Fertility & chemical exposure
21st Apr, 2022


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Wendy McLean (00:06): Welcome to Common Ground, a podcast series discussing new research and interesting projects in the field of complementary medicine. Hello, my name is Wendy McLean, Educator at vital.ly.

vital.ly is a digital platform, a health professional resource, and a distribution service all in one.

Firstly, I'd like to begin by acknowledging the Gadigal people of the Eora Nation as the traditional custodians on the land on which we gather here. I would also like to respect their elders, both past, present, and emerging.

In this episode today, we are joined by Naturopath Tabitha McIntosh to discuss the impact of the environment on reproductive development, health and fertility across the lifespan. Tabitha will journey us through the changing landscape of fertility and plummeting sperm counts and discuss the research linking the cumulative effects of toxic exposures, particularly during vulnerable windows of exposure, to diminishing health and fertility.

Importantly, she will shine the light on the wonderful various tools we have in our Natural Medicine toolkit to restore and enhance fertility outcomes for both men and women.  

Tabitha is an experienced naturopath, founder and director of Awaken Your Health in Woollahra, Sydney, where she has run her own private clinical practice for 15 years, integrating naturopathic healing principles with the latest scientific research to educate and empower her clients.

After obtaining her Bachelor of Medical Science, Tabitha went on to pursue her passion for integrative healthcare by completing an Advanced Diploma in Naturopathy and Nutrition and a Postgraduate Diploma of Applied Science in Nutritional and Environmental Medicine. She is currently completing her Masters in Reproductive Medicine through the School of Medicine at UNSW.

Absolutely passionate about improving the health of everyone she encounters, a focus of Tabitha's practice is working to optimise health and enhanced fertility implementing therapeutic diets whilst educating around the hidden dangers of environmental chemicals to help her clients reach their full potential.

We're very pleased to have Tabitha share her experience with us today on Common Ground. And we welcome you Tabitha.

Tabitha McIntosh (02:18): Thanks so much, Wendy, for that really generous introduction.

Wendy McLean (02:22): So Tabitha, first off you are one of the invited speakers at the NHAA, so that's the Naturopaths & Herbalists Association of Australia, to their herbal medicine summit this year. You'll be speaking about fertility outcomes and chemical exposure. What are you looking forward to mostly about NHAA this year?

Tabitha McIntosh (02:42): Look, I think just being amongst other clinicians and colleagues is going to feel nourishing unto itself, you know, before we even hear the fabulous content that's being presented. You know, I was so chuffed to be asked, because to be sort of included amongst a lineup like, like this. So we've got people like Leslie Braun speaking. We also have Jerome Sarris, which I'm really interested to hear him speak. I know he's a huge advocate for herbal medicine in, in use in mental health arenas. And I'm also particularly excited to hear Aviva Romm speak. So I was lucky enough to hear Aviva speak, but she might be dialing in from the States, but I heard her speak at an international health symposium, the IHS in New York, about six or seven years ago.

And she's absolutely magnetic. She, the way she holds herself and her passion is absolutely palpable, and she is speaking on HPA axis dysfunction and how to look after the nervous system during times of stress and the adrenals. And I must say even though our talks will obviously be entirely different, stress is an enormous piece of the fertility puzzle, the neurohormonal interplay with stress downregulating obviously gonad function and hormonal production and delaying ovulation, or maybe increasing prolactin to prevent ovulation. It's really a piece of the puzzle that can't be ignored. So I can't wait to hear her speak as well.

Wendy McLean (04:17): I have to say I'm very much looking forward to it as well. And actually, as you said, being there amongst colleagues and peers, it's going be so exciting. And also, yeah, Aviva Romm is also one of the highlights for me as well.

And definitely I think, you know, we're all going through, we've all been going through a very stressful time over the last two years with the pandemic, and in Australia now with the flooding. So certainly the talks about stress will be very pertinent at the moment.

