Category: Dr Noble Talks

I’ve seen time and again that many patients experience a major loss or trauma just before their health unravels from biotoxin illness. Stress often acts as the final “hit” that overwhelms the neuroimmune system and triggers the cascade of symptoms I described in last month’s newsletter.

Stress, especially when it’s chronic, disrupts the HPA (Hypothalamus-Pituitary-Adrenal) axis, often mislabeled by influencers as, “adrenal fatigue.” While the name is misleading, the principle is correct: ongoing stress dysregulates the stress response system, leaving us vulnerable to inflammation, immune dysfunction, and chronic disease. Without recovery time, the body loses its ability to self-regulate creating dis-ease.

Years ago, when asked about the key to aging well, I didn’t name a laser or cream—I said, “resilience to stress.” Because if we can master stress, we can preserve health and vitality. As I told the interviewer, “A great paint job on a rusty engine won’t get you very far.”

A sure way to age rapidly is to be in a constant state of stress.

Here’s what happens physiologically: the brain signals the adrenals to produce cortisol and adrenaline, fueling fight-or-flight. Normally, once the threat passes, the system resets. But when the “tiger” is psychological and constant, cortisol stays elevated, then eventually drops too low, leaving us depleted.  The body tries to adapt by active processes that maintain stability through changes in response to its environmental demands in a process called allostasis. An imbalance, from too much “allostatic load” drains metabolic energy, causing sugar swings, poor sleep, hormone disruption, weight gain, blood pressure changes, anxiety, brain fog, and eventually depression.

Unresolved trauma and feelings of lost control only add to our toxic burden, increasing the risk for autoimmune disease, cancer, infections, infertility, irritable bowel syndrome, cardiovascular issues, and diabetes. This mind–body connection is now studied in a field called psychoneuroimmunology.

Testing the HPA axis with salivary cortisol in relation to the hormone, DHEA can provide insight into this stress resilience and neuroimmune function. A healthy rhythm means cortisol peaks 30–45 minutes after waking, then tapers through the day. When this cycle falters, exhaustion of body, mind, and spirit follows.

There are certain “adrenal cocktails” said to be helpful on social media. But some can be more damaging then good. Proceed with caution if they contain fruit juices; They can dysregulate sugar balance further worsening symptoms. Whole fruits high in vitamin C, fiber, leafy green vegetables, whole unprocessed foods, and grains with B vitamins are beneficial.

Evidenced Based Support of the Brain–Adrenal Connection

• Keep consistent rhythms with sleep, meals, and movement.
• Eat breakfast with fiber, and small frequent meals to stabilize blood sugar.
• Limit exercise sessions to under 45 minutes.
• Use adaptogenic herbs under guidance (e.g., Ashwagandha, Eleuthero, Schizandra, Rhodiola, and Licorice, if appropriate).
• Phosphatidylserine or L-theanine may help lower high cortisol.
• DHEA or pregnenolone may help if testing shows deficiency.
• NAD or IV nutrient support can also be beneficial.

Most importantly, healing requires identifying your stressors and building resilience. Try making two lists: what drains you and what brings joy. Begin shifting time and energy toward your “joy list.” Practices like yoga, diagrammatic breath, prayer, meditation, CBT, EMDR, HeartMath techniques, limbic retraining, and Psych-K can be powerful tools to release trauma and restore balance.

True health requires caring for both body and mind.  

Reducing toxin exposure, ridding oneself of energy suckers, resolving childhood trauma, and trusting our intuition “when our body says no,” will strengthen our stress resilience allowing us to heal and live a happier, healthier life!

Wishing you wellness,

Dr. Anjali Noble

 

1. Kalia, M, Assessing the economic impact of stress-the modern-day hidden epidemic. Metabolism. 2002 June, 51: 49-53

2. Leistner, C, and Menke, A. Hypothalmic-pituitary-adrenal axis and stress. Handbook of Clinical Neurology. Volume 175, 2020, 55-64.

3. Lightman, S, Birnie M, and Conway-Campbell, B. Dynamics of ACTH and Cortsiol Secretions and Implications for Disease. Endocrine Review. 2020 June 1; 41.

4. Joseph, D, Whirledge, S, Stress and the HPA axis: Balancing Homeostasis and Fertility. Int J molecular Science, 2017 Oct 24; 18.

