By Lauren Brandstadter | Contributing Writer
- Vol. 15, No. 2. Summer, 2013
All too often, couples struggling to conceive a child undergo expensive, complicated and unsuccessful fertility treatments. Careful assessment of environmental toxin loads and nutritional status of both partners, and judicious implementation of lifestyle change strategies could avert the need for these treatments in some cases.
Available statistics show that infertility is on the rise among men and women in the US. According to the Centers for Disease Control, the numbers of US women aged 15-44 who have “impaired fecundity” topped 6.7 million in 2010. Researchers at the National Institutes of Health, studying data from 7,600 women, estimate that as many as one in six couples seeking to have a child were unable to conceive after 1 year of contraception-free sex (Thoma ME, et al. Fertility Sterility. 2013: 99(5): 1324-31)
The trend is attributable to far more than later marriage and deferred childbearing. There are many factors in our environment, and in the products we use daily, that could be contributing to infertility.
Xenoestrogens, drug residues, pesticides, bioactive compounds in personal care products, and toxins in our environment are interfering with fertility levels. How does one peel back all the layers of information (and misinformation) about the myriad of toxins and their effects?
“Environment is definitely a factor in rising infertility rates”, says Victoria Maizes, MD, Executive Director of the University of Arizona Center for Integrative Medicine, and author of Be Fruitful, The Essential Guide To Maximizing Fertility and Giving Birth to a Healthy Child
. In her new book, she stresses the importance of minimizing toxin loads.
“Avoiding fruits and vegetables that have been sprayed with toxic pesticides, foods grown from GMO seeds, and packaged foods containing ingredients that originate from GMOs, and processed foods, should be at the top of the list of “do’s” when trying to conceive,” Dr. Maizes told Holistic Primary Care
The organophosphates in pesticides have been shown to be endocrine disruptors. While there is not yet a definitive prospective study showing that exposure to pesticides causes infertility, the available science does provide cause for strong suspicion. Roundup Risks
There’s good reason to believe that glyphosate, the main compound in the widely used Roundup herbicide, is interfering with human reproductive function.
One study found that glyphosate is increasing the number of birth defects in vertebrates, contributing to stillbirths and miscarriages (Paganelli A, et al. Chem Res Toxicol. 2010, 23(10): 1586-95)
. The data suggest that glyphosate alters retinoic acid signaling in developing embryos.
“The direct effect of glyphosate on early mechanisms of morphogenesis in vertebrate embryos opens concerns about the clinical findings from human offspring in populations exposed to glyphosate-based herbicides in agricultural fields,” the authors note.
Well over a decade ago, Canadian researchers published a study showing that exposure to this herbicide increased the risk of spontaneous abortion among female agricultural workers exposed to glyphosate (Arbuckle TE, et al. Environ Health Perspect. 2001; 109(8): 851–857)
. “For late abortions, preconception exposure to glyphosate….was associated with elevated risks. Postconception exposures were generally associated with late spontaneous abortions. Older maternal age (> 34 years of age) was the strongest risk factor for spontaneous abortions, and we observed several interactions between pesticides in the older age group.”
Investigators around the world have looked at possible mechanisms by which glyphosate interferes with reproductive function. Richard and colleagues at the University of Caen, France, showed that the compound is toxic to human placental cells at concentrations lower than those found with agricultural use. The toxic effect increases with duration of exposure and concentration (Richard S, et al. Environ Health Perspect. 2005 June; 113(6): 716–720)
In 2009, another group based in Caen looked at the toxicity of four glyphosate-based herbicides at dilutions corresponding to residue levels found in common foods. They found that the compounds could induce apoptosis and necrosis in human umbilical, embryonic, and placental cells (Benachour N, et al. Chem. Res. Toxicol., 2009, 22 (1), pp 97–105)
Also in 2009, a team at Indiana University tracked agrichemical residues in surface water, and found a strong correlation between elevated concentrations during the months of April to July, and higher risk of birth defects among women whose last menstrual periods were in the period from April to July (Winchester PD, et al. Acta Paediatr
. 2009; 98(4): 664-91).A New Threat?
