How to Reduce Toxins in Your Everyday Life (Without Becoming Obsessed) with Aly Cohen, MD

[00:00:00] Dr. Aly Cohen: It's the steady work you do over time that you incorporate. It's not a diet, it's not a one-off, it's not a cleanse, and it's not a detox process or plan. It's really about incorporating some of the most basic tenets that have shown to be effective in reducing those exposures, not only from outside your body, but into your body.

[00:00:20] Dr. Melinda Ring: This is Next Level Health. I'm your host, Dr. Melinda Ring, director of the Osher Center for Integrative Health at Northwestern University. On this show, we explore ways to take actionable steps toward optimizing our health with leaders in the integrative, functional, and lifestyle medicine fields who believe in science-backed and time-tested approaches to well-being. Let's take your health to the next level. Today we're exploring how environmental toxins affect your immune system and hormones and how you can reduce everyday chemical exposure in realistic and meaningful ways to support health and prevent disease. This topic has been especially prominent in the news lately, from concerns about PFAS and forever chemicals in drinking water to conversations about microplastics, endocrine-disrupting chemicals, and how everyday products may influence long-term health. It is a lot to take in and it's easy for people to feel overwhelmed or powerless. My guest today is Dr. Aly Cohen. Aly is a board-certified physician and environmental health expert with more than two decades of experience in clinical practice, integrative medicine, and environmental health advocacy. Her latest book, "Detoxify," was described by Dr. Andrew Weil as a roadmap to better health and resilience in modern life. As an integrative physician myself, environmental exposures are often top of mind for me, especially when I'm working with people who have complex persistent symptoms involving hormones or immune pathways. But I also know this can feel like new and intimidating territory for many patients. So today we are going to focus not on fear, but on clarity and agency and practical steps that can actually make a difference. Aly, welcome. I am so glad to have you here. After you did our grand rounds, I knew we had to have you on the podcast.

[00:02:19] Dr. Aly Cohen: Thank you so much for having me. I appreciate it.

[00:02:21] Dr. Melinda Ring: You have a unique origin story when it comes to environmental health and autoimmune disease, and I think an important four-legged family member. Can you share your story and how it changed how you began to see immune dysfunction in both animals and then humans?

[00:02:39] Dr. Aly Cohen:  Yes, I would not be doing the work that I'm doing if it had not been for the fact that about 18 years ago I was newly out of rheumatology fellowship with two young kids and my golden retriever, Truxton. He was four and a half years old and began getting ill. It turned out that he had autoimmune hepatitis. His immune system was triggered to attack his body, specifically at the liver. When he was diagnosed, he had a liver the size of a golf ball, and it was unsustainable. But we ended up getting him six more months of life. It was such an interesting moment because not only was I completely heartbroken, which I think drives many of us for the missions that we take on, but I started to explore what he was eating, what he was drinking, and whether his food was contaminated. I started to explore his environment, his exposures, even the red toy he sucked on. I didn't realize it then, but that would lead to a lot of amazing learning, research, and academic projects, and also to where we are now, where I'm sharing that environmental health survey with colleagues, practitioners, and patients. It's been quite a journey and his getting sick really opened up my mind to the possibility that environment has a strong effect on pet health, and certainly I found out on human health.

[00:04:27] Dr. Melinda Ring: In your book, and when you lecture and counsel people, you use a framework to help people reduce exposure without being overwhelmed. Can you walk through that framework and explain why the order of those steps makes such a difference?

