The heart damage builds slowly and might be reversible

[00:00:00] Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

High levels of toxic chemicals in children who are exposed to lead and arsenic leads to early cardiovascular disease, according to research conducted in Syracuse. My guest today is Brooks Gump, a professor from SU who led the study. He's from the department of public health in the Falk College at Syracuse University.

Welcome back to "The Informed Patient," Dr. Gump.

[00:00:36] Brooks Gump, PhD: Thanks, Amber. Good morning. Thanks for having me.

[00:00:40] Host Amber Smith: What made you want to investigate what toxic chemicals are doing to children in our community?

[00:00:47] Brooks Gump, PhD: We've been doing this research for over 20 years. We started in Oswego. Actually, my background is in just general cardiovascular disease risks in children. When I first arrived at Oswego, they were doing work on PCBs (polychlorinated biphenyls, a group of chemicals banned since 1979), and so we looked at their cohort, the Oswego cohort, and looked at lead levels and saw some differences in the way the kids were reacting to stress.

We found that in Oswego. And then, the arsenic was an offshoot of a bigger study that we did in Syracuse more recently, where we were looking again at lead and how children react to stress. But we also had arsenic levels that we had collected. So we looked at the same kind of outcomes, cardiovascular disease risks in children, but in this case, with arsenic.

[00:01:32] Host Amber Smith: So how did you structure your study?

[00:01:36] Brooks Gump, PhD: It was designed to be half African American, half Anglo-American (white) children, in Syracuse city, so we selected ZIP codes that had elevated levels of lead. Also, relatively equal numbers of racial distribution, and so that ended up somewhat in the South Side and some of the ZIP code areas in that. We ended up actually expanding because we had such a difficult time with recruitment.

So we got more Syracuse urban area in general, and we also, in terms of what else, other selection, was 9- to 11-year-old children. The reason for that is because most of our research in the past has been that it's an age group where they're able to do the testing that we want, but they're generally prepubertal so that we're not looking at some of the other, more complex, changes that can happen after puberty.

So, we haven't actually done this kind of work with adults or specifically with toxicants. The outcomes that we looked at, which are reactions to stress, that's kind of a standard approach to looking at that risk factor in adults and children. So, we took some basic procedures that are pretty common in the field, in the cardiovascular field, but not common in the toxicology field, and we applied it to the toxicology.

So, most of the toxicologists at the time didn't really understand how you could study actual reactions to stress. They were working with rats and whatnot, but there are ethical ways to do the research we do.

[00:02:58] Host Amber Smith: And this was conducted long term, over several years. Is that right?

[00:03:03] Brooks Gump, PhD: No, actually, in this case, it was a cross-sectional study, so we were engaged in recruitment for five years, but those children were all recruited, 9-, 10- and 11-year-olds, throughout those five years. It essentially spans a number of specific ages, but a number of years.

We haven't followed them up yet. It's all been cross-sectional so far. Which does raise all the issues that you need to consider when you do see associations in a cross-sectional study. But we are trying to recruit, re-enroll, I should say, those children that helped us out so much in the past, in new studies as they age.

But no, so far, we have not yet completed a longitudinal part.

[00:03:43] Host Amber Smith: So what was the commitment from the families and the children who participated in this? What did they do?

[00:03:50] Brooks Gump, PhD: Well, it was a lot, and we really appreciate what they did. The children had a venipuncture. So for a 9-, 10-, 11-year-old, that's a big deal. So these are children that were willing to do that.

And then also collected a number of testing measures in our lab for a couple hours. Then they also went to a local cardiologist, Dr. Nader Atallah-Yunes. a pediatric cardiologist in Syracuse, and he did echocardiograms for all these children.

In addition to that, we had another lab on campus. Dr. (Kevin) Heffernan runs an exercise physiology lab, and he did some of the measures of thevasculature (blood vessels) and how the vasculature in the body is changing.

[00:04:30] Host Amber Smith: You said "venipuncture." That's like a blood draw, taking blood samples, right?

[00:04:34] Brooks Gump, PhD: Right. It's not the finger stick that sometimes you see with lead because we needed to, well, we wanted to, look at a number of chemicals. So, although it wasn't, (in) quantity, very much blood, we had about eight or nine tubes of blood for all different exposures.