5. Juruena, M et al, The Role of Early Life Stress in HPA Axis and Anxiety. Adv Exp Med Biol. 2020:1191 141-153.

6. Rakel, Textbook of Integrative Medicine. 5th Edition. 372-389.

7. Lupien, SJ et al. The Douglas Hospital Longitudinal Study of Normal and Pathological Aging: summary of findings. J Psychiatry neurosci. 2005, Sep: 30: 328-324.

8. Gold, PW and Chrousos, GP. The organization of the stress system and its dysregulation in depressive illness. Molecular Psychiatry. 2013 Jun; 18. 632-4.

9. Kumari M, Shipley M, Stafford M, Kivimaki M. Association of Diurnal Patterns in Salivary Cortisol with All-Cause and Cardiovascular Mortality: Findings from the Whitehall II Study. The Journal of Clinical Endocrinology & Metabolism. 2011;96(5):1478-1485.

10. Hackett RA, Steptoe A, Kumari M. Association of Diurnal Patterns in Salivary Cortisol with Type 2 Diabetes in the Whitehall II Study. The Journal of Clinical Endocrinology & Metabolism. 2014;99(12):4625-4631.

11. Kumari M, Chandola T, Brunner E, Kivimaki M. A Nonlinear Relationship of Generalized and Central Obesity with Diurnal Cortisol Secretion in the Whitehall II Study. The Journal of Clinical Endocrinology & Metabolism. 2010;95(9):4415-4423.

12. Banasik J, Williams H, Haberman M, Blank SE, Bendel R. Effect of Iyengar yoga practice on fatigue and diurnal salivary cortisol concentration in breast cancer survivors. Journal of the American Academy of Nurse Practitioners. 2010;23(3):135-142.

13. Turakitwanakan, W. et al. (2013). Effects of mindfulness meditation on serum cortisol of medical students. Journal of the Medical Association of Thailand, 2013 Jan; 96 Suppl 1:S90-5.

14. Milagros, C. et al. (2010). Stress, social support, and cortisol: inverse associations. Behavioural Medicine, 30(1):11-22.

15. Kennedy DO, Veasey R, Watson A, et al. Effects of high-dose B vitamin complex with vitamin C and minerals on subjective mood and performance in healthy males. Psychopharmacology. 2010;211(1):55-68.

16. Agha-Hosseini, F. S., Moosavi, M., & Shirzad, N. (2016). The association of elevated plasma cortisol and Hashimoto’s Thyroiditis, a neglected part of immune response. Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine, 71 (2), 81-85.

17. Singh N, Nath R, Lata A, Singh SP, Kohli RP, Bhargava KP. Withania Somnifera (Ashwagandha), a Rejuvenating Herbal Drug Which Enhances Survival During Stress (an Adaptogen). International Journal of Crude Drug Research. 1982;20(1):29-35.

18. Kimura K, Ozeki M, Juneja LR, Ohira H. l-Theanine reduces psychological and physiological stress responses. Biological Psychology. 2007;74(1):39-45.

19. Panossian A, et al. (2012). Adaptogens stimulate neuropeptide y and hsp72 expression and release in neuroglia cells. Front Neurosci. Feb. 2012.

20. Kimura, Y. and Sumiyoshi, M. (2004). Effects of various Eleutherococcus senticosus cortex on swimming time, natural killer activity and corticosterone level in forced swimming stressed mice. Journal of ethnopharmacology, Dec; 95(2-3):447-53.

21. Baker ME, Fanestil DD. Licorice, computer-based analyses of dehydrogenase sequences, and the regulation of steroid and prostaglandin action. Mol Cell Endocrinol. 1991 Jun;78(1-2):C99-102.

22. Felitti VJ et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998 May;14(4):245-58.

23. Rockliff H. et al. A Pilot Exploration of Heart Rate Variability and Salivary Cortisol Responses to Compassion-Focused Imagery. Clin Neuro Psych 2008;5(3):132.)

24. Thomaes K et al. Degrading traumatic memories with eye movements: a pilot functional MRI study in PTSD. European Journal of Psychotraumatology.2016;7:10.3402/ejpt.v7.31371. doi:10.3402/ejpt.v7.31371.