Tabitha McIntosh (04:46): One other thing I'll mention actually, a colleague Erin Lovell Verinder. She is speaking on plants, bringing plants to the people and she's all over social media at the moment, advocating for the people in the Northern Rivers. She is experiencing the floods and she is, I know she's kind of looking for a donated caravan, so she can actually literally take the plants to the people in times of need.

Wendy McLean (05:10): Yeah, she is amazing. And certainly there's a lot of practitioners up there banding together and offering their time and help to the community and, and practitioners all around the country. So it's really wonderful to see.

So Tabitha, you've published a book. So with publishing your book One Bite at a Time with Dr. Sarah Lantz you seem quite an advocate for environmental health. Can you talk to us about how you got interested in this and how it impact impacts your consultations with your clients.

Tabitha McIntosh (05:41): Absolutely. I think it, this may be the same for a lot of people, clinicians and clients and public alike. I think that the topic of environmental medicine, when we are thinking about environmental chemicals and pollutants and pesticides and endocrine disrupting chemicals really starts to, I don't know, come to the fore when you're bringing another little human into the world. So I read one of Sarah Lantz’s books. It must have been in the early nineties, 2000 and something. And my kids were born in early nineties and they're teens now, but I read one of her books and it really sparked my interest. And I had done the postgraduate studies in environmental medicine already, but I just, I felt that with all of our training in nutrition and herbal medicine and counseling, which we use every single day with clients I did feel something was missing and I've developed over the last 15 or so years, a bit of a clinical lens that I use myself in clinic.

And I've shared it lots of times before, so it's no secret, happy to share it again, but I'll actually draw it as a visual for the client sitting in front of me. So it's a diamond and I talk about our inherited tendencies or our genetics, and I'll often bring up that lovely quote, “whilst the genes load the gun, the environment pulls the trigger”. So I talk about our inherited constitutions and tendencies and capacity to make certain enzymes, et cetera. But then I talk about nutrition and environment as two levers that we can pull to impact the expression of our genes. And under that enormous umbrella of environment, I'm not just talking about chemicals, which I'll come to. I'm also talking about stress response and sleep and sunshine and, and the access to clean water and things like that. Yep. That I do. I do sort of bring up this topic very early in an initial consultation with an individual or a couple or a family because of the impact that environment can have at particular points across development or across the lifespan.

Obviously I expand on the nutrition apex of the diamond as well. And then the bottom apex, the fourth apex, is the health of the gut, which is very naturopathic in philosophy anyway. But with the increasing amazing information that we can access at our fingertips with all of the publishing on the importance of the microbiome, whether it be relating to mental health or immune capacity or detoxification. The microbes in our gut have a secondary detoxification capacity. So really making sure we've got diverse microbes and not too much of a dysbiosis is really an important piece of the resilience puzzle. So that's, that's my clinical lens, but I do think as health practitioners, we're usually speaking to people who want to have some level of engagement and want to feel empowered with that, their health. And I think that we really have a unique opportunity, but also responsibility in this arena to educate and to advise. So I try to keep my consults really practical, but I have lots of patient handouts that include swaps, you know, swap from these cleaning products to these ones or from this type of food, to these food options. And, and I think that those really practical swaps can be helpful as well.

Wendy McLean (09:03): Absolutely. And certainly I've got a real interest in this as well as my background is as a hydrogeologist. So I've been out there at the coal face, literally firsthand seeing, you know, some of these in, and things like your endocrine disruptors, your PFAS, and things like heavy metals and so on. So I think it's fabulous that you, you know, you start off with this, from the get go and you, and you do have the practical solutions and handouts for your clients.

