Episode 116: Detoxify Your Life: Dr. Aly Cohen on a Balanced Approach to Reducing Your Toxic Load

Adam Rinde, ND (00:00):

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(01:04):

Hey everybody. Welcome to the next episode of the One Thing podcast. This is your host, Dr. Adam Rinde. As you know on this podcast, we talk a lot about optimizing health, but what about the environmental factors that are constantly challenging our bodies, especially our immune systems, from plastics to pesticides? The modern world presents unique hurdles, but how do we tackle this without resorting to extreme and unsustainable measures? This week I'm excited to have back Dr. Aly Cohen. She's a renowned rheumatologist who bridges the gap between conventional medicine and environmental health. She just launched a new book called Detoxify, which is being released in May of 2025. This book is a game changer. Forget deprivation. Dr. Cohen is here to share her balanced approach, focusing not on just avoiding toxins, but also adding supportive nutrients and lifestyle habits that allow for real life. You'll learn simple, powerful ways to reduce your body's burden, protect your health, and gain peace of mind. This is essential listening for all of us. Let's get started with Dr. Ailey Cohen. Dr. Cohen, welcome back to The One Thing podcast. It's great to be here with you again.

Aly Cohen, MD (02:28):

Thank you, Adam. So I love being here and I love that we've continued our relationship, so this is awesome and I'm glad to be back.

Adam Rinde, ND (02:34):

Thank you. Yes. And I also have really enjoyed following what you're up to in the world, like your podcast and now you have a new book and just reading different things that you write throughout the year. So I'd love to just jump into a little bit about your new book and the last time you were on, it was really interesting how you sort of had a method of what you were trying to create with your writing and the tools you were trying to provide for people. So when Detoxify was announced that it will be launched, I was interested in how the two books complement each other.

Aly Cohen, MD (03:15):

Yeah, it's interesting. As I've grown, I've changed as I've been writing curriculum for physicians and healthcare programs and high school students and all different demographics, I've had to sort of figure out what is the easiest and best way to take a very difficult topic, very broad, very full and very intimidating, and really create a framework for this material. And so the last book was a guidebook. It was really the culmination of about 15 years of work what I'd learned, and it was very sectioned out by topic, which I'm very proud of. It was so dense and referenced and I just loved it. And I worked with my co-author Frederick S. Vom Saal, who's a renowned bisphenol- a researcher and endocrine disrupting chemical researcher. But this book was really meant to be for everyday people and to also bring in the easiest ways to get this process going and to really take a big topic and whittle it down into a usable pieces.

(04:18):

So I created ways to feed this information. For instance, the four A's I created the four a's of environmental health navigation because essentially I wanted to be simplified. And so the first A is assess and we have a toxin exposure survey that's very reasonable. And so you want to start to think about what you're exposed to on a daily basis, which rooms you walk through and what are you're experiencing as a human being, as a human body. The second A is a void or swap, but really avoid. So once you know this great information of where these things are coming from, why they're harmful and what to think about, you can start to avoid them, reduce the number of chemicals or by using less products, but you can also swap and have great resources to have things that you like, but maybe safer versions. The third A is add, which is so critical to anthropology and evolution.

(05:13):

We have to add in nutrition, we know certain components in food and certain well done supplements can really offset some of the damage that might come from exposures that we're either aware of or not. But also adding in lifestyle and sweat and sleep and how those play out evolutionarily into reducing some of our exposure. So it's an ad piece that's really critical, not just removal. And then the fourth A, which I like to say is attributed to my love of my hair coloring and of course everyday life and my kids playing lacrosse on toxic turf and things that you just don't avoid and you have to live with. The allow is the fourth A, and that's life. That's the birthday travel, the plastic water bottles that you have to choose. You don't have access to other water. I mean it's really just that that helps people not panic and not increase resistance to change, but really say this is a journey we are going to be empowered and allow is part of the recipe. And I think that's important to put in perspective.

Adam Rinde, ND (06:19):

Yeah, that's really great. I really feel like that's a good message for the times we're in. I think we've gone through this big phase in health of increased awareness and the access to knowledge and getting on AI and just chatting away and going down that path can lead people to information overload. And it's nice to hear that you've packed in more of a practical real life aspect approach where to allow and to add things in versus just take things out. So I think it's really healthy.

Aly Cohen, MD (06:59):

It's what I've discovered works. It's kind of like a culmination of the human body. It doesn't want to have triggers. It doesn't want to have, first of all, the human body has never been exposed to this many synthetic chemicals in a whole evolution. These chemicals, whether they're good or bad, whatever, have only been made. And in part of our lives in the products we love over 75 years, maybe a hundred years if you stretch it. So that's a very short period of time in the whole scope of 4.5 million years of human evolution. And so number one, the body has to get acclimated and it's just too quick for so many chemicals. So the body is really yearning to have removal, to have a blockade of some of these chemicals. But you also still need components that make human cells thrive, which make organs thrive, which make systems thrive. And I think when you take away something that's great, but when you add in things that make the body detoxify naturally and better and give us nutritional power to fight off some of the harm, that's the winning combination from what I've seen clinically as a rheumatologist of 22 years, but also even in my own life. And it also reduces the risk for diseases, not just management of diseases, which we're all managing a lot of stuff now.