Glyphosate is just one of 84,000 known toxins in our environment. Only a few thousand have been studied thoroughly with regard to their effect on human biology.
According to Dr. Maizes, it makes good sense for couples trying to conceive to minimize exposures as much as possible. “An organic diet is the best way to increase your ability to conceive. Eating organic grains, fruits, and vegetables, washing them with filtered water, and avoiding GMOs are very important factors in a person’s fertility.”
She contends that GMO foods are as dangerous as the pesticides that are sprayed on them. GMO foods have been shown to contribute to changes in the number and size of offspring in rats. They may also be contributing to the evolution of new animal and human pathogens.
Two years ago, Dr. Don Huber, emeritus professor of plant pathology at Purdue University, stated that he had discovered a previously unknown pathogenic microorganism associated with Roundup Ready GMO crops. The organism seemed to be linked to infertility and miscarriage among cattle, swine and horses. In an open letter to USDA Secretary Tom Vilsack, Dr. Huber described the organism as having, “an approximate size range equal to a medium-sized virus…able to reproduce and appears to be a micro-fungal like organism.”
Dr. Huber, a long-standing and outspoken critic of GMO technology, claims that the organism is found in much higher concentrations on Roundup Ready soybeans, corn and alfalfa, and that it is also linked to several plant diseases.
“For the past 40 years, I have been a scientist in the professional and military agencies that evaluate and prepare for natural and manmade biological threats, including germ warfare and disease outbreaks. Based on this experience, I believe the threat we are facing from this pathogen is unique and of a high-risk status. In layman's terms, it should be treated as an emergency,” he wrote.
Several scientists at Purdue have challenged the “doomsday scenario” outlined by Dr. Huber. However, none has claimed that his discovery is fallacious. His work has yet to be replicated by other researchers, and the organism he believes he has found has not yet been further characterized. Predictably, the USDA has taken no action in response to his letter. Avoid Processed Foods
Couples trying to conceive should eliminate—or at least minimize consumption of processed foods. This includes some foods that most people regard as “healthy.” Low-fat milk, for example, is very popular with reproductive-age women who believe it is a healthy alternative to full-fat milk.
Dr. Maizes says that’s highly questionable. “When the fat is removed from the milk, the product has less taste and a bluish hue. So the dairy company puts in powdered whey protein, which is technically milk, so they don’t have to put it on the label (as an additive). The end result is a processed food - far from what the cow, and nature, intended.”
She added that regular consumption of low-fat milk actually promotes weight gain in many people – not the other way around. “If you’re going to drink milk, drink it whole, unprocessed, with all the nutrients intact. In some cases, dairy companies add sugar (to low-fat milk) for a better taste. The more processed sugar someone consumes, the lower the production of the sex hormone binding globulin, which influences the body’s production and regulation of hormones.”
In general, she advises patients to avoid “low-fat” foods: they are usually heavily processed, and no longer “whole” foods.
Dr. Amos Grunebaum, a gynecologist with over 30 years experience with high-risk pregnancies, had this to offer about environmental toxins. “Yes. There is now scientific evidence that environmental toxins such as pesticides and exogenous hormones are potentially interfering with fertility in the United States. Research shows that male and female reproductive health is especially susceptible to the impact of these chemicals.”
He went on to say that reproductive toxicologists are constantly uncovering new evidence about how environmental toxins are contributing to suboptimal sperm health, reduced egg quality in women, menstrual disorders, pregnancy complications, low-birth weight and child development issues.Minimizing Toxin Loads
“There is scientific evidence to support this claim that exposure to agents such as BPA affects fertility.” The most dangerous compounds in plastics (BPA), pesticides (dioxins and organophosphates), and drug-residues are definitely endocrine disruptors.
