TONIGHT! Conspiracy of Venus at Freight & Salvage (+ Mercury News CoV interview)
jessie woletz | seaweed sway
From: Myrto Ashe, M.D. <dr....@unconventionalmedicine.net>
Date: November 18, 2018 at 10:16:23 AM PST
To: <solen...@yahoo.com>
Subject: The Effects of Air Quality on the Brain
Reply-To: Myrto Ashe, M.D. <dr....@unconventionalmedicine.net>
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IMPACTS OF POOR AIR QUALITY:
IMMEDIATE AND DELAYED
And what to do now!
In the last week, smoke from the Butte County fire has reached the San Francisco Bay Area and has caused a very serious worsening of our local air quality. Things are finally improving as of this morning, but my research shows that even small changes in air quality can have noticeable health impacts.
Last year, after the Bay Area was impacted by smoke from the Santa Rosa fires, I sent out a newsletter discussing my concerns with poor air quality, based on my understanding of its impact from a functional medicine perspective.
The air quality this time is much worse, and my practice also has more patients who are older, and trying to reverse or prevent cognitive decline. This is why I am sending out another newsletter.
There are several websites with information on air quality. The EPA website was initially dysfunctional but has improved. There is also a Bay Area Air Quality Management District site, and the citizen science site based on air quality sensors at specific homes, Purple Air.
HEALTH EFFECTS
I will start by telling you to take health recommendations very seriously. Poor air quality is not just a problem for premature newborns and elderly people with lung disease - though it's heartbreaking to think about these groups. The warnings about “hazardous air quality” apply to all children, including teenagers, and that's because they move more volume of air in relation to their body size, for developmental and behavioral reasons. The warnings also mention persons "sensitive to pollution" and in my opinion that includes people with lung disease, atherosclerotic disease, and all elderly people.
Immediate EffectsThere are immediate effects of exposure to poor quality air. One way to understand this is to study what happens when the air suddently becomes better: studies done in the days after the smoking bans in public places show an immediate reduction in emergency room visits for certain conditions. For example, one article showed an immediate 13% reduction in visits for angina, a condition usually caused by narrowing of the arteries that supply oxygen to the heart (coronaries). Evidently, the impact of cigarette smoke is to further reduce the blood flow available to the heart in the moment.
Research on acute health effects of pollution focuses on “air pollution events” - often fires or dust storms. Findings include an immediate increase in emergency room (ER) visits for asthma, acute bronchitis and pneumonia, and exacerbations of emphysema and chronic bronchitis (COPD). In heavy smoke situations such as we are seeing, after a 1-day lag, there are increases in stroke, more breathing problems, and ambulance calls for “diabetic issues.” After a 2-day lag, there is also an increase in ER visits for heart attacks, angina, and heart failure. Emergency rooms continue to be busy for 3-4 days after air quality returns to normal.
One study of California fires demonstrated an immediate increase in asthma admissions for kids under 4 years of age, but not older kids, and revealed that the greatest increase in asthma admissions was in the elderly. In the case of the 2003 wildfires in California, the 70 mcg/m(3) increase in small particulate matter (PM 2.5) for 9 days resulted in a 34% increase in admissions for asthma. There was an excess of admissions for 2 weeks after the fires, this time including older children. In our situation in 2018, the increase in PM 2.5 was at least double that reported in the 2003 wildfire article.
Other studies show very significant increases in out-of-hospital cardiac arrests, about a 9% increase for each 7 mcg/m(3) of PM 2.5. This is an enormous increase if it applies to our situation, where our increase has been at least 20 fold higher than that.
Why Does Smoke Impact Us?
Smoke particles are divided by size into particles larger than 2.5 microns (PM10), and particles smaller than 2.5 microns (PM2.5). The latter group includes the ultra fine particles (UFP) which measure about 0.1 microns.
PM10 particles can trigger asthma - they include dust particles, but also particles from fires. However, smaller particles are especially harmful because they land deeper into the lungs and thus cause more inflammation. The smallest ones can even cross from the lungs directly into the bloodstream. They then travel to different organs in the body and cause direct damage there. Rodent studies show that PM 2.5 enter the bloodstream from the lungs, and accumulate in organs including the heart. Gradually worsening inflammation, oxidation and cell death caused by these particles may explain why some health effects are seen only a day or two after exposure, and why they continue to crop up after the air quality has returned to normal.