Today’s Hot Topic: Biotoxin Associated Illness

Are you dragging through your day, feeling depressed, foggy, inflamed and in pain? Are you quick to anger, unable to focus like never before, and experiencing a strange constellation of symptoms that no doctor can fully explain? If so, your toxic load may be too great for your body to handle, and you may have lost your tolerance to chemicals. But the real root cause in most cases is a Chronic Inflammatory Response from prolonged exposure to a biotoxin.

Understanding Biotoxin and Mold Illness

There are many causes of biotoxins, but 80% come from exposures from indoor environments, especially water damaged buildings. For a long time, we blamed mycotoxins-toxic gases produced from molds, as the primary culprits. But we now know that majority are from actinomycetes, endotoxins and inflammagens from damp buildings microbiomes.

Mold illness is far more prevalent and serious than many clinicians realize. I say that with humility, because in the early years of my practice, I likely missed this diagnosis in many of my patients. You do not know what you do not know and when we close our minds, people stay sick, sad, and in despair.

Years ago, a colleague shared that her inability to lose weight and brain fog as being due to this stealth intruder. She was following the “Surviving Mold” protocols and in my mind, I silently dismissed it as nonsense.

My Story: When the Doctor Becomes the Patient

A decade later I found myself battling the same illness, and like many of my patients, I wasn’t sure if I was going to survive it.

I started to feel like a stranger to myself again.

A quiet sadness crept back in—one I thought I had long since worked through. I was pushing hard just to get through each day. I had gained ten pounds, but for the first time, I didn’t even care. I found myself wondering if my kids would be okay if I were not here.

The exhaustion was overwhelming, the kind that made the idea of tackling the second half of my life feel impossible. I couldn’t see a way forward, and a heavy guilt began to settle in—was I even fit to care for my patients anymore? Did I have anything left to offer?

I clung to the words of Dr. Anthony Silvagni, then the dean of Nova Southeastern University’s College of Osteopathic Medicine, after the birth of my third child: “You need to understand that your 50% is still better than most doctors’ 100%. You need to come back and teach.”

We had just lost our family’s most beloved member, and at first, I told myself it was grief. Then one day, our youngest came in our room saying, “it really smells in here.”

We had a hidden leak from the HVAC system. When the mold assessor inspected the wall, he was shocked that we had been living in those conditions. In our grief, the signs were easy to ignore. I followed many of the integrative medicine guidelines that are preached to heal. But, a year later, I was still sick.

It was not until I extensively studied under Dr. Ritchie Shoemaker and followed his protocol that I began to recover.

The Science Behind CIRS

Dr. Shoemaker coined the condition Chronic Inflammatory Response Syndrome (CIRS) in 1997 after treating groups of patients who were sick from a Pfiesteria, a neurotoxin in estuarine waters. He discovered that in certain genetically susceptible individuals, the immune system is unable to properly eliminate biotoxins. These toxins just recirculate in the body triggering a chronic innate immune system response that the adaptive system fails to shut down.

The condition is genetic: 25% of the population carries specific HLA haplotypes that impair their ability to recognize and clear biotoxins. That’s why most people in a water damaged building will feel fine, while others spiral into chronic illness and start questioning their sanity.

A Multi-Symptom, Multi-System Mystery

There are 37 hallmark symptoms, that involve almost every system. If you have 8 out of 13 symptom clusters and fail a Visual Contrast Study (VCS) test, there is a 98% likelihood you are dealing with CIRS:

1. Fatigue
2. Weakness, decreased assimilation of new knowledge, aches, headaches, light sensitivity
3. Memory, decreased word finding
4. Concentration
5. Joint pain, morning stiffness, cramps
6. Unusual skin sensations, tingling, unusual pain, tremors
7. Shortness of breath, sinus congestion
8. Cough, excessive thirst, confusion
9. Appetite swings, body temperature regulation issues, urinary frequency
10. Red eyes, blurred vision, night sweats, mood swings, icepick pains
11. Abdominal pain, diarrhea, numbness
12. Tearing, disorientation, metallic taste
13. Static shocks, vertigo

Testing and Diagnosis: What Actually Works

Air quality tests are inadequate. My own home had such a high biotoxin burden that even air sampling picked it up. But often, it doesn’t. If your space smells musty, actinomycetes are likely present and you are not free and clear of it. Dust testing, such as ERMI or HERTSMI-2 from Envirobiomics, is currently the best method to detect environmental biotoxins, especially actinomycetes and endotoxins. You can also order HLA genetic testing to determine if you’re one of the lucky 25%.

