July 2021
This month, we spoke with Lara Adler, an educator and holistic health coach specializing in environmental toxins. We talked with her about the role of chemical exposure in our everyday life and how these toxins can affect fertility, the vaginal microbiome, and reproductive health.
Lara Adler is an environmental toxins expert and educator and a certified holistic health coach who teaches health coaches, nutritionists, and other health professionals how to eliminate the #1 thing holding their clients back from the results they are seeking – the unaddressed link between chemicals and chronic health problems. She trains practitioners to become experts in everyday toxic exposures so they can improve client outcomes without spending hundreds of hours researching on their own.
Combining environmental health education and business consulting, she’s helped thousands of health professionals in over 25 countries elevate their skillset, get better results for their clients, and become sought out leaders in the growing environmental health & detoxification field. Lara is a member of the National Association of Environmental Medicine, and the American Holistic Health Association.
SHWI: How did you become interested in environmental toxin education, and particularly for healthcare professionals?
I stumbled into this field quite by accident; I had funneled my lifelong passion for health and nutrition into a new career as a health coach and was working with clients preliminary around general health and weight loss. While most of my clients had success with their weight loss, a few of them experienced no change at all, despite implementing numerous diet, lifestyle, and behavior changes.
I was eager to figure out what I was overlooking or missing since I thought I’d covered all the bases, so I dove into the literature around resistant weight loss. It was at this point that I learned that certain environmental chemicals can interfere with metabolism in ways that result in weight gain, or that could lead to things like insulin resistance and diabetes. I found this absolutely fascinating, because this was the first I’d ever heard of anything like this, but also a bit shocked that in all my reading, training, and talking with other health professionals, this was the first I was hearing about it. I became quite obsessed with the topic of environmental chemical exposures and spent a little over two years reading every study and book on the topic I could find, and attending workshops, conferences, and symposiums held by some of the top environmental health organizations.
I quickly started to see that while there was an enormous body of research showing that low levels of exposure to environmental chemicals were linked with a long list of chronic and acute health issues, most health professionals didn’t know anything about this. My colleagues in the health coaching and nutrition space shared with me that they hadn't learned anything about environmental health in their training either, and when I reached out to other types of health professionals, including MDs, ND, and RNs, they shared that they too had no real understanding of these issues. There’s a huge education gap here.
According to a 2016 article on the American Association of Medical Colleges website, “An Institute of Medicine report 20 years ago framed the need for an environmental health perspective in medical practice and suggested six related learning objectives for medical students. In a study of pediatricians published in 2006, however, just one in five had received training in environmental history taking. An earlier study reported that in medical schools requiring content related to environmental medicine, students received just seven hours of such training. Nearly one-quarter of schools surveyed did not require any environmental content. And the AAMC’s 2013 survey of medical school graduates found that more than one-third of respondents said they received 'inadequate' instruction in environmental health.” Other types of health professionals often have zero training in environmental health, leaving them at a disadvantage when working to support their client’s or patient’s health.
So in 2012, I shifted my business from health coaching to educating health professionals of all types on the links between environmental chemical exposures and the very health issues their clients and patients struggle with. My work focuses not on the clinical aspects of detoxification, but rather the important and often overlooked step of identifying and then minimizing the exposures in our daily lives, from a real-world, practical perspective to reduce the body burden of chemicals and optimize overall health.
I think that health professionals are in a unique position to dialogue about toxic exposures with their clients and patients because they’re already on a journey to get healthy or deal with a health issue. Most folks sadly don’t start learning about this topic until they are already struggling with poor health. I hope that by integrating this topic into all health care conversations, health professionals will be able to minimize the risk for future health issues in their client or patient base.
SHWI: Recent studies have found chemicals in pregnant mothers and their offspring, warning us about the risks of prenatal chemical exposure. What do trying-to-conceive patients need to know about the impact of environmental toxins on fertility and reproductive health??
Several studies have found low – but concerning – levels of chemicals in umbilical cord blood, including PFAS chemicals, metabolites of long-banned pesticides, and flame retardants. Recently, microplastics were discovered in human placental tissue. What this tells us is that contrary to what we used to believe, the womb is not a sterile environment and the chemicals mothers encounter can easily be passed on to the developing baby. In-utero exposures are the most concerning as chemicals like endocrine disruptors or neurotoxins can interfere with normal, healthy fetal development and can contribute to both short-term and long-term health effects.