Adam Rinde, ND (08:21):

Literally just having this conversation with a patient today about when we're dealing with the immune system, there's these two aspects. We're trying to of course clear and remove this driver and we tend to leave out the aspect of how to actually support the immune system and balance the immune system or modulate it. And so I love that. It's definitely thinking about the whole picture and hard to do. Of course, not an easy quest. I keep the non-toxic book here in my clinic literally over my shoulder. If I had a way to, I could reach and grab it, but it's like seven feet away from me. But I use that a lot for reference. I'll remember something that you said or something that you mentioned in something I read in the book and I know I can just kind of grab it for quick reference in the moment when I'm thinking about what the recommendations for water were or what recommendations to do as far as household products. And it's just so helpful and it's nice to have confidence in it versus Googling or searching on the internet. It's like you don't really know it's referenced or where they got the information. So I like the combo of the books because the detoxify seems like it takes you through the whole journey.

Aly Cohen, MD (09:47):

It's very usable. And it's interesting when you write something or you do anything in life, you don't know always how it's received. And what I really found out, which is exciting is that the 21 day plan that I worked on, that's part of this book, the 21 day plan to really reduce chemicals in your life is so simple, but it's so motivating because it's like this is day one, this is day two, this is day three. You don't have to think so much. You want to learn the material prior. And the 21 day plan is more towards the end to get started, but it's kind of like now you can just get going. It doesn't have

Adam Rinde, ND (10:22):

Be affect. It's

Aly Cohen, MD (10:23):

Really just starting the process. And I think that was the component of the book. And there's lots of bells and whistles. There's a hundred things that you should have in your shopping cart that helped detoxify. There's recipes for cosmetics and personal care products and then also for food that are detoxifying, but also cleaning products. So there's lots of stuff, but the 21 day plan I think has resonated the most just because it's such a difficult topic to get started in if you're really overwhelmed.

Adam Rinde, ND (10:54):

For sure. So I think it'd be interesting to hear about who you see would be someone who really, this should be a top priority. I mean, of course everybody needs to be thinking about toxicities and toxins and we're all affected by themm. But when it becomes more at a higher surface level, who are people that you're seeing are more susceptible to immune toxicity?

Aly Cohen, MD (11:24):

So I have even patient cases in here of people I've seen over the years, and I kind of categorize them in sort of what's the real complaint and then how we go about figuring it out and removing and working together and then what the results are. The way I see it, I'll start off by saying the book was really designed and driven by my years of working with patients with immune and autoimmune diseases as a rheumatologist. What I've noticed over the last 22 years of practice and which mirrors epidemiology is that we have a much bigger problem than we thought. We have a rising, almost an epidemic rise in the number of autoimmune disease cases,

(12:04):

Immune and autoimmune. So autoimmune being kind of your immune system attacking itself, but also immune meaning like eczema, psoriasis and dermatitis where your body is sort of responding to the outside world, not necessarily turning inwards, but certainly having a reaction. And so we now have seven to 14% of the US population, which has an autoimmune disease of some type. And there's 80 listed in the medical literature, but I would argue there's many more that don't fit criteria. I see a lot of in-between cases that don't hit all the boxes and people are dismissed. So this book was designed for a lot of people who don't have all of the lab tests that support lupus or rheumatoid or chronic fatigue or this or that, but they have a lot of symptoms that are uncomfortable. There's a lot of symptoms that bother them and they're looking for some ways to clean up their body or feel better.

(12:57):

And a lot has to do with, again, nutritional levels of what we eat, how we live our lives, the food quality, the water quality, and then a lot of the choices we make that we unknowingly add problems to our bodies just because we don't know better how to choose better lipsticks or personal care or what have you. Cooking products and stuff, cooking utensils. So number one, I want people who are not sick to certainly not get sick or to prevent illness. I'm all about prevention. We certainly don't want to get sick if we don't have to. What I've seen is younger people getting sicker with diseases you wouldn't expect and also without any family history. So there's an environmental component that's really real that we're seeing across the globe. But I also want people, and I think they're forgotten often, is people that actually are living with chronic illness, lupus and rheumatoid and Crohn's disease and MS and any type of immune or immune disorder, and how do we quiet those symptoms down? They may not completely remove the disease or illness, but we know that we can manage them because many of them are inflammatory. So we want to reduce inflammation. And I'm connecting the dots between how environment plays a real role in aggravating our immune systems, which therefore aggravate our symptoms of diseases that we may already have. So it's for everybody. It's for the prevention and for the management. And I think everything in between because no body, no human being should really be living in this ideally with as many chemicals as we're walking around with.

Adam Rinde, ND (14:32):

Yeah, so I think it'd be interesting to get your take on this. I had a dear friend, she's no longer with us, Dr. Seligman, who had a really severe case of Crohn's disease. I mean, she's published stories about it, and this is not private information, but she shared because she wanted people to learn from her situation. And I remember sitting down with her early in my career and just, she was a friend and I really wanted to help her. And I said, I really have some ideas to help boost your immune system. And she looked at me straight in the eyes and said, Adam, my immune system is supercharged. I don't need help boosting my immune system. And I was like, wait a second. And that was a game changer for me to learn about autoimmunity. So I wonder if you could talk about that, and a lot of people don't really understand on a ground level what's happening in an autoimmune condition. Can you explain that to people?

