whole food molecules also illustrates the deep conceptual differences between the reductionistic medical interventionist model and the probabilistic nurturing model of health medicine. I believe we need both approaches, and by understanding the differences we can better integrate perspectives for the best patient outcomes.

"Unimportant" Molecules?-Part 2.

"Unimportant" Molecules?-Part 1 reviewed the research on how the loss from the food supply of molecules that are not considered required nutrients has substantially contributed to the chronic disease epidemic. In Part 2, I present more research on the clinical benefits of dietary and supplemental carotenoids, flavonoids, and other important plant molecules. The research is clear that regularly eating colorful, organically grown foods is required for health.

Thoughts on Non-Alcoholic Fatty Liver Disease and Chronic Disease.

The relentlessly increasing prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) represents yet another chronic disease epidemic. Why have so many chronic diseases become so common? This editorial discusses NAFLD in the context of a few of the factors that underlie so much of chronic disease: excessive fructose consumption; sedentary lifestyle; poor diet; body load of bisphenols, phthalates, per-/polyfluorinated substances, and polychlorobiphenyls; and several commonly prescribed drugs.

Consideration for Flavonoid-Containing Dietary Supplements to Tackle Deficiency and Optimize Health.

Randomized clinical trials (RCT) and observational studies have highlighted the importance of flavonoid consumption for human health. Several studies have associated a high intake of dietary flavonoids with (a) enhanced metabolic and cardiovascular health, (b) enhanced cognitive and vascular endothelial functions, (c) an improved glycemic response in type 2 diabetes mellitus, and (d) a reduced risk of breast cancer in postmenopausal women. Since flavonoids belong to a broad and diverse family of polyphenolic plant molecules-with more than 6000 compounds interspersed in the human diet-researchers are still uncertain whether the intake of single, individual polyphenols or a large combination of them (i.e., synergistic action) can produce the greatest health benefits for humans. Furthermore, studies have reported a poor bioavailability of flavonoid compounds in humans, which presents a major challenge for determining their optimal dosage, recommended intake, and, consequently, their therapeutic value. Especially because of their scarce bioavailability from foods-along with the overall declining food quality and nutrient density in foods-the role of flavonoid supplementation may become increasingly important for human health. Although research shows that dietary supplements can be a highly useful tool to complement diets that lack sufficient amounts of important nutrients, some caution is warranted regarding possible interactions with prescription and non-prescription drugs, especially when taken concurrently. Herein, we discuss the current scientific basis for using flavonoid supplementation to improve health as well as the limitations related to high intakes of dietary flavonoids.

Polycyclic aromatic hydrocarbons and risk of rheumatoid arthritis: a cross-sectional analysis of the National Health and Nutrition Examination Survey, 2007-2016.

OBJECTIVE: While there are several well-established environmental risk factors for rheumatoid arthritis (RA), a paucity of evidence exists linking environmental toxicants with RA prevalence. We aimed to examine the associations between various environmental toxicants and RA among adults in the U.S. general population while adjusting for non-heritable risk factors. DESIGN: Cross-sectional study. SETTING: National Health and Nutrition Examination Survey conducted from 2007 to 2016. PARTICIPANTS: The study included 21 987 adult participants (no RA: 20 569; RA: 1418). Participants were excluded (n=7214) if they did not answer questions related to self-reporting of RA, had another or unknown type of arthritis, or did not have interview or biospecimen data. PRIMARY AND SECONDARY OUTCOME MEASURES: Association between individual toxicants and body burden scores for polycyclic aromatic hydrocarbons (PAH), phthalates and plasticisers (PHTHTEs) metabolites or volatile organic compounds (VOCs) and participant self-reported RA based on multivariable logistic regression models while adjusting for age, sex, urine creatinine, body mass index, smoking, race, education, family poverty income ratio, any vigorous or moderate activity and dietary fibre. RESULTS: While increased prevalence of RA was observed in participants with the highest quartile of various individual PAHs, only 1-hydroxynaphthalene (OR: 1.8 (1.1 to 3.1); p=0.020) remained associated in a fully adjusted model. PAH body burden was found to be associated with RA (Q4 vs Q1, OR: 2.2 (1.09 to 4.2); p=0.028) in a fully adjusted model. Interestingly, after accounting for PAH body burden, smoking was not associated with RA (OR: 1.4 (0.89 to 2.3); p=0.13). A mediation analysis demonstrated that PAH body burden accounted for 90% of the total effect of smoking on RA. PHTHTE and VOC metabolites were not associated with RA in fully adjusted models. CONCLUSIONS AND RELEVANCE: PAHs are associated with RA prevalence, mediate the majority of the effects of smoking on RA, and are associated with RA independent of smoking status.