Many of these same chemicals also appear to interfere with fertility in both men and women; in particular, endocrine-disrupting chemicals (EDCs) like bisphenols, phthalates, flame retardants, certain pesticides, and PFAS. Studies have also found associations between higher levels of bisphenol A (BPA) metabolites in the urine of women undergoing IVF treatments and increased odds of implantation failure.
For these reasons, it’s important that couples who are trying to conceive (TTC) work towards minimizing as many of these environmental exposures as possible, ideally, at least six months before conception. In practical terms, this means making a number of small but meaningful changes to the things you buy and habits around the home.
You could minimize or avoid the use of plastics that come in contact with food, as well as plastic food storage containers, plastic dishware and utensils, and plastic water bottles. You could also minimize your consumption of canned foods which are lined with epoxy resins containing bisphenols to help lower your exposure to BPA and it’s replacement chemicals bisphenol S (BPS) and bisphenol F (BPF).
Phthalates, a large class of endocrine-disrupting chemicals, are often found in scented products in the home, as well as soft plastics like vinyl shower curtains. Getting rid of household fragrances like air fresheners, plug-ins, furniture sprays, and household cleaners like laundry detergents can lower blood levels of these chemicals and improve indoor air quality.
Choosing organically grown foods, whenever possible, can also help to minimize exposures to organophosphate pesticides, many of which are linked to fertility issues, poor birth outcomes, learning disabilities, and cancers.
SHWI: Environmental toxins can play a role in underlying chronic health problems that patients may not be aware of. What are some primary toxic offenders that affect overall health and how can practitioners address these with their patients??
This is a tricky question to answer because many chemicals like pesticides or bisphenols are linked to such a wide range of health issues, and there’s no real way to determine which symptoms or health conditions will present in a given person. For example, chemicals like bisphenols are linked to metabolic issues like insulin resistance, weight gain, and diabetes, but also reproductive issues, immune system issues, and breast cancer. This is often why toxicants are often overlooked in clinical practice - because they can present in so many different ways that can also be attributed to other things.
To me, the primary toxic offenders are the chemicals that we’re exposed to every single day like bisphenols, phthalates, organophosphate pesticides, methylmercury, lead, arsenic, flame retardants, and PFAS chemicals.
Data from the National Health and Nutrition Examination Survey (NHANES) tells us that some of these, like phthalates and bisphenols, are present in over 90 percent of the population, despite them being non-persistent and having very short half-lives in the human body; between 5-24 hours. This tells us that exposure is ubiquitous and ongoing. Other chemicals, like per- and polyfluoroalkyl substances (PFAS), which are found in non-stick cookware, stain- and water-resistant sprays for textiles, and even in firefighting foam (and as a result, in drinking water) are more persistent in nature; they build up in the environment, and in people. It’s estimated that 99 percent of the U.S. population have PFAS chemicals in their blood.
When it comes to addressing these exposures, practitioners – rather than looking exclusively through the lens of the specific health challenge their clients or patients are dealing with – can make recommendations to help lower the overall body burden. This starts with the practitioners having an understanding of where these exposures are happening (through food, personal care products, household cleaners, drinking water, or household furniture), and then guiding their clients or patients towards safer, less toxic products or behaviors.
I like to remind the practitioners I teach that outside of high-level occupational exposures, a single exposure to BPA isn’t going to be a concern. It’s the chronic exposure to low levels of toxicants that can bioaccumulate that are more concerning. Passing this message on to clients can help minimize the overwhelm that can come up for people as they start to learn more about chemical exposures.
What’s great is that as people work on reducing their overall body-burden of chemicals, they can likely have positive effects on aspects of their health that maybe they hadn’t considered. For example, I had someone tell me that after months of trying to figure out why she was experiencing hair loss, which included multiple practitioners and numerous tests, she heard me talk about chemicals in water, and realized that her water filter for her home had broken a few months prior. Fixing the water filter stopped the hair loss almost immediately.
SHWI: Many studies are now recognizing that some ingredients can be toxic to the vaginal biome. What kinds of ingredients should physicians counsel their patients to avoid?