Aly Cohen, MD (15:35):

Sure. So what we describe when we say autoimmune is auto meaning self and immune, meaning your immune system is directed towards self. And that could mean different things for different illnesses. Categorized illnesses, say for instance, multiple sclerosis, is your immune system kind of turning in at the brain and spinal cord and neurologic condition. When you talk about rheumatoid arthritis, we generally think the joints right, your body is fighting the synovium in each of the joints of the body, but it also happens to be a systemic illness where your eyes can be affected as well. Your cardiac risk goes up and bones can be a little bit more at risk for osteoporosis. But generally it's joints we think of with rheumatoid. And then when we think of psoriatic arthritis, we think of the skin, we think of the joints as well. When we think of Crohn's and ulcerative colitis, those autoimmune diseases generally try to, the body's turning against the gut.

(16:28):

So it can be different organ systems, but generally the mechanism is the immune system is aggravated. It is turning on itself because it thinks that certain tissues within the body are enemies. And so it's revved up and of course you're not going to leave your body. So those tissues don't get quite, that immune system towards those tissues doesn't quiet down as easily as we'd like. So then it requires either lifestyle changes and trying to quiet down some of the background noise of inflammation from food, from stress, from water quality, but also medications. And I'm not against medications. I am against the reflexive use of medications if we don't think about other ideas too. But I think medications have really changed the face of immune system disorders. No doubt about it. I was around when there was no biologics. I was around in training where we had chronic dysfunction and joint changes from rheumatoid that we don't see now.

(17:28):

But like I said, I think the focus of what I'm trying to do is saying aside from medication, the environment we live in and how we change it and what choices we make can profoundly change the destiny of our health if you think about it, because we are reducing not only the inflammation but also the consequences, inflammation, which could be joint changes and physical changes as well as quality of life. So we have very little in life that we can change, but we can do this. And studies show that we not only lower those numbers in our bodies, not urine and blood and breast milk and those kinds of things, but also reduce inflammation and flares. And that's what I've seen clinically as well.

Adam Rinde, ND (18:11):

So if we were to zoom in on that scenario and we have a load of arsenic or mercury or some type of phthalate in the system that's become excessive or has aggravated the immune system, how would that look to someone who has an autoimmune disease or someone who doesn't have an autoimmune disease? What is the mechanism of that toxin and how it's impacting the immune system?

Aly Cohen, MD (18:40):

So different chemicals, and there are about 95,000, believe it or not. It's very overwhelming, but they're also classes of chemicals. We have the bisphenols like BPA, we have the phthalates, which are class of plasticizers that are in a lot of our plastic products and fragrance. We have the  per- and polyfluoroalkyl substances,(PFAS)  that are the non-stick pans and some of the rainproof and stain proof gear. So we have classes and essentially they have different effects in the scientific literature. Many of them have originally what was mostly studied was the hormone effects, the endocrine disruption effects

(19:16):

And what was discovered while studying the hormone effects, which by the way is not separate from the immune system, but more immune system effects were identified. And so that's really one of the focuses I like to show is that our body is a network of communication between many systems. There's crosstalk between the hormones, the endocrine system of our body, and also the neuroendocrine system and also the immune system. And so it's hard to pinpoint exactly at what moment, which chemical you're exposed to is doing what. It's just too intricate of a system. But we know that by lowering the overall amount that's circulating in your body, that you're less likely to have an inflammatory response no matter what, no matter what part of your body. So if we get into the mechanisms, that gets a little bit more scientific, but essentially some of them have half-lifes that are short like Bisphenol-A where if you stop eating canned foods for example, and move towards fresh or frozen foods, you're going to lower your exposure to BPA, which is a plastic chemical that lines the interior of all cans, even if it's organic food or infant formula.

(20:24):

But just by making that swap in six to eight hours is the half-life of BPA. And over the course of two weeks, you will wash that all out. There's great studies that I talk about in the book showing that behavior change choice changes actually reduced actual levels in urine and blood where it's tested. So there are real life consequences to making those changes in a positive way, and those things reduce the risk of having those inflammatory responses as well.

Adam Rinde, ND (20:55):

Yeah. So I want to throw a concept by and see if this is something that you subscribe to related to the mechanism. So there's the free radical theory of these toxins getting trapped in a phase of detoxification, and that's very pro-inflammatory. Is that part of what you look at?

Aly Cohen, MD (21:17):

Yeah, I mean there's cytokine activation, there's tolerance, antigen presenting cell issues. There's direct hits to the gut microbiome for some of these chemicals. So it's not always just at the cellular level. There's actually barrier issues when we see chlorinated drinking water or ultra processed foods hitting the microbiome and actually affecting directly the microbes and the balance of microbes that hit the gut. So there's a lot of those potential risks. There's also epigenetic changes. So in terms of the proteins that sit on gene sequences and how those genes become expressed into disease or clinical activity, again, your environment, but also your chemical exposures can change your epigenome. But we also know food can offset that. We know healthy foods and nutrition, we know that cleaning up some behaviors with the gut and starting to add probiotic foods and prebiotic foods can offset that direct effects of exposure to the chemicals I was just mentioning.