[00:04:49] Host Amber Smith: So what did you think you might find, and what did you find?

[00:04:54] Brooks Gump, PhD: Well, we've been exploring, and we have a new paper coming out in a couple of months on it. What we're exploring is how to classify these toxicants in general as cardiovascular disrupters. Just as there's endocrine disrupters that you hear about in the (medical) literature and the press, we think that also some classes of chemicals fall more into the cardiovascular disrupter category.

So the neuroendocrine system, the stress response system, involves both the endocrine and catecholamines, the adrenaline, noradrenaline, things like that, that you react to, but it also involves all the cardiovascular side to things in the vasculature -- constricting, increasing your blood pressure, all those things.

And those are intertwined, those two systems, but we think some of these toxicants are essentially targeting the cardiovascular side to that system, increasing vascular resistance and things like that. So, we think lead for sure is a cardiovascular disrupter. We're looking at perfluoro chemicals, PFAS ((per- and polyfluoroalkyl substances), and looking at that as a cardiovascular disrupter. And arsenic is another that's been shown in the past.

But most associations are these overall associations with disease in adults. What we're trying to find is how these chemicals affect the reactions and the underlying processes that lead to that disease way down the line, so children that don't have disease per se, but they're reacting more to stress in their cardiovascular system, which is damaging to that system and ultimately could lead to heart disease.

[00:06:21] Host Amber Smith: Well, in addition to the cardiovascular, what did you find with sleep disorders and behavioral issues?

[00:06:29] Brooks Gump, PhD: Some of those were with other chemicals, so arsenic wasn't associated with those. We did find some behavioral disorders, and this has been shown before with lead, so, conduct disorders. We also, in the past, in the Oswego cohort we found impulsivity related to the PFAS, which are the toxicants that are in things like Teflon and Gore-Tex and Stainmaster carpets and wrappers on fast food, things like that, and those seem to increase impulsivity.

And the idea is all of this work showing these different things like sleep, we did with activity, actographs -- so, the children wore these kind of watches around for a week, so we could look at how much activity they had, but also how much they slept, and we looked at some of the effects of that sleep on their outcomes, cardiovascular disease.

So that study had nothing to do per se with toxicants actually, but it was just looking at what are the outcomes of poor sleep quality in terms of the cardiovascular system?

[00:07:27] Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with public health professor Brooks Gump from Syracuse University.

Let's talk about how kids are exposed to begin with and how common these chemical exposures are. How are kids exposed to lead and arsenic and mercury?

[00:07:46] Brooks Gump, PhD:

There's a whole, essentially separate, field in the science where you look at the sources. So, most of our work to date has been looking at the effects. So we say, essentially, regardless of where they're getting it from, what effect does it have on the cardiovascular system?

But with the new study in Syracuse, we actually added Dr. Lynn Brann, who's a nutritionist, and so we're looking at all the foods they consume. We have another researcher at Upstate, actually he's a postdoc now, Dr. Dustin Hill. And he does some of the geographic mapping that we've looked at, to try to see, what's the distribution, to see if we can identify the sources.

So these chemicals, one of the facts you see is that the chemicals are widespread. So all of these children have PFAS. We looked at about 10 different types of PFAS chemicals, and some, 100% of the kids had it in detectable levels. So, there's probably 50 to 100, at least, chemicals that are man-made that are circulating in most children and adults.

It's not so much "if" we're exposed, it's how much and how much is enough to actually find detrimental effects. So these these thresholds are critical, even though they're probably not hard thresholds, probably it just progressively get worse as you get more and more exposure.

So, zero is certainly nice, but that's unrealistic, so they establish thresholds that are more realistic. Like our work with lead, they cited that when they lowered the threshold for children from 10 micrograms per deciliter down to 5. They cited our findings showing that kids are reacting more to stress, even at very, very low levels of lead.

So that resulted in that reduction, which results in all kinds of remediation and other efforts to try to deal with it. So what you do is you essentially lower the threshold, and you create, in quotes, a "public health problem," which needs to then be addressed. If you have the threshold up higher, then everyone will say, "Oh, I'm fine," when in reality, they're not, they're just getting exposed at lower levels and smaller effects.