[00:04:47] Dr. Aly Cohen: It's taken many years to figure this out because I was on a learning curve to understand what the problems were. These weren't taught in med school in terms of environmental health and nutrition information was limited. I created something called the Four A's of environmental health navigation. The first A is Assess. I'd like people to think about what they put on their skin and what they're breathing in their home, whether it's incense, plugins, cleaning products, perfumes, or cosmetics. Assess what you cook with. You don't have to go nuts, but you want to start to think about potential exposures. Understanding the problem is a big part of this so you can do the practical work to change to safer products. The second A is Avoid or Swap. We've been marketed a lot of nonsense to believe that we need to keep up with the Joneses with our cleaning products. Think about how many products we use for cleaning: sink cleaner, window cleaner, surface cleaner, floor cleaner, and doorknob cleaner. We had all the antibacterial cleaners during COVID that were a ramp-up of toxic chemicals used through fear tactics. Avoid is really about asking if we need all the products we're currently using. Can we cut back? The swap portion is where we find safer versions of what we love. If it's makeup or hair coloring or nail salons, find better products vetted through the Environmental Working Group and other free apps. The third A is Add. Our bodies at the cellular level require a lot of support: clean drinking water that's filtered, sweating, and a lymphatic system to move fluids around. We want to add clean water, sweat, movement, nutrition from the foods we choose, and sleep, which helps to clear out the glymphatic system. Adding evidence-based nutritional supplements is where we're going to get the most out of our bodies. And the last A is Allow. This is the deep breath we take when we feel overwhelmed. Allow is the colored hair I continue to do, or kids playing on turf for sports, or using water bottles when you're traveling and don't have your filter. It's the allow that keeps the process moving without shame, guilt, or regret.

[00:08:54] Dr. Melinda Ring: What is your take on the concept of detoxification? What does the body naturally do in its own wisdom versus in modern life where it may be overwhelmed? Do people need detox support while they're making these swaps?

[00:09:13] Dr. Aly Cohen:We have a modern-day dilemma where we are getting exposed to many synthetic chemicals—up to about 300,000 estimated over the past 75 years. These chemicals are getting into our bodies, and we know this from research that finds them in urine, blood levels, and even breast milk. They make their way across the placenta into our bodies. I like to start by keeping it simple. We're all trying to get a quick fix because it's a scary topic, but it's the steady work you do over time that matters. It's not a diet, a one-off, a cleanse, or a detox plan. It's about incorporating basic tenets to effectively reduce exposures.I want to use the physiology of our human body. Some people have kidney or liver disease, or difficulty with movement, so there are individual limitations, but generally speaking, we want to harness what we've been blessed with to reduce as many chemicals as possible. Do I believe everyone should get tested? No. I lean on the side of spending your money on solutions. I put a bunch of ICD-10 codes in the book so regular doctors can order basic tests through insurance-supported labs. We want to know those codes so we can ask for heavy metal tests that are covered by insurance. Put your money into a water filter, like a reverse-osmosis system. Put your money into a gym membership where you're going to sweat, or cognitive therapy if you're feeling stressed, or organic foods. Even frozen organics are nutritionally rich and have far fewer chemicals. The message is not "testing, testing, testing." The message is to put that money into the work and be consistent with your activities. That's how it becomes part of your lifestyle.

[00:12:59] Dr. Melinda Ring: What about all of these detox supplements? Do you think that we need to take milk thistle, n-acetylcysteine, or turmeric to be supportive of liver detoxification?

[00:13:13] Dr. Aly Cohen: Yeah.

[00:13:13]  Dr. Melinda Ring: For example.

[00:13:15] Dr. Aly Cohen: Yeah.

[00:13:15]  Dr. Melinda Ring: Specifically?

[00:13:18] Dr. Aly Cohen: I rationalize it as a busy mom who works all the time. Do I get eight vegetables a day, particularly cruciferous vegetables, which are valuable in detoxing the body? This group of vegetables is a powerhouse. I want people to consider cruciferous vegetables, but some of us don't get five to seven servings a week, let alone a day. I love people to think of food as medicine because it has fiber, which binds chemicals and protects against colon cancer risk. Now, the supplements you mentioned are popular and safe, but I think it's a balance. Humans were meant to have real food. In the book, I talk about four "fertilizer" vitamins that I think everyone should be on. Vitamin D3 is something modern humans do not get enough of. I recommend trying to get blood levels up to 60 to 80. Multivitamins are also important, provided they don't have fillers and additives. They provide basic Bs and Cs and iodine—I recommend 150 micrograms every day to protect your thyroid. If you're not getting probiotics from foods like sauerkraut and kimchi, then a good living probiotic is useful. Lastly, I recommend omega-3 fish oils if they are from a vetted brand and you aren't getting them from fish like herring, sardines, or wild-caught salmon. If you don't get it from food, you may want to think about the supplements.