Serum markers that are frequently altered in CIRS include:

• TGF-Beta 1
• C4a
• VEGF
• MMP-9
• MSH

These biomarkers are often abnormal when basic labs indicating inflammation, like CRP and ESR, are normal. I have tested siblings with identical HLAs living in the same environment and found nearly exact serum abnormalities, reconfirming this gene-environment interaction as a root cause of CIRS.

We need to proceed with caution when dealing with some commercially available testing and treatment options. Elevations of urinary mycotoxin and antibodies to mold are found in some healthy individuals, leading to false positives. Antifungal treatments based solely on these tests can alter our mighty mitochondria and delay recovery.

The Path to Recovery

Healing starts with removing exposure. If you remain in a contaminated space, progress is limited, if not impossible. It is important to know that you can carry the toxins with you on your clothes and porous materials if not handled correctly.

The only validated treatment approach is the Shoemaker 12 Step Protocol, which includes: 

• Removing exposure
• Binding circulating biotoxins with “anion resin binders” like cholestyramine or Welchol
• Treating MARCoNs (a biofilm-forming staph in the sinuses)
• Normalizing disrupted neuroimmune markers
• Administration of VIP (vasoactive intestinal peptide) once the patient meets recovery thresholds

Some patients may benefit from adjunctive therapies, like peptides, for symptomatic relief, especially if more than one etiology is at play, as in Lyme disease and co-infections. But they need to be instituted at the right time in the process. Treating hormones prematurely can backfire if the root cause is not addressed and can worsen the symptoms. People are different and individualized care is what is most important.

While you wait to get into see a Shoemaker trained physician, you can start removing yourself from the exposure, improving detoxification with fiber and pre-treating with fish oils.

A New Era of Hope 

We now have advanced tools like NeurQuant MRIs and transcriptomics, epigenetic tests, to detect neuroinflammatory patterns and even identify triggering organisms. Recent studies have now linked CIRS not only to depression and chronic fatigue, but also to neurodegenerative diseases like Parkinson’s and dementia.

These are exciting times. Thanks to research and pioneers like Dr. Shoemaker, there is now a cure. For those suffering with chronic unexplained illness—there is thankfully hope.

I’m living proof. And now, I get to see my patients not just survive, but thrive.

Wishing you wellness,
Dr. Anjali Noble

P.S. Let me know what you’d like me to cover next!

 

Recommended Reading

Mold Illness: Surviving and Thriving
A Recovery Manual for Patients and Families Impacted by CIRS
By Paula Vetter, Laurie Rossi and Cindy Edwards
Foreword by Ritchie C. Shoemaker, MD

This is an excellent resource for anyone struggling with CIRS. “May you hold onto hope knowing healing is possible and you are not alone.”
– Dr. Anjali Noble