Tabitha McIntosh (09:30): Yes. Opening the conversation in a non-daunting way just to get them thinking as well. And you'll find often at a follow up, it won't be the focus of the follow up, but they might say, Hey, I was just wondering what makeup do you use? Or have you got a good shampoo or, you know, or I might even comment on something not directly in an abrasive way, but if, you know, I've seen lots of clients with various types of thyroid cancers that are still drenching themselves in perfume, and I'll just politely drop into conversation, the word phthalates, and talk about where phthalates are found. And I won't say perfume first, I might say nail polish first, and, but organically kind of bring it up and talk about you know, if you really have to use it a couple of times a week, what about spraying it in an open area, not indoors and or here are some essential oil alternatives, you know, so yeah. I just bring it in, I bring it into conversation in a non-daunting way.

Wendy McLean (10:22): Yeah. I like that approach. And that leads nicely into the next question, actually. So what are some of the biggest challenges you see in this area in clinical practice?

Tabitha McIntosh (10:32): Oh, there, there a handful. And, and I won't even talk about the challenges in the clinical literature just yet, but look, there's, there is a lack of awareness. There really is. People don't necessarily connect their daily habits to their health outcomes. They don't necessarily connect, you know, I'm just thinking on my feet, but they don't necessarily connect a high, heavy metal load from eating copious amounts of canned tuna or a large fish to a thyroid disorder or, or heavy metal burden, potentially being linked to diagnosis of a new autoimmune condition. People don't think about necessarily the, the smelly perfume that they're burning in the evening as a stress management tool and how that might impact or how that might have some endocrine disrupting effects. I do think that there is a lack of daily awareness.

I also think that there's this issue of the variable handling of toxicants. So whether it be age, gender, you know, stage of life, comorbidities that, you know, we all have a very unique relationship with toxins around us and with our stress response and the way we respond to stress. So I think that sometimes digging around a little bit to sort of balance out, or, you know, doing some SNP testing to balance out methylation. Methylation is a huge part of detoxification but also, you know, supporting other metabolic pathways and just, you know, understanding that there are certain conditions, even just dysbiosis, frequent antibiotic use, all of these things can increase intrahepatic recycling of toxins and, and effectively make a particular load of toxins louder on the body and have a louder effect. So lots of increased exposures based on occupation or living on a farm or things like that. And you know, that's, that's another challenge because there's such a variable interaction that we all have with our exposures.

And then another challenge that's really, you know, hard not to get upset about is just the fact that some exposures, I think of them as kind of indecent exposures, you know, these infants in utero, embryos in utero, developing at these vulnerable times being exposed to mum's background body burden. And as a mother myself, there's lots of things I'd go back and change if I could. I was just reading a meta-analysis yesterday on endocrine disrupting chemicals. And we, we know that there are very vulnerable windows of development. And I will also story this with my patients. I will, I call them clients, but I'll story the, the moment of conception and the size difference between the egg and the sperm, 10,000 times difference in size; how small the sperm are and how relevant that is to their vulnerability, to, to exposures.

But I'll also talk about preconception. If this were to be a baby boy, testes development structurally is really quite they're formed and quite set by 14 weeks gestation. But I hadn't heard this term before, the masculinising programming window. Masculinising programming window between eight- and 14-weeks’ gestation. So, you know, it is the case that if mum is exposing herself to sort of non-persistent endocrine disrupting chemicals in that first trimester of her pregnancy, unbeknownst to her, she can have not just a functional, but also a structural impact on the development of her son's testes. So I do raise these sorts of conversations. I also talk about how some chemicals might interfere with thyroid hormone feedback and how important mum's thyroid function is in that first trimester of pregnancy and really the first half of gestation. So I think those indecent exposures upset me a little bit, and that's probably a driving force to make me be a bit of an advocate to all clients that I see. And the other thing is I remind clients that really what stands between a child, or an infant and environmental exposures is really just the education and awareness and commitment of, of that family or, or that mother.

Wendy McLean (14:40): Yeah, absolutely. Yeah. And I think you know, there's the critical development period, but also it can set them up for lifelong conditions. So metabolic conditions, you know, obesity.

Tabitha McIntosh (14:55): So some of the endocrine disrupting chemicals are termed obesogens.

Wendy McLean (14:59): Yeah, exactly.