Many, if not most of the vaginal products on the market are made with ingredients that have no place near the vagina. Certainly, hormone-disrupting chemicals like phthalates, parabens, and triclosan should be avoided, as well as allergenic chemicals like methylisothiazolinone and fragrance compounds. Unfortunately, depending on the product, these ingredients aren’t always listed on the label, making it harder for consumers to make informed purchases. In 2020, New York became the first state in the country to require period products to disclose ingredients. It’s wild to me that this hasn’t been the case everywhere!
As I’m sure your readers know, commercial products marketed to women for vaginal odor issues are inherently problematic, even if we aren’t thinking about their ingredients. These products send the message that there is something wrong with our bodies and that we need to cover those odors up – or worse, can lead to women not seeking medical care for a bacterial infection that may be causing that odor.
Additionally, these products are often marketed more aggressively to Black and Brown communities, who are already disproportionately exposed to environmental chemicals. For example, Black women are three times more likely than non-Black women to develop uterine fibroids, and we know from epidemiology research that exposure to certain EDCs, like the phthalate DEHP, is associated with increased fibroid risk.
Douche products should probably be avoided by all women – first, because they are typically unnecessary, and second because their ingredients can disrupt the vaginal microbiome and expose us to endocrine-disrupting chemicals.
Even strong-smelling laundry detergents can likely lead to vaginal microbiome disruptions; if the scent of your detergent lingers on fabrics, it’s because the molecules of those chemicals are still present. We know that vaginal skin is thin and highly absorbent, so using safer, fragrance-free laundry products can help.
SHWI: What resources would you recommend to healthcare professionals to begin educating themselves about environmental toxins?
There are so many great resources online to help bring health professionals up to speed on this topic! This certainly hasn’t always been the case, but I’m grateful to see more and more popping up. I’ll mention my own work here, as I’ve been educating health professionals since 2012 on these topics, and have had nearly 4,000 people from a wide range of modalities in my courses.
My approach is to focus on the practical aspects of minimizing exposures to environmental toxins in ways that are both grounded in research and that are practical in real-life situations. For those health professionals looking for more clinical resources, the National Association of Environmental Medicine (NAEM) and The International Society for Environmentally Acquired Illness (ISEAI) both have great information.
While not specifically for health professionals, I find the work of Environmental Health News – a nonprofit nonpartisan news organization that focuses on environmental health – to be essential, as they both aggregate news articles from around the world and also produce some great reporting on toxics in our daily lives and the broader environment.
There has also been an explosion of great books written by renowned scientists, doctors, and epidemiologists over the last decade, many of which I share on the recommended reading page on my website. Staying up to date with the latest research in the space is a full time job as new studies are being published daily – setting up Google Scholar alerts is something that I’ve found extremely useful.
SHWI: Do you know of any studies that show how environmental toxins impact reproductive health?
Yes! There are thousands of studies looking at environmental chemicals and reproductive health. In the last 10 years, there have been over 2,000 studies published on the topic of environmental chemicals and reproductive health, more than half of those just in the last five years. Thankfully, research in this area is really heating up, which is great because we’re seeing fertility rates and reproductive problems increasing around the world.
This topic was most recently explored in the excellent book Countdown: How Our Modern World Is Threatening Sperm Counts, Altering Male and Female Reproductive Development, and Imperiling the Future of the Human Race by Shanna H. Swan, Ph.D., who is one of the world’s leading environmental and reproductive epidemiologists and a Professor of Environmental Medicine and Public Health.
Related Studies
Sharma A, Mollier J, Brocklesby RWK, Caves C, Jayasena CN, Minhas S. Endocrine-disrupting chemicals and male reproductive health. Reprod Med Biol. 2020;19(3):243-253. Published 2020 Apr 14. doi:10.1002/rmb2.12326
Brehm E, Flaws JA. Transgenerational Effects of Endocrine-Disrupting Chemicals on Male and Female Reproduction. Endocrinology. 2019;160(6):1421-1435. doi:10.1210/en.2019-00034
Sirohi D, Al Ramadhani R, Knibbs LD. Environmental exposures to endocrine disrupting chemicals (EDCs) and their role in endometriosis: a systematic literature review. Rev Environ Health. 2020;36(1):101-115. Published 2020 Sep 9. doi:10.1515/reveh-2020-0046
Gonsioroski A, Mourikes VE, Flaws JA. Endocrine Disruptors in Water and Their Effects on the Reproductive System. Int J Mol Sci. 2020;21(6):1929. Published 2020 Mar 12. doi:10.3390/ijms21061929