Buy on Amazon

References

The Art and Science of CIRS

1. Dooley M, McMahon S, A Comprehensive Review of Mold Research Literature from 2011-2018. Internal Medicine Review. Vol 6; Page 1.
2. Shoemaker R. Diagnosis of Pfiesteria-human illness syndrome. MMJ 1997. Page 121.
3. Shoemaker R. Residential and Recreational Acquisition of Possible Estuary-Associated Syndrome: A New Approach to Successful Diagnosis and Treatment. EHP 2001; 109:971.
4. Shoemaker R, Rash J, Simon E. Sick Building Syndrome in Water Damaged Buildings: Generalization of the Chronic Biotoxin-Associated Illness paradigm to Indoor Toxigenic Fungi. 2006 Johanning, ed., Toxicology and Neurological Effects.
5. Shoemaker R, House D, Ryan J. Defining the neurotoxin derived illness chronic ciguatera using markers of chronic systemic inflammatory disturbances: A case/control study. NTT 2010; 1:7.
6. Shoemaker R, House D, Ryan J. Vasoactive intestinal polypeptide (VIP) corrects chronic inflammatory response syndrome (CIRS) acquired following exposure to water-damaged buildings. Health 2013; 396:401.
7. Shoemaker R, House D, Ryan J. Structural brain abnormalities in patients with inflammatory illness acquired following exposure to water-damaged buildings: A volumetric MRI study using NeuroQuant. NTT 2014; 1:9.
8. McMahon S, Shoemaker R, Ryan J. Reduction in Forebrain Parenchymal and Cortical Gray Matter Swelling across Treatment Groups in Patients with Inflammatory Illness Acquired Following Exposure to Water-Damaged Buildings. J. Neurosci Clin Res 2016; 1:1.
9. Shoemaker R, McMahon S, Ryan J, et al. Intranasal VIP safely restores volume to multiple grey matter nuclei in patients with CIRS. Shoemaker R, McMahon S, et al. Internal Medicine Review 2017; Page 1.
10. Ryan, J, Wu Q, Shoemaker R. Transcriptomic signatures in whole blood of patients who acquire a chronic inflammatory response syndrome (CIRS) following an exposure to the marine toxin ciguatoxin. BMC Medical Genomics 2015; 8:15.
11. Ryan J, Shoemaker R. RNA-Seq on patients with chronic inflammatory response syndrome (CIRS) treated with vasoactive intestinal peptide (VIP) shows a shift in metabolic state and innate immune functions that coincide with healing. Medical Research Archives, 2017, 4:1.
12. McMahon S. An Evaluation of Alternate Means to Diagnose Chronic Inflammatory Response Syndrome and Determine Prevalence.
13. Shoemaker R, Lark D. Urinary Mycotoxins: A Review of Contaminated Buildings and Food in Search of a Biomarker Separating Sick Patients from Controls. Internal Medicine Review 2019; Page 1.
14. Head, A Sarah, et al, Antifungal drug itraconazole targets VDAC 1 to modulate the AMPK/mTOR signaling axis in endothelial cells. PNAS, December 10, 2015.
15. Shoemaker, et al. A Novel Therapeutic Approach to Parkinson’s Disease: Using Transcriptomics to Identify Unique Patterns of Gene Expression including ‘Triple Positives, Toll receptors, and Endotoxin Exposure. The European Society of Medicine, Medical Research Archives, Volume 13 Issue 6, June 30, 2025.

Have you been frustrated by the mixed health information circulating on the Internet and social media? Me too, and I’m ready to speak up about it. I’ll share what the science shows and reflect on what I have experienced with patients during my 28 years of practice to support your personal wellness goals.

Today’s Hot Topic:  Microplastics (Toxins)

Last month we learned how to create a happier, healthier you by supporting our mitochondria with NAD+ the right way. We learned the importance of these tiny but mighty organelles in supplying the body with its energy and improving your health. (Did you miss it? Click here.) Knowing what you know now, wouldn’t you do all you can to keep them healthy? I sure would.

When I first started my journey into functional medicine, I was laser-focused on hormones. I was personally struggling with a hormone imbalance that had influenced my ability to be the mother, wife, and friend I wanted to be.  Back then, very few practitioners truly understood hormone dysfunction. The protocol to address symptoms like mine was to prescribe birth control pills or rebranded antidepressants like “Sarafem” (Prozac).

Those treatments somewhat stabilized my mood, but I was becoming someone I did not recognize. Realizing that I did not have a Prozac deficiency, I searched further. That realization sparked a journey of discovery to uncover the deeper imbalance. Around that time, actress Suzanne Somers began speaking publicly about hormones, guided by her physician, Dr. Uzzi Reiss, who was one of the first diplomates of the then unofficial Board of Anti-Aging Medicine. I studied and implemented his guidelines using bioidentical hormones. It changed my life. I became 99.9% symptom free.

I felt so passionate about the field that I have served as an oral board examiner for this same board for the past 15 years. As the decades have gone by, I have learned more and more about the intricacies of hormone dysfunction. It’s rarely just about the transition to menopause. We must ask:

Why are the hormones imbalanced in the first place?

Often, the root cause lies in toxins–both environmental toxicants and biological toxins. Toxins can disrupt the enzymes and nutrients our bodies rely on for hormone regulation. For instance, in my case, it was not Prozac itself that caused worsening of my issues, but a genetic enzyme deficiency that impaired my body’s inherent detoxification pathways.

So, we cannot ignore toxins (man-made chemicals) or biotoxins (toxins of biological origin) as a potential culprit of our hormonal and health issues. With great delight, I have seen tons of influencers and wellness advocates trying to shed light on toxins, especially microplastics. These tiny plastic fragments (under 5mm) are an inescapable part of our modern world. They have been found in nearly every corner of the earth, from the top of our mountains to the depths of our oceans, and increasingly, in our bodies.