Chronic Exposure and Brain Effects
There are also emerging data on the impact of air pollution on cognitive decline and Alzheimer’s disease. The evidence here concerns chronic exposure, which is a different problem than the one the Bay Area is facing now, but has been reported at much lower amounts of pollution. There is a noticeable difference between health outcomes of people living with 20 mcg/m(3), vs. 30 mcg/m(3) of PM 2.5.
The silver lining to learning how to pay attention to horrid air quality may be that we learn what we need to do to optimize our environments when the air is back to its normal quality.Particulate matter (PM) impacts the brain either by:
- becoming trapped in the upper respiratory tract if they are larger (PM 10) and trigger inflammation in the body, and this body inflammation can cause brain inflammation
- depositing deep in the lungs if they are fine and ultra-fine (PM 2.5 and 0.1), also causing inflammation
- traveling directly across the membranes in the nose to enter the brain (PM 0.1)
Once at their destination, these particles cause more inflammation, oxidation, cytotoxicity (cell death) and amyloid deposition.
We have known for years that living near freeways during pregnancy raises the risk of having a child with autism, as well as having a child with decreased cognitive ability. Early childhood exposure to pollution, especially for female children, and especially if they have an apoE4 allele, is also linked to worse cognitive performance.For adults, chronic exposure to higher levels of particulates results in remarkable increases in rates of dementia. The risk in one study in Taiwan was reported as “138% risk of increase of Alzheimer’s Disease per increase of 4.34 μg/m(3) in PM2.5.” This language is a bit unclear so I am not sure if this means that the dementia rate was 38% more or 138% more per 4 micrograms, but either value is worrisome.
I’m sure other medical conditions also worsen with increases in air pollution. If the mechanism is inflammation, oxidation, and cell toxicity, then most diseases will likely be impacted. I would expect the list to include autoimmune diseases, diabetes and insulin resistance, mood issues, joint and muscle aches, anything related to chemical sensitivity, and even cancer - in addition to pulmonary, cardiovascular, and cerebrovascular (stroke) disease.
What You Should Do Now
Please take this seriously and take some time to decide what you will do about your exposure these next few days and into the future. Thankfully it seems that things are beginning to improve. But I have also heard that the smoke is trapped in the Bay, so we also need a good rain to get rid of this problem. And as we all understand, California will continue to have fires, and perhaps worse ones every year.
You should establish safe air in your home and workplace, have a mask you can wear when you have to breathe polluted air, and consider filtering the air in your car as well, or wear a mask there. A brief trip out to my local grocery store revealed that a few people are finally wearing a mask in the car, and even one in the store. However the store employees are not protected, and on the street, it’s the people working outdoors (service trucks, people in work uniforms) who seem oblivious, driving with the windows down for example, with no protection in most cases. The more we wear masks in public, the more we make it acceptable, and the more people we help.Masks
You must pay attention to the number on the mask, and find some that fit you well. Facial hair is a problem. The N-series masks (N95 and N100) filter out particles but not oils. Recommendations for workers in smoky areas recommend protecting them against oils that may be floating in the air from burning. It sounds to me like the P-series masks are better, but Amazon is out of them. Still, I bought some in preparation for next year - not a big investment, $30 or so for 10 masks. They are disposable however, which means that if they get dirty or if they start getting difficult to breathe through, they need to be replaced. The N-series are still better than nothing. For children, there are 8110S masks made by 3M, but no standards to tell us if they are good enough.Automobiles and Public Spaces
I tried to research automobile filters. Most cars have HEPA filters, but evidently, they are not very efficient. It still makes sense to have the air on “recirculate” when on the freeway, even under normal conditions. In terms of air purifiers that can use the electrical power source in your car, one online source recommended the Homdox car air purifier, but when I looked on Amazon, there were many unhappy customers. In the next few days I will be receiving a Foobot air quality monitor, as I am interested to find out whether these machines work. I would like to know whether my home air is safe, or if I need to optimize it by installing more filters. I also want to know whether my car is safe, whether the gym, library, or other outdoor spaces are safe. After several days of very poor outdoor air quality, local schools finally shut down - apparently their cutoff was "very unhealthy" or PM 2.5 near 200 micrograms/m(3). I wonder if anyone can tell us what the air quality is inside classrooms!!Our local health department recommends heading to local libraries or the mall when air quality is poor and people can’t stay in their homes. The concern is that if you close the windows in summer, it might get dangerously hot inside your house. However, the locations they list do not necessarily have air filters. Research indicates that the portion of outdoor pollutants that end up indoors can be up to 100%. Tight buildings may keep ozone out, but for particles like PM 2.5, the relationship is not as clear.
