[Music] hey it's Adam Suil MD welcome to module four of the microplastics toxicity training certified by the Microplastics Health Alliance in this section we're going to focus on something that every clinician regardless of specialty needs to master recognizing the clinical presentation of microplastic toxicity as we covered in module 3 microplastics can enter the human body through ingestion inhalation or even through the skin but the real challenge for clinicians is identifying how these exposures show up in the form of patient complaints symptoms and laboratory abnormalities and unlike acute toxic exposures like lead or mercury microplastics produce a slow insidious burden on the body their effects are often non-specific and diffuse so the key is pattern recognition part one symptom clusters the clinical fingerprint of microplastic burden let's start with the five major domains where microplastic related symptoms tend to cluster gastrointestinal neurological hormonal dermatologic and systemic gastrointestinal GI symptoms patients often report chronic bloating intermittent constipation or loose stools increased food sensitivities or unexplained nausea these symptoms likely reflect microplastic related gut inflammation disbiosis and increased intestinal permeability in an animal study by Wei Swan Suadal polyyrene nanoplastics were shown to disrupt the intestinal micro environment by altering bacteria host interactions through extracellular visical delivered microRNAs neurological and cognitive symptoms microplastics and their associated chemicals like BPA and phalates can cross the bloodb brain barrier and activate microgal inflammation common complaints include brain fog poor memory recall irritability anxiety sensory sensitivity and sleep disruption patients with significant burden may also report dizziness lightadedness or difficulty concentrating in environments with fluorescent lighting or high electromagnetic fields hormonal symptoms microplastics act as endocrine disrupting agents bpa mimics estrogen and phalates block testosterone production women may present with irregular cycles heavy or painful menstruation fibroids endometriosis or infertility men may experience reduced libido erectile dysfunction low testosterone or gynecomastia you may also see secondary hormonal effects like altered thyroid function adrenal fatigue or insulin resistance dermatologic symptoms patients often overlook this domain but chronic exposure to microplastics has been linked to eczema erdicaria chemical sensitivity and flares of psoriasis or acne these may be related to immune disregulation mass cell activation and accumulation of toxins in subcutaneous fat systemic and non-specific complaints this is where things get tricky many patients present with fatigue sluggishness unexplained weight gain or loss chronic pain and a general feeling of being unwell these symptoms are easy to dismiss or misattribute which is why this training is so important part two patient profiles and phenotyping let me give you a few example patient profiles we often see in clinical practice a 32-year-old female with no known autoimmune disease but reports worsening premenstrual syndrome bloating fatigue and chemical sensitivity labs show normal CBC but borderline low progesterone and elevated sex hormone binding globbulin you find she's using plastic Tupperware daily microwaving in plastic drinking from plastic bottles and using synthetic skin care products a 41-year-old male executive presents with brain fog low libido and rising triglycerides despite regular exercise his testosterone is 280 nanogs per distiller estradol is 38 pogs per milliliter and urinary BPA is elevated he drinks five bottles of water per day from soft plastic and uses a vinyl floor mat in his home gym these aren't just lifestyle complaints they're environmental toxicology cases hiding in plain sight we need to start thinking in terms of toxic burden phenotypes not every patient with microplastic exposure will show the same symptoms some may lean neurocognitive others hormonal others immunologic this is why symptom clustering is so important in your diagnostic process part three supporting literature and clinical validation let's anchor this in published data in a 2018 study by Schwabble at all microplastics were found in the stool of every human subject tested all were asymptomatic volunteers suggesting the burden is widespread and subclinical in many patients the WHO's 2019 report on microplastics and drinking water emphasized that although acute toxicity is unlikely chronic low-level exposure is almost universal and poorly understood leslie at AL in 2022 confirmed microplastics in human blood in 80% of tested individuals highlighting the systemic absorption and circulation of these materials while randomized controlled trials on symptom resolution post-exposure reduction are still emerging clinical experience and mechanistic studies suggest a direct link between plastic burden and these clusters of dysfunction part four the MHA screening tool bringing structure to your evaluation to help clinicians systematically assess for microplastic toxicity the Microplastics Health Alliance has developed a validated clinical screening tool this tool evaluates exposure patterns symptom clusters and known risk factors and then provides a standardized risk score here's how it works as a physician you can create a free account on the MHA website from your dashboard you can send a secure HIPPA compliant link to your patients the patient completes the survey on their own device and the results are automatically transmitted back to both the patient and your account the score is color-coded into low moderate and high risk for microplastic related toxicity this screening tool is designed to fit into your workflow you can send it ahead of a new patient consult or integrate it into your functional medicine or integrative intake protocols it gives you an immediate databacked window into the environmental factors that may be driving your patients symptoms and for patients who are already symptomatic it helps quantify burden and prioritize treatment even when labs are pending or inaccessible so to summarize microlastic toxicity presents as a constellation of vague but persistent symptoms across multiple systems as clinicians we need to become experts at pattern recognition looking for those combinations of fatigue brain fog hormone imbalances GI symptoms and chemical sensitivity that point to environmental burden we also need to use tools like the MHA clinical screen to gather data track changes over time and support our diagnostic reasoning in the next section we'll go over how to take a focused environmental exposure history including the high yield questions you should be asking every patient let's keep building your clinical toolkit i'll see you in section 4.2