Growing evidence links microplastics to cardiovascular disease and arterial plaque progression. Even more disturbing, recent research shows they can cross the placenta during pregnancy and breach our blood-brain barrier. A 2019 Australian study estimated that we ingest a credit card’s worth of microplastics every week, through our food, air, water, and even skin.  These particles lodge in our lungs and intestines, disrupt our gut microbiome, travel to our liver, and circulate throughout the body. This ultimately causes inflammation, oxidative stress, and mitochondrial dysfunction.

Microplastics are everywhere: in water bottles, food packaging, utensils, cosmetics, fragrances, equipment and toys. Recently, tea bags and chewing gum have been found to contain microplastics. A new French study even discovered plastic particles in glass-bottled water, due to the plastic-lined caps.

The chemicals used to manufacture plastics—like phthalates, which are used to make plastics pliable, and bisphenol A (BPA) used in its manufacturing—are linked to hormone disruption, infertility, obesity, cancer, and neurodegenerative disease. But most importantly, what matters is your individual toxic burden or load, which determines how your body will react.

I tell all my patients: we live in a toxic soup, and we all have different detoxification abilities based on our genetics, nutritional status, and lifestyle.

Our best bet is to reduce toxins in and help support toxins out. If the bucket of toxins is overloading our ability to detoxify them, we then get the damaging oxidative stress, inflammation, and mitochondrial insults as a result. I am seeing more and more Polycystic Ovarian Syndrome (PCOS) that has been linked to this. It’s estimated that teenagers are using up to 18 personal care products per day that are full of chemicals. If you are being bombarded by toxins and you are not doing anything to support detoxification, while your body is dealing with other infections or biotoxins, you can become hypersensitive to toxins resulting in a condition toxicant induced loss of tolerance (TILT). It is like post-traumatic stress disorder of the immune and nervous system, and it is much more difficult to treat.

If you feel your mood is labile, your brain is foggy, your weight and sugars are going up, you are having fertility issues, you are super sensitive to foods, fragrances, tobacco smoke, cleaning supplies and new carpet, and antibiotics and vaccines make you sick, or you are just “feeling off,” then your body’s inability to handle your burden of toxins and microplastics may be the culprit or root cause. You can take the Quick Environmental Exposure and Sensitivity Inventory (QEESI) at https://tiltresearch.org, and visit http://iseai.org/ to find a clinician trained in environmental medicine who can assist you in the proper testing and support.

How can I lower my toxic load?

The best tool is prevention! Here are a few practical steps you can take:

Reduce “Toxins In”

• Use stainless steel bottles with filtered tap water
• Eat organic foods (Check the EWG’s Dirty Dozen and Clean Fifteen guides)
• Use reusable cloth or paper bags to shop
• Limit consumption of certain high-mercury seafood
• Use loose tea instead of tea bags
• Avoid microwaving or heating foods in plastic containers
• Avoid polyester, nylon and acrylic in your clothing
• Avoid chewing gum
• Choose fragrance-free, clean beauty products and reading labels

Support “Toxins Out”

• Optimize your gut health and nutritional status
• Exercise regularly and get good sleep
• Practice mindfulness and stress reduction
• Use sauna therapy (safely and under guidance)
• Consider supporting detox with nutrients like:
  • Glutathione (IV, topical, intranasal, nebulized, or liposomal forms)
  • NAC, Vitamin C, alpha-lipoic acid, milk thistle, SAM-e, and whey protein

Other therapies are being investigated. More studies are needed before I can recommend them, as some therapies can be more damaging than good. Plasmapheresis seems promising, but it is expensive and not yet readily available. As always, please check the credentials of who is advising you, and don’t make yourself crazy over it.

Focus on what you can control to keep those good energy cells thriving: eat well, stay calm, sleep deeply, and move your body to support your health.

Wishing you wellness,
Dr. Anjali Noble

 

P.S. Let me know what you’d like me to cover next!

---

Recommended Reading

Good Energy
by Casey Means, MD

This is another trusted source of information backed by science. She too is trying to shift the paradigm of medicine to a more preventive model. Chapter 8 speaks on all the environmental toxins that impede our mitochondrial health and more ways to support them. I love her quote by Dhru Purohit on water, “Either you have a filter, or you become the filter.”