[00:16:51]  Dr. Melinda Ring: Going back to food, I am also a big proponent of "food as medicine" and the cruciferous family—broccoli, kale, cauliflower, and Brussels sprouts—for supporting hormone and general detoxification. But let's add another layer. It's not just what we eat; it's how the food is grown, processed, and packaged. There are pesticides, food additives, and plastic materials. Why do those factors matter for chemical exposure and long-term health, and what are a few of your top tips for taking those out of the equation?

[00:17:42] Dr. Aly Cohen: Food has gotten complicated because we rely on supermarkets rather than our own backyards. Pesticides are pervasive and actually knock off the good bacteria in the microbiome. When you're choosing produce, USDA organic is a valuable choice. You can also follow the EWG's Dirty Dozen and Clean 15 lists to see which non-organic produce has the least pesticide residue. USDA organic is the only certification in the U.S. that has value in this regard; it gives us an opportunity to eat cleaner just by looking for that seal. It's not perfect, but it's good.

[00:19:33]  Dr. Melinda Ring: It is very expensive for farmers to get that certification. I tell people that if they go to a farmers market, they can just ask the farmers. Many smaller farmers grow things organically but haven't invested in the official seal.

[00:20:05] Dr. Aly Cohen:I totally agree. We support local farmers, and having that conversation with them is key. When food is picked that morning at a farmers market, it has a higher nutritional value than supermarket food that has traveled or been frozen. I just had blueberries from Peru, and I can assure you they were not picked this morning.

[00:20:39]  Dr. Melinda Ring: That affects planetary health as well.

[00:20:40] Dr. Aly Cohen: Exactly.

[00:20:43] Dr. Melinda Ring: It impacts our environment and exposures in general.

[00:20:46] Cohen: Here are some solutions. When you buy frozen fruits and vegetables, they are sealing in the nutritional value. Most big-box stores have their own line of USDA organic frozen produce, which lowers the price and increases access. Non-organic produce should be embraced as well if you wash or soak it in warm water with white vinegar or baking soda to remove residues. Regarding microplastics, washing them off is another layer to remove manufacturing chemicals.

[00:20:46] Dr. Melinda Ring: yeah.

[00:20:47] Dr. Aly Cohen: is what it is. But here's the solutions that I have seen being very valuable. When you're buying fruits and vegetables that are frozen, you are, they're sealing in their nutritional value and they're locking it in. So that really is very very helpful when it comes to, you know, lowering the costs and the access. So every big box store in the country,, they all seem to have their own line of USDA organic frozen produce, fruits and vegetables. And that's important because they've seen how lucrative it is for them. It cuts out the middleman. So to speak. So it does lower the price and then the access to some of the most remote parts of the US now have these big box stores that they can get it from. But non-organic produce. Should be embraced as well if we can try to wash those or soak and agitate in warm, clean water. To about three parts of white vinegar, or even baking soda and water, you can actually take a lot of those residues off. And it takes a little more time, but then there you go. You have less pesticide laid in foods. And then when you're talking about microplastics, yeah, that's a big topic., So washing them off just a another layer to this in order to get some of the microplastics off, not just the chemicals that might be there for manufacturing. 

[00:22:01]  Dr. Melinda Ring: I always encourage people to remove things from plastic or styrofoam containers and put them in glass containers. Wrap your herbs in paper towels.

[00:22:22] Dr. Aly Cohen: You can "gamify" this. When you go to pick up takeout, bring a stainless steel camping container. Most places are happy to put the food in that instead of plastic, which is especially important for hot soup.

[00:22:58]  Dr. Melinda Ring: You mentioned BPA. While many things are now "BPA-free," my understanding is that this is often greenwashing and companies are replacing it with other toxic alternatives. How can someone manage that?