At Home
Indoors we need air purifiers with HEPA filters, and possibly also carbon filters. I am not concerned with eliminating germs. The vast majority of germs are helpful, and we sterilize our environment at our peril. What we need to remove are these particles, and the smaller ones even more so. At the moment, I recommend Air Doctor. My colleagues also recommend IQ Air, Austin Air, and Blue Air. Austin Air may be best at filtering volatile organic compounds (VOCs), which are not "particles" and thus were not addressed in this newsletter. Evidently a charcoal pre-filter is needed to filter out VOCs, and the Air Doctor charcoal is skimpy.
None of us have done air quality studies in our homes, to my knowledge. Let me know if you have! I’ll write a blog about it on my website in a few days when I get my air quality monitor. In the meantime, Air Doctor has a 50% sale for California residents. The link is here:http://www.airdoctorpro.com/CA.
Conclusion
This morning I woke up to a markedly improved situation: the ratings of 208 yesterday, most of it PM2.5, have improved to 135 in my area. My neighbor with the Purple Air sensor registers 78. There is thick fog in the air, and maybe it has captured some of the particles. This is still a level that causes acute health effects, so I'll use my mask to head to the farmers' market. I am happy to have had a chance to learn about the health effects of smoke and hope this is of use to my community!
The following is the list of science articles I’ve based this newsletter on. If you want to read more about the science of how smoke impacts us, there’s an addendum after the references titled “for functional medicine geeks.”
REFERENCES
Lee M, Koutrakis P, Coull B, Kloog I, Schwartz J.
Acute effect of fine particulate matter on mortality in three Southeastern states from 2007-2011.
J Expo Sci Environ Epidemiol. 2015;26(2):173-9.Kilian J, Kitazawa M.
The emerging risk of exposure to air pollution on cognitive decline and Alzheimer's disease - Evidence from epidemiological and animal studies.
Biomed J. 2018;41(3):141-162.https://www.ncbi.nlm.nih.gov/pubmed/15660564
Indoor Air. 2005 Feb;15(1):2-12.
Relationship between outdoor and indoor air quality in eight French schools.
Blondeau P1, Iordache V, Poupard O, Genin D, Allard F.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4271508/
Environ Res. 2011 Aug;111(6):811-6.
Johnston FH, Purdie S, Jalaludin B, Martin KL, Henderson SB, Morgan GG.
Air pollution events from forest fires and emergency department attendances in Sydney, Australia 1996-2007: a case-crossover analysis.
Environ Health. 2014;13:105. Published 2014 Dec 10.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4824441/
Xu Q, Li X, Wang S, et al.
Fine Particulate Air Pollution and Hospital Emergency Room Visits for Respiratory Disease in Urban Areas in Beijing, China, in 2013.
PLoS One. 2016;11(4):e0153099.https://www.ncbi.nlm.nih.gov/pubmed/23731106
Aust N Z J Public Health. 2013 Jun;37(3):238-43.
Air pollution from bushfires and their association with hospital admissions in Sydney, Newcastle and Wollongong, Australia 1994-2007.
Martin KL1, Hanigan IC, Morgan GG, Henderson SB, Johnston FH.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3230437/
Rappold AG, Stone SL, Cascio WE, et al.
Peat bog wildfire smoke exposure in rural North Carolina is associated with cardiopulmonary emergency department visits assessed through syndromic surveillance.
Environ Health Perspect. 2011;119(10):1415-20.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4740122/
Du Y, Xu X, Chu M, Guo Y, Wang J.