– Dr. Anjali Noble

https://www.caseymeans.com/goodenergy

 

References

1. Zhang T, et al. Tiny Trouble: Microplastics, Nanoplastics, and their Heartfelt Impact on Cardiovascular Health. Cardiovascular Research. 2025 April 18: cvaff068.doi:10.1093/cvr/cvaf068. PMID: 40147666
2. Ziani, K et al. Microplastics: A Real Global Threat for Environmental and Food Safety: A State of the Art Review, Nutrients 2023 Jan 25: 15 (3):617. doi:10 .3390/mu15030617
3. McBrady, Rachel. “Birds on Remote Island Make Gut-Wrenching Crunching Sounds Because They Are Full of Littered Plastics,” com.
4. Miller, CS, Prihoda, T. J. , The Environmental Exposure and Sensitivity Inventory (EESI): a standardized approach for measuring chemical intolerance for research and clinical applications. Toxicology and Industrial Health 15:370-385 (1999)
5. Palmer, RF et al, Validation of a Brief Screening Instrument for Chemical Intolerance in a Large U.S. National Sample. Int J Environ Res Public Health. 2021 Aug 18; 18 (16):8714. doi:10.3390/ijerph18168714.PMID:34444461.
6. Chaïb, S. et al. Microplastic contaminations in a set of beverages sold in France. Journal of Food Composition and Analysis, 2025,144, pp.107719. �10.1016/j.jfca.2025.107719
7. Melnick, R.L. & Schiller, C. M. Mitochondrial toxicity of phthalate esters. Environmental Health Perspective, 45, 51-56. Pubmed. PMID:7140696
8. Cirillo T, Latini G, Castaldi MA, et al. Exposure to Di-2-Ethylhexyl Phthalate, Di-N-Butyl Phthalate and Bisphenol A Through Infant Formulas. Journal of Agricultural and Food Chemistry. 2015;63(12):3303-10. doi:10.1021/jf505563k.
9. Tumu K, Vorst K, Curtzwiler G. Endocrine Modulating Chemicals in Food Packaging: A Review of Phthalates and Bisphenols. Comprehensive Reviews in Food Science and Food Safety. 2023;22(2):1337-1359. doi:10.1111/1541-4337.13113.
10. Baneshi M, Tonney-Gagne J, Halilu F, et al. Unpacking Phthalates From Obscurity in the Environment. Molecules (Basel, Switzerland). 2023;29(1):106. doi:10.3390/molecules29010106.
11. Woodruff TJ. Health Effects of Fossil Fuel-Derived Endocrine Disruptors. The New England Journal of Medicine. 2024;390(10):922-933. doi:10.1056/NEJMra2300476.
12. Banaderakhshan R, Kemp P, Breul L, et al. Bisphenol a and Its Alternatives in Austrian Thermal Paper Receipts, and the Migration From Reusable Plastic Drinking Bottles Into Water and Artificial Saliva Using UHPLC-MS/MS. Chemosphere. 2022;286(Pt 3):131842. doi:10.1016/j.chemosphere.2021.131842.
13. Palsania P, Singhal K, Dar MA, Kaushik G. Food Grade Plastics and Bisphenol A: Associated Risks, Toxicity, and Bioremediation Approaches. Journal of Hazardous Materials. 2024;466:133474. doi:10.1016/j.jhazmat.2024.133474.
14. Martínez-Ibarra A, Martínez-Razo LD, MacDonald-Ramos K, et al. Multisystemic Alterations in Humans Induced by Bisphenol a and Phthalates: Experimental, Epidemiological and Clinical Studies Reveal the Need to Change Health Policies. Environmental Pollution (Barking, Essex : 1987). 2021;271:116380. doi:10.1016/j.envpol.2020.116380.
15. Singh S, Li SS. Bisphenol a and Phthalates Exhibit Similar Toxicogenomics and Health Effects. Gene. 2012;494(1):85-91. doi:10.1016/j.gene.2011.11.035.
16. Callaghan MA, Alatorre-Hinojosa S, Connors LT, Singh RD, Thompson JA. Plasticizers and Cardiovascular Health: Role of Adipose Tissue Dysfunction. Frontiers in Pharmacology. 2020;11:626448. doi:10.3389/fphar.2020.626448.