Tabitha McIntosh (15:00): They interfere with insulin feedback systems.

Wendy McLean (15:02): So, yeah. And concerning reading that, you know, this may impact then the next generation and the generation after that.

Tabitha McIntosh (15:09): The epigenetics and intergenerational things, sometimes I feel like my mind might burst, you know, doing the gymnastics to fathom all of this. The, the way I make it easier to understand and also to speak about in, in my head is the, the prenatal exposures. And it is the case that at particular, you know, windows within that masculinising programming window, conditions, you know, that, that condition hypospadias where the opening of the urethra turns up somewhere else along the shaft of the penis is, is really because of an androgen blocking exposure that interrupts the urethral folds, you know, developing in, in the penis. And so it's thought to be of both genetic and environmental causes, and we can't really put a percentage on it. Actually that was something that always fascinated me as a child, the nature versus nurture debate. I think it's one of the reasons I went into the medical science. I just, it's such an excellent debate, forever debatable.

Wendy McLean (16:13): Absolutely.

Tabitha McIntosh (16:15): It really piques my interest. But yeah, so something of an exposure that interferes with androgen signaling in those early weeks can result in hypospadias, but in addition to those prenatal exposures, there's also a great deal of research on postnatal. So like non persistent endocrine disrupting chemical exposures within a period of time, months for example, prior to ejaculation, that can impact not just female fertility, but also male fertility parameters.

Wendy McLean (16:45): Yeah. So again, that leads nicely into the next question. So with reproductive disorders rising at an alarming rate in both men and women, can you hone in a little bit more on these endocrine disrupting chemicals that you've been talking about and the reproductive outcomes? Which you kind of touched on.

Tabitha McIntosh (17:06): Yeah. Well look, reproductive problems and challenges are, I think they're even increasing in the, in the short 15 or 16 years that I've been in clinical practice, like the amount of clients leaning into IVF for support because of male factor infertility issues is, is really profound. But you know, it, it is a global issue as well. I'll come back to the infertility, but endocrine disrupting chemicals, ultimately they have like multiple mechanistic pathways and they can be persistent chemicals. So things like dioxins or PCBs that are in our environment. So they're in our food chain, they have half-lives measured in decades, and they might be in sort of the fat of animal products or dairy products. And, and they just persist in our environment, in our, in our bodies.

But then there are the shorter acting endocrine disrupting chemicals, things like phthalates and parabens and bisphenol A where half-lives are measured in hours actually. But look, they can work by mimicking hormones in the body. They can also work by attaching onto receptors and blocking receptor functions. So they're therefore blocking the actions of hormones and then they can also impact or affect the synthesis and the metabolism and the excretion of, of hormones. So there are just multiple mechanistic pathways, but what we know about them is because, you know, reproductive development in utero, and then also at other vulnerable stages like puberty, you know, these endocrine disruption chemicals, small exposures at the wrong time and cumulatively with other body burdens that we might not even be thinking of, or a constipation problem, or a nutritional deficiency or a dysbiosis, you know, that these cumulative and synergistic impacts really do contribute to conditions that we see in clinic every single day, whether it be endometriosis, polycystic ovarian syndrome, breast cancers, or reproductive outcomes. But yeah, the, the changes to reproductive health are, you know, are really a global issue. So I'm, sure you're aware of that huge regressional meta-analysis published in 2017 by Levine and also Shanna Swan, who, who published…

Wendy McLean (19:22): The book Countdown. Yeah.

Tabitha McIntosh (19:24):

Countdown, which is actually a fascinating read, probably a little bit alarming. You got, you got with some of the grain salt. Yeah.

Wendy McLean (19:32): Well, and I said, I'm glad I stuck it out to the end, because there was some positivity and hope at the end of it.