(22:20):

So we have a hack for everything that's been discovered in terms of inflammation. We know how to offset it, and a lot of it has to do with just better choices and a little bit better behavior. It doesn't have to be perfect. I'm not a purist, I'm a realist. I'm a mom of two teenage boys. I color my hair, my kids play lacrosse on toxic turf. I live in the same world. But it's how you sort of implement little changes over time, and that's kind of where you start to see real changes clinically and how you feel.

Adam Rinde, ND (22:52):

Yeah, I love that thinking because one of the processes that I'm working on in helping people is making decisions that are sustainable and build resilience versus just always living in this kind of fear mode of that what's going to get me next, the toxins and other things. And if you have both those levers working, I think you don't have to be perfect in either of 'em because you're building resilience and you're doing your best to mitigate. So it's a really good combo.

Aly Cohen, MD (23:32):

It's taken a while to get here. I started off on the ledge when I was learning this material, very angry. I hadn't learned it in med school. I'm still a little bit irritated that we're not teaching this to newly minted professionals in a real way because it really goes to the idea of prevention more so than what's taught now, which is sort of symptoms and treatments, symptoms in pharma. But the idea is that my evolution, over 15 years of doing this work started off in a panic mode and a real angry mode. It was like Kübler-Ross mourning of what I should have learned. But I will tell you, having family, having children working, you have to start to be realistic about your goals. And I think that that's kind of how I'm I'm teaching these days is that these are the high yield changes and maybe start with your high yield changes as opposed to nitpicking a birthday cake that you cheated on and wanted to eat all the icing or traveling. And I really don't want people to feel regret or penalized for some of those choices because I think it's part of life and access to foods and choices that you would wished you had. It's mostly thinking about big ticket items like the quality of your food, choosing USDA organic for example, because that is so powerful. We have no other regulation in our food system, but guess what? It's not expensive. You can get frozen USDA organic foods in every big box supermarket

(25:03):

In the country. And not only do they not have pesticides and genetically modified ingredients because they're USDA organic, which is a really important label, but also they have high nutritional value because they're flash frozen when they're picked. And so often we think of fresh as being so much better. In fact, in our food system, fresh organic in our supermarket travels long distances and it loses nutritional value as it's traveling. But frozen USDA organic does not. So you've got this cost added value, you've got the accessibility to some of the big box stores, and you also get this nutritional component and you get less pesticides. To me, it's like a real win-win. It's just very different than childhood. When I didn't think like that, I thought fresh food was always the best

Adam Rinde, ND (25:50):

And they chop it for you, which I'm always happy about. What could be better?

Aly Cohen, MD (25:56):

I mean, as long as you don't steam them in the plastic bags, which again, plastics, that's a whole other topic,

(26:01):

But really reducing plastics also means removing them your food whenever you can from plastic containers, including steamer bags. And I opt out from hot soups on the go because I know that whatever's going to be a hot soup is going to be a hot plastic soup. So it's just one of the choices I've chosen to do, and I try to create that at home without the plastics. But aside from that, I think just putting one extra step into your activity that reduces harm without a lot of stress, I think is very helpful to the body.

Adam Rinde, ND (26:34):

So a lot of people who hear this word detoxify or go on a detoxification plan, we'll just think of, okay, this person's recommending juicing and these liver cleanses and liver flushes, and I mean, I really like that you're approaching this with a method and a process and looking at this more from a science standpoint and a system standpoint versus just sort of recommending a bunch of supplements or juices or what have you to help people. So I'd like to kind give people a window as to what you are sharing, and if you could unpack the process a little bit of walking through the assessment, for example, how would someone get assessed for toxins that's not going to cost them a fortune.

Aly Cohen, MD (27:28):

Yeah, I actually don't promote a lot of blood testing in this area. I do. And you'll see this. You had a copy sent. What's really interesting is that I've always wondered why we're not utilizing our insurance better for screening. And it's a lot of it has to do with who's ordering the tests, right? If doctors aren't trained in this material, they're not going to think to ask about it, not going to ask exposures or a survey. And they're certainly not going to order anything just because they're interested. So I think what I wanted to do is have a list of ICD 10 codes for insurance for the very basics like heavy metals, which I think is worth checking once a year, every other year, even if you don't have symptoms of anything scary, they don't have to have symptoms to, you don't have to have symptoms to be exposed and to be able to work on some of the changes if you find a high level.

