How I discovered a coffee pot was making my patient sick

coffeepot imageThe evidence for the health benefits of coffee may be growing, but what if your coffee pot were contributing to chronic disease?

A recent patient of mine fit this picture. She was having troublesome symptoms that looked classically perimenopausal, but also suffered from a worsening skin condition that left bumps on her shins. She asked me if there might be a common cause.

I listened carefully for clues—food sensitivities, a low vitamin D level, uterine fibroids, an autoimmune disease. I ordered tests and asked her to begin an elimination diet (avoiding wheat, dairy, soy, citrus, and eggs) and keep a symptom record. I also gave her my environmental handout, which covers a wide range of recommendations like avoiding artificial fragrances and insecticides.

Twelve days later when I called to check in, she exclaimed, “I think I figured it out! It’s the coffee!”

My patient was savvy about environmental chemical exposures; she regularly consulted the skin deep website and carried around a stainless steel water bottler filled with water she filtered at home.

However, just about the time her symptoms began, she had hired a new employee who brought her old, electric coffeemaker with her to work. She’d gotten into the habit of drinking a cup each afternoon.

After our office visit, she suspected it might be the pot. As the hot, acidic coffee passed through the plastic tubing, could it be leaching BPA and phthalates? To test out her theory she replaced the pot with a glass French press. What happened next was astounding: her periods went back to normal and her skin symptoms disappeared.

Does this give you pause? It did me.

It would have been so easy to see this as a “simple” story of a challenging menopause transition. Instead, it raises a big question: How much chronic disease might due to such seemingly trivial exposures?

In January, a study published in PLOS linked environmental chemical exposure with early menopause. This study suggests a connection between the ubiquitous chemicals we’re exposed to and our health. Other studies support this concept, such as a 2014 research study showing BPA in the liners of canned beverages increases blood pressure. Health care providers generally are not taught to consider common household items as a potential cause of disease, but perhaps we should be.

BPA is a known endocrine disruptor. Research evidence links BPA exposure with early puberty, infertility, breast cancer, and abnormal periods. It has also been tied to obesity, prostate cancer, and neurodevelopmental problems in children. The National Health and Nutrition Survey (NHANES) found that obese adults are likely to have higher levels of BPA in their urine.

While we can metabolize and rid our bodies of BPA rapidly, we are so frequently exposed to it in plastic food containers, can liners, and cash register receipts that our levels remain high. In the US, the CDC periodically samples the urine of people participating in NHANES and has found BPA in 92% of those sampled. And lest you think “BPA-free” is the answer, the substitute plastics which contain bisphenol S or other resins appear to be equally hazardous.

Of course, my patient’s story is not a randomized controlled trial, and one might argue that it was a coincidence that she got better when she switched to the French press.

In medicine, the gold standard for assessing an allergic reaction is to test, eliminate, and retest. I hadn’t wanted to ask my patient to do this, but as life would have it, she did it on her own.

Recently, she sent me an email to say that she had heated up a frozen meal in a plastic bowl (“I know, I know…” she wrote) and within two hours the bumps on her skin had returned.

While there are numerous root causes of chronic disease, many scientists believe that we are all on a continuum of sensitivity with respect to the chemicals in our environment, which explains why one person may get sick while others can tolerate high exposures with little effect.

As health professionals, how are we to determine whether these exposures are playing a role in the obesity, high blood pressure, cancers, infertility, thyroid disease, and neurodevelopmental diseases of childhood that fill our offices?

We have not been trained to consider BPA or other environmental exposures as causes of disease. How many of us ask our patients about their use of plastic bottles and food storage containers, canned foods, or exposure to receipts? How many pediatricians talk to parents about BPA as a possible contributor to pediatric obesity?

The EPA, which we would hope could protect us, seems hopelessly mired in unreachable standards of proof. While we may not have expected to use a medical school education to discuss plastic bottles or Tupperware, we are on the front lines, and unlike US government agencies, we are free to use the precautionary principle’s higher bar in our care of patients.

While we can’t prescribe away all environmental exposures, and we badly need new national policies, we can encourage sensible precautions. Some of them are very effective. For example, when children eat an organic diet, the levels of pesticides in their urine become undetectable.

There are many resources available for clinicians to learn how to take a better environmental history and to learn the common environmental triggers of disease including the Agency for Toxic Substances & Disease Registry and the Collaborative on Health and the Environment. The University of Arizona Center for Integrative Medicine, where I serve as executive director, has a free six-hour online continuing medical education course.

Meanwhile, patients shouldn’t wait for a doctor to tell them to take stock of their exposures. Endocrine disrupting effects, like the hormones they mimic, arise from doses measurable at parts per billion. So do not be mollified when someone tells you the amount of chemical in a product is very small. Be a detective; don’t settle too easily with a diagnosis if the label doesn’t make sense to you. Try minimizing your exposures for three to four weeks and notice any changes in your symptoms.

What if the cure were as simple as changing your coffee pot?

This article was originally published on Quartz on April 3 2015.