Tabitha McIntosh (19:39): And that's right. And, and constructive and prescriptive advice, which I, I agree with that. But you know, she talks about the changes to male sperm counts as really a public health emergency. But the, the amazing thing about this study published three or four years ago now is that it was looking at sperm from over 43,000 men from all over the world. And it showed a 50% decline in sperm counts over the last say 40 years in men, including from Australia and New Zealand and Europe, and men from, you know, industrialised countries and, and far less change to people still living in parts of Africa, et cetera. So, you know, but you know, it's a global issue, but on our soil we know, you know, fertility or subfertility is really sort of been, I think women have been burdened with, with it for a very, very long period of time.

And I just feel like I want to be the advocate to, to say actually in the almost 27%, it's almost 30% of cases, it's a male only factor contributing to the, the need for intervention with IVF or ART. And rather than for these men who can feel ashamed or feel that a low sperm count or poor sperm morphology is, is a reflection of their masculinity, which is definitely not the case. I like being really constructive and, and changing that negative connotation by, by talking about the size of the sperm and what happens at the moment of conception, and the fact that actually it's a biomarker for environmental exposure. And there's a lot that we can do to protect the sperm. Heaps of research looks at the semen and nutrients and antioxidant load of our diet impacting the antioxidant and phytochemical amounts in the semen which are bathing the sperm and can really act as armour or, or protection against DNA fragmentation, et cetera. So I like taking the, the weight off the woman's shoulders, talking about how pivotal male health is and how sperm can be a biomarker for health and exposure. And how also, how well they often respond to, to naturopathic intervention.

Wendy McLean (21:52):

Yeah, absolutely. And so can you share some of your other clinical tools that you may employ to address this enormous area?

Tabitha McIntosh (22:02): It is, it is a really big area and there's lots of, you know, lots of things I talk about with my clients as to, you know, the, the strategies. I obviously, I've written the book and I've also got an e-book called Be Your Own Solution. Which is really helpful. People can just, people can have a read through that and go room by room, kitchen, pantry, diet. What can I do to, to improve my home environment. But I go through a bit of a process, and I've got a five-step process. So, I, the first step I've discussed already having the conversation and just shining the light on the impact of the environment with my clinical lens and talking about some of the research showing prenatal and postnatal exposures impacting fertility outcomes.

Step two, we have the option of testing. If I, if I am working with someone rural or working, you know, a cattle farmer or a cotton farmer or something like that, I will often employ some testing. I try to hold off because of the expense to the patient, but in some situations I think the benefit outweighs the cost. And if the client's happy to go ahead, it allows us to really target our, target our management.

I think that the, the, my third, switching to safer. So before, you know, even spending money, in some clients just talking about the swaps they can have with their personal care, cleaning and home items and maybe employing, you know, a HEPA filter on the vacuum, but also in an air filter in their home if they live on a main road, et cetera.

But then I like to do what I can with diet, nutrients, and lifestyle, to really upregulate the detox processes. So again, making this really accessible for clients. But whether it be, you know improving or balancing methylation for phase one, maybe using, Deanna Minich has published some wonderful information on herbs and spices and, and nutrients for upregulating detox. So I will often refer to some of her research, talk about foods for healthy methylation and the use of turmeric to upregulate phase two clearance of certain toxins. But we also, I talk about infrared saunas for sweating, talk about getting at bowel evacuating really well, hydration. So and I also share heaps of recipes for the brassica family, so interesting ways to use the kale and cauliflower and Brussel sprouts and broccolini. And, you know, the, with the NHMRC recommendations of five cups of veggies a day, I might say, I want three or four of those to be from the brassica family. And here are some ways to prepare those kohlrabi fries. And I just get, I just get interesting and a bit playful with it.

And then of course my next step is maximising resilience. So, you know, making sure that all the, a nutrient dense diet coming in, obviously with diversity of plant foods, to really upregulate that diversity in the bowel microbiome, but also, you know, just making sure that women are iron replete prior to conception. And through first, second, third, and even fourth trimester, they're getting enough choline to protect baby's brain and iodine intake from diet and prenatal is, is adequate to protect the thyroid and things like zinc levels. And even some of our nutrients like magnesium are implicated in detoxification. So I really think that, that fifth step of maximising resilience, I think is, is really important. And doesn't have to be too complex and doesn't have to, it might involve some standard pathology investigations, but really, it's a cleanup of the diet and lifestyle and making sure that the diet’s nutrient dense and where there are gaps in the diet maybe I can step in some supplements.