(28:18):

But it's nice to be able to give to your healthcare practitioner the blood test ideas that you would like to have. And I gave those in the book and then the ICD 10 code, so they don't have to freak out, they just write it on the script. So that's using your own insurance wisely in terms of spending a lot of money for out of insurance laboratory testing. I think that runs pretty expensive for a lot of people, especially if you're screening, you're not feeling particularly ill or having a condition. In that case, I would rather people spend money putting it towards what to do and the solutions. Now, when you're surveying, again, I provided a 50 question survey, very reasonable questions, and you put down a score and you get a total score and you start working on that score. But it's very reasonable questions and it helps people to pinpoint where the problems may be in a very reasonable way. Do you use dry cleaning? Do you put the stuff indoors or outdoors? Do you have canned foods? More often than not, do you filter your water if you do what kind? So it's really starting to pinpoint all this sort of on and around exposures in a very, I think, honest way. And that's how you can start your assessing. So then you can start to work on how to avoid or swap from that

Adam Rinde, ND (29:38):

Assessment. So as we're talking, I'm drinking out of a compostable cup, so I'm hoping this is okay, but

Aly Cohen, MD (29:47):

Well, it's lined with some amount of plastic, so else paper would shrivel up and be sake.

(29:53):

So it's not to say you can never have paper goods. I mean, we all go out to dinners and picnics and birthday parties and holidays, and a lot of that is plastic coated materials, but it's not like you're going to bring your own plates necessarily. And silverware, I think you might get shunned from your family, but I'll give you an example. In my car, which I spend a lot more time than I probably should. I have a little stainless steel knife fork and spoon in a little pouch next in my side door. And when I'm running around and I need some food, I just opt for those instead of using plastic utensils. I just happen to have them. And I just think having those, a little bit of an extra piece of thought about it. I have my water bottles that are stainless steel and glass, like 10 or 15 of them at home. They're constantly being used and recycled. It's just a matter of implementing little by little.

Adam Rinde, ND (30:48):

Yeah, so that's really good. I think questionnaires are so helpful because they're educational while you're taking the questionnaire, just asking yourself why is this question being asked? And that can lead you to further understanding. The questions are very intentional and they open the door for learning even more in that, that even more is in the book. So that's really helpful. I love when questionnaires are available because they start the process and if you get into a real complex situation, someone's say in a battle with dementia or early Alzheimer's disease, or maybe they're at an advanced condition with a chronic inflammatory disorder, they might want to do more advanced testing or find nuanced factors, invest.

Aly Cohen, MD (31:45):

Yeah, I think that's the thing. It's this idea that if we test everything, we're going to have answers to everything. In fact, if you test too much and the numbers are off even by a little bit, it's going to actually create more stress, more questions than answers. I think really pinpointing what your exposures may be from occupational exposures to hobbies and habits. Are you gardening all the time? Maybe you're exposed to more organophosphate pesticides or glyphosate than you were thinking about. Maybe you should be wearing gloves and you can implement by putting in more protection measures, maybe occupationally, you're coming home with more exposure and bringing in into the home than you might expect or want. So I think it's all about growing and making changes. Not condemning, not regretting. I mean, people have cancers, have children with disabilities and learning issues. It's not to do any of that. That's not the point. The point is really when we know better, we do better. And if I had changed a lot, as you'll read in the book, it's very self-deprecating because I want people to understand the truth is I was like everyone else in terms of the knowledge base, and it just took me 15 years to get here, and I don't want anyone else to take 15 years to get where they want to be.

Adam Rinde, ND (33:05):

And I had a very similar life experience that we shared, I think on our first chat, but where I lost a loved one to cancer and I was his caregiver. And I remember after a little while, like three months, I started going back and replaying everything I might've done that led to this. And yeah, it's a very dangerous slippery slope, and it's important to step back and see yourself as someone who's constantly growing and improving. And if you had the awareness that you had, then you wouldn't have done it. And

Aly Cohen, MD (33:47):

It's the serenity prayer.

Adam Rinde, ND (33:49):

It's

Aly Cohen, MD (33:49):

Knowing what you can change, knowing what you can, and having the wisdom to know the difference. But I think that's a brilliant way of looking at this topic because clearly we could do things better and should have maybe would've, who knows? But it's over. Put that energy into moving forward, making some really nice changes. I mean, I test myself for, I mean, I have fun with this. The documentary supersize me. I've been testing my blood and doing changes and then seeing where it goes because I can and because I want to spare people a lot of lab work. It also mirrors what the epidemiologic studies show, what the NHANES data shows in terms of exposures to human beings, and also behavioral change experiments, which I put in the book. I wanted people to have tangible understanding that when you change, for instance, to organic diets that you definitely studies across the board, show that you're going to reduce exposure in the blood and urine and wherever those particular chemicals are tested.

(34:50):

We know flame retardant chemicals, when you reduce those, they go down in breast milk. We know that BPA, when you give up canned foods, wonderful study on reducing the addition of progresso soup, which they used in the study for lunch versus homemade soup, changed the outcome of urinary BPA levels in urine by 1100% just by swapping from a canned soup every day for five days to a homemade soup. So there's lots that we can do that have real tangible outcomes, but extending that into clinical outcomes like how you feel, fatigue, joint pain, swelling, skin irritation and inflammation, weight gain, these are all things that come with reduction of exposure in

Adam Rinde, ND (35:35):

General. Amazing. Yeah, that's great. So before we leave the testing and assessment component that we're talking about, I just want to share something I learned early on and using functional tests and using these other tests and just get your take on it. So I think early in the functional medicine world, there was a big push on exhaustive testing. And then you have all this data that's supposed to help you figure things out. And I think the industry or the field is moving away from that, thankfully, and looking at treat the patient, not the lab first of all. That's one big principle and I'd love to get your thoughts on that. And then the second thing is testing. You should always be able to answer. If so, then before you order a test, if so, then yeah,

Aly Cohen, MD (36:34):

You should know what you do with those results. I mean, I was always taught don't test for something. You either can't explain or don't know what to do with.