What Have We Learned About Preventing and Treating COVID-19? Part 1: Physical Strategies, Natural Health Products, and Lifestyle.

Many strategies were tried by our public health authorities to contain, mitigate, and treat the COVID-19 pandemic. With now 3 years of experience, research is being published that can help us determine what worked, and what did not. Unfortunately, assessing the research is very challenging. Not only are many of the approaches still not rigorously evaluated, but politics and censorship clearly distorted the research and reporting. In this, the first of 2 editorials, I review the research on Physical Strategies, Natural Health Products, and Healthy Lifestyle. In the next editorial I will take on Drugs and Vaccinations.

Health Medicine.

For almost two centuries, disease-treatment medicine has dominated healthcare. This has resulted in many benefits, especially for acute infections, injuries, acute life-threatening disease, congenital malformations, etc. However, we have also seen a parallel and relentless increase in chronic disease. In fact, we now suffer the highest burden of virtually every chronic disease in every age group ever in human history. Why? It is not because disease-treatment medicine is wrong, but rather because it is incomplete. Today's healthcare is missing health care and is focused almost solely on disease. Through recorded history, there has been an ongoing philosophical dynamic between treating disease vs promoting health. Dominance by either side is insufficient. This editorial explores Health Medicine and why embracing this concept is critical for solving our healthcare crisis. It is organized as follows: a brief review of history, the rationale for "Health" medicine, what defines it, why organizing under it is important, how an optimal system could be organized, and the potential response of conventional medicine.

Subclinical Hypercortisolism: An Important, Unrecognized Dysfunction.

While Cushing syndrome is rare, but well-recognized, subclinical hypercortisolism (defined as excessive cortisol secretion without the classic manifestations of Cushing syndrome) is significantly more common. Subclinical hypercortisolism contributes to several chronic diseases, such as diabetes, osteoporosis, sarcopenia and hypertension. The incidence increases with age and correlates with body load of environmental toxins such as bisphenol A (BPA). This editorial discusses prevalence, contribution to disease, causes, diagnosis, and intervention.

Strategies for Protecting Mitochondria From Metals and Chemicals.

Mitochondria are required for life, and dysfunction leads to chronic disease and shortened life expectancy. Unfortunately, suboptimal mitochondrial function is very common. While genetic mutations play a role, far more common is the damage from nutrient deficiencies and regular accidental and intentional exposure to mitotoxic metals and chemicals. Alcohol, antibiotics, metals, bisphenols, phthalates, pesticides and herbicides, and statins-the list is long-all impair mitochondrial function. Fortunately, toxins can be avoided and their elimination from the body can be enhanced. In addition, many natural health molecules help protect mitochondria and restore function.

How Should We Teach Nutrition to Health Care Professionals?

Nutritional deficiencies are rampant throughout the world. Health care professionals have a unique responsibility and opportunity to help their patients understand the critical impact of nutrition on health. While nutritional supplements are of great clinical benefit, they are not a substitute for eating healthfully. In this editorial I discuss ways to think about nutritional medicine and priorities for educating health care professionals.