[00:23:22] Dr. Aly Cohen: It goes back to being leery of the system. We now have "regrettable substitutions." My co-author, Dr. Frederick von Saal, was a lead researcher in getting BPA out of plastic baby bottles in 2012. It was never taken out of other pervasive places, like the lining of cans—even organic food cans. BPA is still present and leaches into foods and drinks. I try to buy more fresh or frozen foods because you can't always wash residues off canned foods. Companies have now put in BPS and other bisphenol compounds. Studies show BPS could be worse in terms of exposure. If you stop canned food consumption, BPA has a six- to eight-hour half-life in most healthy people, meaning your levels will go down dramatically in a couple of days. We have a lot of control depending on the chemical's half-life.

[00:25:56]  Dr. Melinda Ring: Autoimmune disease rates continue to rise, and while genetics matter, genes alone can't explain the trend. From your perspective as a rheumatologist and environmental expert, how big a role do you think these ongoing low-level chemical exposures play in immune dysregulation and chronic inflammation? Are there actual studies that link them, or is it just a postulate?

[00:26:35] Dr. Aly Cohen: I've been managing this for about 15 years. What I see in my practice mirrors world epidemiology: younger and younger patients are exhibiting diseases like Hashimoto's and rheumatoid arthritis with no family history. Between seven and 14% of the U.S. population is diagnosed with at least one autoimmune disease—about 34 million people. Rheumatoid arthritis is growing. The immune system is just doing its job; the human body was never meant to have these chemicals. We want an immune response for vaccines, but we don't want it overloaded by chemicals in our bloodstream. We have robust research on the phthalate group, bisphenols, and heavy metals. BPA has some of the best data regarding cytokine increase and how it causes the body to attack itself. Non-stick chemicals have been found to affect the immune system and endocrine system, and they can even dampen the immune response to vaccines. These are not completely benign exposures, but they are not a reason to freak out. Reducing exposures leads to less inflammation and fewer disease issues.

[00:30:51]  Dr. Melinda Ring: I see many people with autoimmune disease. Eliminating toxins is important, but I don't want them to feel they caused the disease. It's more important to look forward and ask how we can limit immune dysregulation and help the body heal.

[00:31:17] Dr. Aly Cohen: It's hard to tell people with new-onset rheumatoid arthritis or lupus why this happened. It could have been an infection 10 years ago or a major stressful event in childhood. The best we can do is take this moment to reduce what we can. The "Add" piece is valuable because the body needs to be nutritionally sound, have peace and quiet, and exercise. When you take things away and add what makes bodies run optimally, the magic happens.

[00:32:27]  Dr. Melinda Ring: What is one piece of personal wisdom or one small doable practice you would share to help our listeners reach their own next level of health?

[00:32:37] Dr. Aly Cohen: Start with the habits you do every day and make one piece of that habit a little cleaner. For example, my morning tea. I worked slowly to make sure it's not in a styrofoam or paper cup. I use glass, filter my water, use organic creamer, and use loose-leaf tea. Tweaking a habit a little every day provides positive motivation for the next change. That's the wisdom I've employed instead of freaking out.

[00:33:38]  Dr. Melinda Ring: That's great. Aly, thank you for such a grounded and empowering conversation. You're a leader in the field and you help reframe environmental health as something we can thoughtfully engage with.

[00:33:56] Dr. Aly Cohen: Thank you.

[00:33:57] Dr. Melinda Ring: For everyone listening, we will link to Aly's work and resources in the show notes. Protecting your health doesn't require perfection. It starts with awareness, assessing, making small changes, and choosing what's realistic for your life. Thanks for listening, and I'll see you next time on Next Level Health. Thank you for joining me on this episode of Next Level Health. I hope you found some inspiration and practical insights to enhance your wellness journey. Don't forget to leave a comment on YouTube or a review on Apple Podcasts. Be sure to follow Next Level Health with me, Dr. Melinda Ring, as we continue exploring the path to healthier, happier lives together.