Adam Rinde, ND (36:41):

And I think sometimes with the amount of testing that's available over the counter direct to consumer, I mean you come back with, it's like fishing. You might pull up something and you don't even know what it is and you could Google it and get really scared.

Aly Cohen, MD (36:57):

Correct.

Adam Rinde, ND (36:58):

So I think having a methodical approach and really working with someone if you're in these weeds and nuances to help hold that container for you and guide you is really important.

Aly Cohen, MD (37:10):

Well, absolutely agree. I think, listen, look, whoever you go to as a practitioner needs to balance this detective work in a way that's not overly diagnostic with testing. But really, I've always said that the money lies in the history. And the problem is western medicine doesn't allow for more than what 15 minute follow-ups and 30 minute new patient slots.

(37:35):

But some of these out-of-pocket practitioners, and hopefully they're not overcharging too much, they allow for more time and the time allows for more history. And the history tells it all to me. It tells me where were you living for these years, where you developed exposure, and what was your drinking water and when did the rash begin and when did you change out your hair shampoo? Was it around the same time that they started having a rash? Maybe we should change out our shampoo and conditioner and here's the app to look that up. And so I think you really want to, without scaring anyone, you really want to sort of put a timeline, especially with exposures. You can have latent problems with health obviously years or even we know nine 11 for instance, years, decades after exposure. So it's just a matter of getting a great history to start with having the right questions, which I hope people will find very helpful with this book.

(38:29):

And then I had patient cases that I think most people reading would identify with very reasonably. I wanted to have those patients, they are my routine patients, the ones that come in for fatigue and they don't know why they're fatigued. And then you have to go through a reasonable set of questions. Are you having restless leg? Are you snoring or is it a vitamin deficiency or is it an exposure to chemicals because chemicals can affect your inflammation. So it's kind of like looking at this holistic picture and narrowing it down. And so hopefully those patient cases will resonate with readers and then it will guide them not only to ask questions maybe of their practitioners, but also how they should change some of the components of their life in maybe a positive way.

Adam Rinde, ND (39:16):

So let's go into treatment approaches and strategies. Just from a high level, if you could share with us how you came up with the three S's and what they are.

Aly Cohen, MD (39:28):

Yeah, you're making me forget what was in my book. So it's basic. I swear to God, it has been such a long day. Yes, the three S's, and I think that was sleep stress. And what was the, oh, sauna, sweating. Yes. And it wasn't just sauna, it was extra. I mean, this is literally my life. I'm just, my head is spinning.

Adam Rinde, ND (39:46):

Yeah, yeah, that's okay.

Aly Cohen, MD (39:47):

So forgive me for being human and maybe perimenopausal. But anyway, the idea is that the S is, I try to make it simple with the Ss. Clearly it was not simple enough for my day to day, but the idea is that we have all these great anthropologic, and I always tie into anthropology. I trained in medical anthropology. I think we forget that we didn't just plop onto this planet with nice shoes and great cologne. We've been here a long time. We've had really great use of organs for many, many millennia. And when we talk about detoxifying, again, it's not just removing products and removing things that piss off the immune system, but it's adding in things that have made our bodies thrive for centuries and millennia. So things like managing stress. Stress was never supposed to be all day long, round the clock. It was meant to be when you went to the watering hole and you're drinking water and all of a sudden a buffalo came up next to you.

(40:45):

That's a good time to stress, right? But it wasn't meant to be all the time. And that's what, so it conserves the energy of our immune system, for instance. We want to keep it quiet so that when we really need our immune system to work properly and act, we got it. It's ready. So managing stress is a really important part of, in terms of detoxifying is another environmental exposure that we don't think about. And so reducing that stress also reduces our revved up immune system. Sleep is really important. I get into that because we take advantage of the fact that sleep doesn't always speak to us, but we take advantage of it. We're always not sleeping and we blow off this and that. We use technology, we're on our phones. And the thing about sleep is that sleep was designed, and we've now figured this out in recent years, that our bodies clear chemicals while we sleep.

(41:43):

It's fascinating. So even when you don't get it right and we're exposed to air quality that we had to drive through and things we can't control, our bodies when we sleep have this glymphatic system, which is really clearance of chemicals around the spinal cord and brain fluid while we sleep. So it's not just about quality, quantity of sleep, feeling rested and cognition is improved, but we want to actually clear house while we sleep. It's like a washing machine. And then the third S is really sweat. Utilizing our ability to sweat has been part of human existence, and it's a remarkable way to not only feel good, but you're clearing out some very important chemicals that we know can clear through the skin and the sweat through the skin. So that's exercise, that's natural. It's mobility, it's movement. I wear extra layers when I go jogging. I look crazy when I'm wearing layers and a hat in the middle of 75 degree weather, but I'm well hydrated and I'm doing that because I want to utilize that moment. There's also sauna, there's chair exercises. There's lots of different ways even with arthritis that you can get a good sweat in. And again, it's utilizing what our bodies have to benefit our health.