[00:09:48] Host Amber Smith: So, what about the future for these kids who were in your study who already have cardiac damage? Are they having symptoms?

[00:09:56] Brooks Gump, PhD: So, they don't have any clinical disease, meaning there are no symptoms.

And the thing with cardiovascular disease is, it develops very slowly. So, toddlers that are given autopsies because of accidental deaths, you can already see cardiovascular atherosclerosis, the disease process has already started even in the toddlers. And then they did some studies with casualties in Vietnam, and those young men and women had cardiovascular disease indicators as well, when you do the autopsy.

So, anyone who's prone to this disease, either genetically or because of their situation, is going to develop it very slowly from a very young age, so this is just one of those kind of pushes on that. So, if they're eating poor food, they're not exercising, those are also risk factors for eventual cardiovascular disease.

So, this is another in that line. What we found is just subtle changes, in their vascular thickness and some of the other things, and they're not irreversible. With healthy diet and healthy exercise -- there's some work by (widely published researcher) Dean Ornish looking at interventions -- I think the general consensus is that you can reverse some of these subclinical (hard to detect) indicators, subclinical changes, through other healthy behaviors or, of course, removing the problem, to the extent you can remove it, but it's difficult in this context, because we're not even sure where they're exactly getting the arsenic, for example. We believe right now it's in the soil. One hypothesis, we don't really know, one hypothesis is there's a lot of orchards in that area and there's lead arsenate, (which) would elevate both lead and arsenic in that soil in that area.

So, if you look at old maps of Syracuse and that South Side, in addition to the salt flats, there was also some orchards in that area, apple orchards, so that's another possible. It's kind of like forensics toxicology. We really don't know yet exactly where it's coming from. We do have some ongoing soil studies looking at old soil samples, and hopefully, that will give us some clues as to where it's coming from.

[00:11:54] Host Amber Smith: Why is there arsenic in apple orchards?

[00:11:57] Brooks Gump, PhD: It's a pesticide, so lead arsenate was sprayed on them to prevent this specific moth that was eating them. And I have pictures of these sprayings, without any protection. I mean, they heavily sprayed this lead arsenate.

[00:12:11] Host Amber Smith: Well, what additional research would you like to do on this subject?

[00:12:16] Brooks Gump, PhD: The one I'm most interested in right now is kind of a "food is medicine" approach. There's a colleague at SU, Sudha Raj, who does some work on food as medicine and Ayurvedic methods for reducing toxicants. I'd like to see if there's something that's natural and not harmful, so it doesn't have side effects, because their current methods for chelating and pulling out metals and toxicants frequently have side effects attached to them as well, so you're getting one substance replacing another.

So, if there's some natural dietary changes, even something as simple as drinking more water during the day, and we can start to look to see if there's something that people can do daily. Just as they're daily probably exposed to these toxicants, maybe they can be daily exposed to some foods that will remove the toxicants, is where we're hoping to head.

[00:13:05] Host Amber Smith: You mentioned that you might want to do some more work involving the kids that were in this original study. What is that about? And where does that stand?

[00:13:15] Brooks Gump, PhD: We recently got a grant, internal grant, from Syracuse University to try to reconnect with these children, or now young adults, so they'll be 18, 19, 20, and we're hoping that with their generosity, they might participate again, as we can do some more studies, more questions, kind of follow up, see where they're at, what they're doing, how they're feeling.

And so, if they want to contact me, that's at: [email protected]. I'm happy to receive emails and direct you to the research team and for any of those children or parents, because the parents also did a lot for our study. I should mention, I'm sorry, that parents were also bringing the children, filling out many, many questionnaires, things like that, so we're really grateful for all their work.

[00:14:04] Host Amber Smith: Well, thank you for making time for this interview, Dr. Gump.

[00:14:06] Brooks Gump, PhD: You're welcome, Amber. Thank you for having me.

[00:14:09] Host Amber Smith: My guest has been Dr. Brooks Gump. He's a professor in public health at Syracuse University's Falk College.

"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe.

Find our archive of previous episodes at upstate.edu/informed.

This is your host, Amber Smith, thanking you for listening.