Air particulate matter and cardiovascular disease: the epidemiological, biomedical and clinical evidence.
J Thorac Dis. 2016;8(1):E8-E19.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4176821/
Delfino RJ, Brummel S, Wu J, et al.
The relationship of respiratory and cardiovascular hospital admissions to the southern California wildfires of 2003.
Occup Environ Med. 2008;66(3):189-97.https://www.ahajournals.org/doi/10.1161/JAHA.114.001653
Journal of the American Heart Association. 2015;4:e001653
Impact of Fine Particulate Matter (PM2.5) Exposure During Wildfires on Cardiovascular Health Outcomes
Anjali Haikerwal , Muhammad Akram , Anthony Del Monaco , Karen Smith , Malcolm R. Sim , Mick Meyer , Andrew M. Tonkin , Michael J. Abramson , and Martine Dennekamp
Increase in 9 mcg/m(3) results in a 7% increased risk of out of hospital cardiac arrests.Did Fine Particular Matter from the Summer 2016 landscape fires in Tasmania Increase emergency Ambulance Dispatches? A case crossover analysis Edwards LJ, et al (PDF)
https://www.ncbi.nlm.nih.gov/pubmed/17704195/
Occup Environ Med. 2008 May;65(5):319-24.
Experimental exposure to wood smoke: effects on airway inflammation and oxidative stress.
Barregard L1, Sällsten G, Andersson L, Almstrand AC, Gustafson P, Andersson M, Olin AC.
Environ Health Perspect. 2016;124(9):1334-43
Critical Review of Health Impacts of Wildfire Smoke Exposure.
Reid CE, Brauer M, Johnston FH, Jerrett M, Balmes JR, Elliott CT.
ADDENDUM for Functional Medicine geeks
(from Air Particulate article)
Particles come in several sizes:
PM10 (larger than 2.5 microns): come from road and agricultural dust, tire wear emission, construction and demolition work or mining. Wildfires and windblown dust are also sources of PM10.PM2.5 come from traffic and industry, including fuel combustion, oil refinery, brake emissions. They seem the main culprit for adverse cardiovascular effects. They include UFPs (smaller than 0.1 micron).
UFPs (ultrafine particles) include tailpipe emissions. UFPs penetrate the alveolar-capillary membrane and are found in remote organs. They also go straight to the brain from the nose.
Ambient aerosols are created when ambient particles interact with atmospheric gases, ozone, SO, NO, and CO).
PM2.5, especially UFPs, cause direct and indirect effects:
Indirect:
1. pulmonary oxidative stress and inflammatory response - several hours or days after inhalation. Trigger inflammatory cascade: CRP, IL-6, IL-7, IL-1beta. They result in systemic inflammation, which increase coagulability, endothelial dysfunction, myocardial ischemia.2. There is also interaction on the autonomic nervous system via specific lung receptors. They increase sympathetic activation.
Direct:
UFPs deposit in the vascular endothelium, aggravate local oxidative stress and inflammation, cause instability in the atherosclerotic plaque, and lead to thrombus formation.Injecting rats with UFPs shows increased cardiac ejection fraction and PVCs.
Eventually the UFPs have cardiac depression effects, myocardial stunning and deterioration of cardiac function.
Note on heavy metals: industrial PM2.5 may include copper, lead, iron, nickel and chromium. Gaseous pollutants are also related to cardiovascular disease (CO, NO2, NOx, O3, and SO2 etc).
And more: PM stimulate the autonomic nervous system, impairing balance and favoring sympathetic tone. Also, PMs modulate microRNAs involved in the processes of systemic inflammation, endothelial dysfunction and atherosclerosis.
(from Critical Review article):
PM cause lower numbers of lung macrophages, antioxidant depletion, elevated cytokines, lower lung glutathione, and lung monocytes make more hydrogen peroxide. They lead to increased cell death of rat macrophages and human lung epithelial cells.Also, they cause DNA damage: all size fractions extracted from wildfire smoke caused DNA damage in mouse monocytes.
Early life exposure can make baby macaques have long term lower immunity - lower cytokine synthesis in peripheral blood cells.
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