Adam Rinde, ND (42:55):

Yeah, I always say if you're someone who likes to stress really likes it, you also should really like to laugh. It is definitely a good balancer. I mean, stress. I've had so many patients over the years look at me and say, you want me to stop stressing? How is that even possible?

Aly Cohen, MD (43:19):

And listen, I get it. I'm stressed a lot. But I also, a couple hours ago, I sat in my car in this beautiful spring weather, which we have not seen a lot of, and I just played really great seventies music, laid in my car under a tree and just felt a breeze across the car window. Nice. It didn't take long, but it was like a moment where I could take a breath and no one was trying to reach me. Kids weren't trying to reach me, patients weren't trying to reach me. No one was bothering me, and I could just take deep breaths. That's like medicine. That's really medicine to a human being in our physiology. And I think you have to fight for it. You have to fight for it and say you're worth it, and you have to say that this is good for me. I think it's really a part of taking good care of

Adam Rinde, ND (44:06):

Yourself. That's really great advice. Thank you. So with food, are there certain foods that you feel should be added to the diet that people tend to skip over? I mean, besides just basic things like vegetables, is there specific vegetables or specific foods that you like to see people add to their diet that help with detoxifying?

Aly Cohen, MD (44:33):

Yeah, sure. Absolutely. So and I list a lot of them and all the science behind them, I would say as a class, cruciferous vegetables are a powerhouse in terms of what they do with liver enzymes and liver compounds that are really good at breaking down chemicals that we now can study so many. But there's certain classes that we can really see that cruciferous vegetables, and there's dozens of them. I mean, I don't even like to cook that much, but when I researched and put them in the book, the list of cruciferous vegetables, these are things that most people would be excited about. Some people, I wouldn't even know half of them, but when you start to incorporate them into your diet, they're delightful. I mean, they're really quite amazing. And you're feeding your body, your food is medicine. I mean, food is medicine if you choose correctly.

(45:19):

But cruciferous vegetables happen to be a standout group of foods that are excellent probiotic foods, foods that enrich the gut and not make the gut healthier. The gut is the largest immune system in the body. It's 24 to 26 feet of bowel. And the microbiome, which is on the interior portion of that tube, so to speak, is one of the most important findings I think in the last three decades. In terms of what we now know we can help control for human health, feeding our microbiome is eating healthy foods, but also removing some of the chemicals in processed and ultra processed foods, chlorinated drinking water if you can filter it, and then adding in rich foods that feed these microbes like an ecosystem. So it's those kind of things. Then there's also things that offset genetic changes like B nine, vitamin B nine, and folic acid, omega fatty acids.

(46:12):

We know quercetin and antioxidants like vitamin C are very good at what you said earlier is ROS and reactive oxygenated species. So some of the inflammatory components. So food is medicine and our bodies respond to it nicely in a detoxifying way. And I give lots of lists so people can really see that. I will argue that USDA organic versions are always better when you can find them. It's not always perfect system where you can find them, but it seems almost a little ironic or oxymoronic, I'm not even sure what word. I would say that if you're going to have a kale salad or a big bowl of broccoli to help detoxify that, you might want to keep that, wash those off with baking soda or white vinegar. And I give recipes for that if it's not organic or just looking for USDA organic, you don't want to bring in those chemicals while you're trying to make an effort to do well.

Adam Rinde, ND (47:05):

What do you think about gardening your own veggies?

Aly Cohen, MD (47:09):

I think it's fantastic, as long as you know that the soil is in good shape, soil itself is basically key to the nutrition of that plant. So the soil's in good shape, and you can use organic soil use beds that you can raise. Beds are great and try to watch for the wood that's not treated with any type of arsenic or types of wood sealants. I mean, that sort of gets leached into the soil, but lots of people are making really great vegetable beds and growing your own food is remarkably awesome. I am so busy that I can't even keep my house plants alive, let alone my kids.

Adam Rinde, ND (47:46):

I think

Aly Cohen, MD (47:47):

You just have to be kind to yourself and just know who you are.

Adam Rinde, ND (47:51):

So on that note, you're a doctor, an author, you have a podcast, you're probably involved with your community. You're raising children, you have a family, you're seeing what's going on in the world with all the things people are faced with these days. How do you feel hopeful for your children and their future? How do you hold onto that when it's regarding the environment and the chemicals that are being introduced to the world? How are you holding onto that?

Aly Cohen, MD (48:27):

I even have some immediate family that's young and sick right now, and it's exactly what I'm talking about that I see in patients. But when it hits home and it's family, it's certainly like my dog getting sick. It affects you in a way that's very different than when it's someone else or a patient or what have you to some degree. Look, I think life is about taking on what comes at you. I think you do the best you can. You have to have a healthy perspective that there's no perfection in anything. That going for perfection only leads to disappointment, and in fact, probably hinders people from making better choices along the way. So what I like to do with my kids is set an example. Do they listen to me? Of course, not all the time. I mean, the amount of cologne that gets snuck into our house, believe it or not, it makes not crack, which is great, but I mean, it's the amount of cologne that teenage boys are using and swapping and checking out and wafts through my kitchen.