Common Chemical Pollutants Causing a Lot of Ill Health.

Due to industrialization and inadequate controls on release of manufacturing chemicals into the environment and into the products being made, the entire population is constantly being exposed to a wide variety of chemical pollutants. The key question, of course, is their safety. The most acutely damaging ones have been progressively limited. However, virtually all safety research is on single toxins and very little of it looks at the impact of chronic exposure, especially chronic exposure to multiple chemicals simultaneously. This editorial discusses the clinical significance of 4 of the chemicals (acrolein, acrylamide, perchlorate, and phthalates) found most often in samples doctors send to labs for analysis. The research clearly demonstrates that these chemicals in a dose-dependent manner disrupt physiology, impair health, and increase risk for common diseases.

Vitamin D (Like Every Nutrient) is a Team Player.

Vitamin D is critical for many physiological functions in humans. Numerous population-wide assessments have shown that vitamin D deficiency is very common. Unfortunately, far too many studies intending to assess the clinical efficacy of supplementation are poorly designed. They look at vitamin D as an isolated agent, independent of the complex matrix required for it to be physiologically effective and at dosages inadequate for much of the population. These errors cause inappropriate and invalid results that are then misused to not only recommend against supplementation but to also recommend against even measuring vitamin D levels. This editorial addresses the weaknesses of typical vitamin D research, such as VITAL, and the key factors that must be addressed for accurate vitamin D research.

Modifiable Risk Factors for SARS-CoV-2.

As the COVID-19 pandemic has raged on, considerable research has been performed around the world evaluating the environmental, genetic, lifestyle, and nutritional factors that significantly impact the COVID-19 pandemic. Many studies have now shown that key risk factors for SARS-CoV-2 infection, severity, and even death are modifiable. Patients, whether partially vaccinated, fully vaccinated, or not vaccinated, are expecting their clinicians to provide them with evidence-based guidance and to help them prioritize the factors most important for them. In this editorial we review the current state of the research on modifiable risk factors for SARS-CoV-2 infection, disease severity, and death.

"Unimportant" Molecules?-Part 1.

About a century ago when research into the nutritional components of food began, scientists were limited by the technology and physiological understanding of the time. Nonetheless, this pioneering research revealed the importance of many nutrients for the maintenance of life and prevention of overt deficiency diseases. Unfortunately, the necessary simplifications led to the unrecognized assumption that the constituents in food not required for life were not important. This justified growing food chemically rather than organically because essential nutrients were largely (but not entirely) conserved. However, as technology advanced-especially at the turn of this century-much was revealed. Nutrients considered single molecules when discovered were now realized to represent multiple variants and vitamers with significantly different physiological effects, and many of the molecules considered "unimportant" have huge impacts on health and resistance to disease.

Commonly Prescribed and Over-the-Counter Drugs as Secondary Causes of Osteoporosis-Part One.

Prescription and over-the-counter drugs have been effectively used to manage many diseases and to provide symptom relief. Unfortunately, their use may also result in adverse drug reactions and unintended consequences. Proper use of these powerful agents requires understanding both their desired effects and their potential downsides. Fully understanding the unintended consequences can be challenging. Virtually all safety studies are carried out for far shorter periods of time than the actual use of these agents in the real world. Some may take years of use before their sequelae are recognized. This is especially a problem where bone health is concerned since the damage caused by years of minor disruption in function does not show up until compounded by other factors, such as andropause and menopause. This 2-part editorial covers the primary classes of drugs that require bone health monitoring and that may require alternative prescriptions or mitigation strategies. Part One covers aromatase inhibitors, gonadotropin-releasing hormone agonists, anticonvulsants, benzodiazepines, antidepressants, insulin sensitizers, and NSAIDs and acetaminophen. Part Two covers opioids, glucocorticoids, calcineurin inhibitors, H2 blockers, diuretics, anticoagulants, thyroid medications, and contraceptives.