Linking Air Pollution to Ulcerative Colitis and Crohn’s Disease;
A statement for Northport residents, epidemiologists, research organizations and universities on an opportunity for an epidemiological case-control study on Crohn’s and Ulcerative Colitis that continues to be ignored
By Jamie Paparich
Extensive studies continue to be done on human health issues linked to exposure to air pollution. It is well documented that exposure to air pollution has been a contributing factor in multiple forms of lung and heart diseases.
However, almost no studies have been done on the effects of air pollution on the gastrointestinal tract, specifically the intestines. Even though the bodies intestines absorb the majority of the toxins inhaled and ingested from air pollution.
Crohn’s Disease and Ulcerative Colitis are the two known inflammatory bowel diseases (IBD). Crohn’s disease can cause inflammation throughout the entire GI tract, anywhere from the mouth to the anus. It most commonly effects the small intestines, causing chronic inflammation of the lining of the small intestines. Ulcerative colitis impacts the large intestine/colon. Colitis causes inflammation and open sores, or ulcers on the lining of the large intestine/colon. Both Crohn’s and Colitis causes severe abdominal discomfort and frequent emptying of the colon. These diseases are incurable and impacts not only the patients long term health, but also their quality of life. The scientific and medical community have been unable to discover what causes these rare diseases, which limits the treatment options.
Depending on where you are, air pollution can contain anything from fire smoke, ash, emissions from smelters, mining operations, power plants, construction sites, road construction, and automobiles…just to name a few. All air pollution contains particulate matter (PM). Particulate matter is liquid and solid particles suspended in the air that contains a mixture of the toxic pollution, the dust and pollen in your air. The particulate matter is how the toxins from pollution enter the body.
Inhalation & Dermal:
There are two sizes of particulate matter.
– PM 10: 10 microns (a millionth of a meter) in diameter or less. These are small enough to be inhaled and accumulate in the respiratory system. Many of the particles pass from the respiratory system through mucus down the GI Tract.
– PM 2.5: 2.5 microns in diameter (1/10,000 of an inch). These are so small they are inhaled into the respiratory system, but then are able to pass through the lungs into the bloodstream, and also from the respiratory tract through the GI Tract. These size particles can also be absorbed through the skin.
The particulate matter falls onto gardens, crops, the food animals ingest, water sources, and the water ways fish inhabit. In turn, we ingest the PM through those products when consumed.
NORTHPORT AIR POLLUTION
In the case of Northport, air monitoring has shown that our air contains dangerous levels (way above safety standards) of arsenic and cadmium. This is from the emissions released from the smoke stack at Teck Resource, a Canadian smelter located 3 miles upriver. The particulate matter in our pollution contains several heavy metals, not just arsenic and cadmium, because of the smelters emissions.
- Inhalation: Once particulate matter is inhaled into the respiratory tract, it is sent through the GI tract through mucocilliary clearance, eventually entering the intestines. The majority of the particulate matter inhaled into the body will end up in the intestines. Not all of these toxins are expelled from the body. Many are absorbed and accumulate into the intestinal walls. This induces systemic effects; directly effecting the epithelial cells (the barrier between toxic invaders and healthy cells lining the intestine). System inflammation then triggers immune activation. Over time, this leads to the immune system turning on the bodies good cells as well.
- Ingestion: Food and water containing PM toxins are ingested into the stomach, then passed to the intestines, where the toxins will, once again, spend the longest amount of time in the body, before being expelled from the body. The toxins not expelled will also inducing systemic effects, system inflammation, and eventually immune over stimulation.
IMMUNE SYSTEM & BIO-TOXICITY
Particulate matter alters the body’s immune system reaction. The immune system discovers and destroys disease causing organisms, viruses, and foreign agents in our bodies. The immune system kicks into overdrive due to the ingestion and inhalation of particulate matter, especially containing heavy metals. Eventually the chronic, overstimulation of the immune systems will cause chronic inflammation throughout the body, or to specific organs.