Wendy McLean (25:36): Yeah, absolutely. Yeah. I do love that approach. And like you said, doing an audit of the house and doing those swaps. And do you also recommend water filtration as well?

Tabitha McIntosh (25:47): Definitely. So there's a huge chapter on water in the textbook, and I've got a relationship with the, the water shop in Cammeray in terms of recommending which sort of filters and or they offer fantastic advice actually. Excellent. But you know, I, in terms of auditing the house, this is where I might lean into the fabulous industry of building biologists. So I've got some building biologists I refer to because I'm not in there. Actually, the one upside of doing all of the zoom consults during the lockdowns is people could go to the pantry and show me what they were using, or what do you think about this? And, and I could also go to my pantry and say, oh, we use this one instead. And I found this to be real, this, this deodorant for the teenagers to be really good or personal care items. So that's one of advantage of being at home through some of these consults, actually being able to see, but yes, the building biologists really have an expertise in auditing homes for EMF, moisture, mould and chemicals lead, even in windowsills and things like that. So we couldn't do without them.

Wendy McLean (26:47): Yeah, absolutely. And certainly, mould is, is a huge issue at the moment. And will be for the next little while in the east coast of Australia, particularly with all of this rain and damp.

Tabitha McIntosh (27:00): It's a bit dampening on the old spirit too, isn't it?

Wendy McLean (27:03): It is, it is you know, but we, we, we are resilient nation and you know, we can band together.

Tabitha McIntosh (27:12): We sure we can. And we do. And, and we will.

The other thing I thought I’d just mention, even though it's not particularly nutritional or, or even herbal, but because of that piece of the puzzle, you know, when our catecholamines and cortisol are really high, that actually has a bit of a downregulating or a blocking effect on detoxification. So I do talk about how our, the balancing our autonomic nervous system and I give strategies for stress management, possibly also there's some herbal prescriptions, you know, anxiolytics or adaptogens to really support women and couples and clients in general with their stress response. And I talk about how…Wendy, quite often in clinic I’m a see saw, like this and like this.

So it's true that when our stress is very high, our body is not prioritising detoxification and metabolism and things are quite compromised. So I like to talk about the stress management pieces as part of maximising resilience as well prioritising sleep, getting out in nature.

Wendy McLean (28:16): Yeah, absolutely. Nature's a big one, exercise and yeah, I'm doing a lot of research around the vagus nerve and looking at ways to stimulate it. So I'm like, yeah, I'm always singing on the top of my voice.

Tabitha McIntosh (28:32): That's very good.

Wendy McLean (28:35): Well look, Tabitha, that's just been absolutely wonderful. So many pearls of wisdom there and your clinical experience as well. And I know yourself, like many others have been impacted by the current floods. And so we really do appreciate you taking your time out today to, to talk with us.

Tabitha McIntosh (28:55): It's my pleasure. I hope you couldn't hear the gurney out the back.

Wendy McLean (28:59): So now we know why. Yeah. And I really look forward to hearing you at the NHAA symposium as well at the end of May.

Tabitha McIntosh (29:09): Thank you, Wendy. I can't wait to see you there and all of our colleagues that can make it. And I just think it's going be a nourishing event for a whole lot of reasons.

Wendy McLean (29:16): Absolutely.

Tabitha McIntosh (29:17): Very happy to be speaking.

Wendy McLean (29:19): Thank you. And thank you to our listeners for tuning into this episode today, we appreciate your ongoing support and feel free to leave us a review. We'd love to hear from you. Thank you.


Tabitha McIntosh book – One Bite at a Time