(49:23):

It's insane. And they're starting to change. We sat down and we picked cool safe colognes I bought a sample pack for, and so we did it together, and actually we found colognes for my son that he liked and I liked. And now we're getting safer versions. So I think there's a hack for every behavior. My kids have a mind of their own as they should, but when I lead by example a little bit and they get sort of this stuff by osmosis, just by being around us and watching our habits, the culture changes for them too. So I'm pretty hopeful. I think kids in my work with high school students right now and into the future, I feel like kids and this generation, they get it. They don't want dirty stuff in their bodies. They do want to look up products. They are the ones that are most affected by immune disrupting chemicals, as I call them, not just endocrine disrupting chemicals, but they're very attuned to looking up and protecting their bodies from what they see as a problem that maybe we didn't see and we grew up on this stuff. So I think a lot easier for them, and I think I'm hopeful for their future that they'll get it right, actually.

Adam Rinde, ND (50:32):

Yeah. That's great. Yeah, and I think one of the things I've been along those lines as a parent have been doing, because it's like I, you have all this information and I'm watching and wanting to comment and wanting to control the situation, but I think a lot about what my people that I really respected that came before me and what they were doing at my age, I think about, oh, what were they doing? And I use that as information to make my own health choices. So I think we just are setting them up for their future choices more than maybe in real time.

Aly Cohen, MD (51:17):

Well, they don't believe in delayed gratification. They're all about their own moment now, getting the girl now smelling good now. And that comes with maturity. And I think just giving them doses of information without overwhelming them with teenagers, they'll run away from information if it's overbearing. So listen, I think you have to know your own kid, and as you do, and I know mine and I know which battles to pick, and I think that that plays into whether or not they're listening because they're not kind of shutting me down from so much nagging.

Adam Rinde, ND (51:55):

Sure.

Aly Cohen, MD (51:56):

So you pick your battles and whoever does shopping really has control, right? I mean, whoever does the water filtering, food shopping, whoever's got the money. I mean, my kids don't work right now, so I say, if you want to work and buy your own junk food, go for it. And what do you know? They start eating clean foods. So you have to hold that over them too.

Adam Rinde, ND (52:16):

Yeah, unless you're a softie like me,

Aly Cohen, MD (52:20):

We all have our weaknesses, right?

Adam Rinde, ND (52:22):

Yeah. It's always good to have someone that holds the line, and then there's one of us that bends a little bit. But I think the important thing that I'm hearing is you're an example. You're providing the opportunity for them to learn and see and get exposed to these tools. And when they have their own families and their own situations, they're going to be in the same decision spot and they're going to have something to lean on and reference, which I think is really valuable. Well, I really appreciate you being here. Once again. I'm excited to see the response to the book and how everybody's going to be. Yeah, hold it up there.

Aly Cohen, MD (53:09):

I'll hold it up. This is the galley copy. But yeah, I'm excited about it. It's been a four year challenge, and I'm glad you got a copy and that you had a chance to read it. But yeah, I'm hoping people will really embrace it.

Adam Rinde, ND (53:23):

I really encourage people to buy the two together if they can. I think that's just a really awesome combo. A lot of times you can do that on Amazon, they'll sell themem together and package it. So I think that'll be a really good volume set for the home and for the office, for the clinic. So I look forward to keeping in touch as we do from time to time and wish you the best and success with all this.

Aly Cohen, MD (53:54):

Thank you. And I have more, I mean resources for your audience. I do post routinely on the Smart Human on Instagram, TikTok on Twitter. I have the Smart Human Podcast, so I am sharing a lot of this stuff whenever people are interested to just jump on and follow. And then also, I'm doing courses, so the smart human.com, I'm now filling with small mini courses for things that people want to dive into deeper, heavy metals, pesticides, rheumatology, and integrative medicine type of conversation. So I think it's a lot for people. It's going to build over time. But us smart human.com is sort of my flagship,

Adam Rinde, ND (54:32):

And people who, once you learn something for the first time, learn it again, learn it again, learn again, because there's always little nuggets and crumbs in there that are going to reinforce one time, and then the next time it'll be deeper and then you'll learn new things. So even if sometimes you feel like you've learned it, it's really valuable just to keep kind of going back to these resources. So we'll put those links in our notes, and yeah, thanks for being here.

Aly Cohen, MD (55:00):

My pleasure. Thank you so much for having me and for bringing me to your audience and everyone listening, so thank you.

Adam Rinde, ND (55:06):

You're welcome. Thank you so much for tuning into this week's episode of The One Thing Podcast. Please share these episodes with your friends, loved ones, colleagues, patients, healthcare providers, anyone who you feel might benefit from hearing these informative interviews. We tend to learn best from people sharing things with us. That's often the first time it's introduced. So don't hesitate if the content of these episodes reminded you of someone that might benefit from that. Forward the episode to them, and I'm sure they'll either appreciate it or be appreciative that you've thought of them. So once again, we'll look forward to seeing you next episode on The One Thing Podcast. And again, much appreciation for you being here with me.