Exposure to high levels of heavy metals is an obvious concern. However, the more dangerous type of exposure is long term exposure, even to low levels. This type of exposure causes the heavy metals to slowly accumulate in the bodies organs, causing biotoxic effects. According to the research published in Heavy metal pollution and human biotoxic effects, (Duruibe, J. O. 1 *, Ogwuegbu, M. O. C. 2 and Egwurugwu, J. N. 3), “….(G)eneral signs associated with biotoxicity of (sic) cadmium, lead, arsenic, mercury, zinc, copper and aluminum poisoning: gastrointestinal (GI) disorders….”
INFLAMMATORY BOWEL DISEASE
In people with IBD, the immune system attacks the heavy metal toxins in the intestines. Because of the accumulation of heavy metals toxins, from chronic exposure to specific air pollution, some individuals immune systems go haywire, attacking the toxins and healthy cells. This eventually leads to chronic-inflammation, ulcerations, and thickening of the intestinal wall. The result of this is Crohn’s disease or Ulcerative Colitis, and likely several other auto immune health issues.
However, not all people exposed to the same level of specific heavy metal toxins will develop Crohn’s or Colitis. When the first cluster of Northport residents with either Ulcerative colitis or Crohn’s disease was discovered in 1992 statistically 1 in 100,000 people in the U.S. were diagnosed with one of these IBDs. In 1992 Northport’s population was approximately 375 people, and 15 residents had been diagnosed with either Crohn’s or Colitis. In 2012 a research team from Massachusetts General Hospital’s Crohn’s and Colitis Center conducted an IBD study of Northport and confirmed 17 people had either Crohn’s or Colitis, the population in 2012 was still around 375 people. This is 11.5 to 15 times higher than the national standard.
In 1992 and 2012’s study the residents diagnosed with either Crohn’s or Colitis lived within a two mile radius of each other, in the Columbia River Valley. This valley was nicknamed “The Heavy Fallout Zone” by the EPA, due to the high levels of heavy metal toxins found in their sampling. The levels were so elevated in this area because Teck’s air emissions, full of heavy metal toxins and sulfer dioxide, would flow north down the river and become trapped in the valley. There is would settle, the particulate matter falling onto every surface below it, and being inhaled by the residents living on the little farms scattered along the banks of the river. These residents were chronically exposed to the dangerously high levels of arsenic and cadmium in the air for decades.
However, the question still remains. Why did some of these residents, living in the “heavy fallout zone”, contract Colitis or Crohn’s and some didn’t. It impacted the children who grew up in the area the most, but not all of the children. In the study; Exposure to ingested airborne pollutant particulate matter increases mucosal exposure to bacteria and induces early onset of inflammation in neonatal IL-10-deficient mice, (Salim SY1, Jovel J, Wine E, Kaplan GG, Vincent R, Thiesen A, Barkema HW, Madsen KL), the research team aimed to determine if exposure to particulate matter during the neonatal period and early-life would alter colitis in a mouse model. The team concluded “Our data suggest that early exposure to pollution particulates can result in an earlier onset of intestinal disease in genetically susceptible hosts and can alter responses to gut injury in later life.”
Scientist have not been able to discover an inheritance/genetic pattern to IBDs. Most scientists and researchers whose work is focused on Inflammatory Bowel Diseases and the GI Tract believe both genetic and environmental factors trigger the illnesses.
Science Director of the Science and Environmental Health Network (SEHN) , Ted Schettler, M.D., M.P.H., shared his thoughts about the high occurrence of these diseases in our area; “If it is in anyway related to smelter emissions I’d wonder about changes in the intestinal micro biome as a plausible mechanism that could link metal exposure to inflammatory bowel disease.”
EPIDEMIOLOGY CASE-CONTROL STUDY
The community of Northport exceed all of the requirements to conduct an accurate epidemiological case-control study of the contribution chronic exposure to specific heavy metal toxins in air pollution has on triggering inflammatory bowel disease, as well as the impact it may specifically have on the immune system response.
The EPA is currently conducting a Human Health Risk Assessment of the area, as part of their agreement with Teck Resources in conducting remedial investigations and feasibility studies of the Upper Columbia River area and Northport. The EPA, nor Teck have any plans to monitor our air in any of the investigations or assessments. The EPA has no interest in looking at the cluster of diagnosed cases of Crohn’s or Colitis in the area, spanning three generations.
Today members of the community continue to be diagnosed with Crohn’s or Colitis, and more will continue to be diagnosed until something is done.