Some can mimic the action of a certain hormone (such as estrogen) by binding to that hormone’s receptor and activating the same response that would be triggered by the natural hormone. Others prevent hormonal action by binding to hormone receptors, thereby leaving no room for the real hormones. Still others bind to carrier proteins, thereby reducing the availability of these proteins to transport hormones like estrogen and testosterone through the blood stream to target tissues.
Some endocrine disruptors negatively impact hormone levels by either accelerating the breakdown of hormones or by deactivating the enzymes that facilitate their breakdown.
Dr. Grunebaum says avoiding canned foods, unless the can has a BPA-free liner, is a simple way to begin minimizing exposure to endocrine-disrupting compounds like phthalates and BPA. The website, www.treehugger.com
has posted a guide to canned products rated for likelihood of containing BPA. Purchasing jellies, jams, sauces, and prepared vegetables in glass containers, whenever possible, is a safer alternative.
Other toxins affecting fertility are right in our homes. Chemicals in beauty and skin care products, shampoos and other hair care products, toothpastes, oral products, as well as deodorants, contain toxins that inhibit fertility. Dr. Grunebaum and Dr. Maizes both suggest using only non-toxic cleaning supplies. To learn more about potential toxins in common household products, visit http://www.ewg.org/skindeep/
. A Bit About Fish
For many reproductive-age women, the subject of fish consumption has become cause for confusion. On the one hand, they hear the message that ocean fish are a healthy, lean protein source rich in omega-3s. On the other, there are the frightening reports of mercury and other toxic metals found in some types of fish.
Dr. Maizes suggests that fish should not be eliminated from the diet of women wishing to conceive. Omega-3’s found in wild caught salmon, herring and other oily fish help raise fertility levels, and also aid in averting or lessening postpartum depression after childbirth. Trout, though a fresh water fish, is also high in Omega-3s.
People should avoid wild fish that are known to have high levels of mercury, such as tuna, swordfish, mackerel and shark. The best fish to eat with the highest levels of Omega 3’s are wild-caught salmon, trout, herring and anchovies – and no more than 2-3 servings a week of about 6 ounces per serving, says Dr. Maizes.
The key, she says, is “wild caught.” Farm-raised fish are also eating processed foods – not algae—and this creates an imbalance in the ratios of omega-3 and omega-6’s. She recommends against eating a lot of farmed fish, as they produce higher omega-6 levels, which are inflammatory.
While it is true that we need both types of omega fats, Americans in general tend to be imbalanced in the omega-6 direction. There’s certainly no benefit in pushing this imbalance even further.
She noted that elevated omega-6 is a common finding among infertile men. Men with low sperm counts should also be taking Omega 3 oils, which are an important determinant for fertility (Saferinejad MR, et al. Clin Nutr. 2010: 29(1): 100-5)
Both Dr. Grunebaum and Dr. Maizes suggest incorporating detox programs into the care of couples trying to conceive. This is especially true if either or both partners are trying to lose weight. As people shed weight, they release toxins stored in the adipose tissue, and this can have a detrimental effect on the odds of conception.
The shedding of fat cells and release of toxins should be eliminated before conception occurs. It is important to ensure that calorie restriction is not too severe and that all nutrient requirements are met.
Trying to conceive can be very stressful, and any treatments that improve a couple’s sense of wellbeing and increase the partners’ energy levels should be encouraged. Women who are having difficulty conceiving might also inquire about other approaches such as acupuncture and acupressure, which can increase the body’s ability to naturally balance energy and organ processes.
By Linda Clark, MA, CNC | Contributing Writer
- Vol. 15, No. 2. Summer, 2013
It is no secret that as a nation, the United States is getting fatter.
Over the past 50 years, the prevalence of obesity in adults has nearly tripled, from 13.4% in 1962 to 35.7% in 20101-3
. The economic, social, and medical burden this places on our society cannot be overstated. It is a healthcare crisis of immense proportions.
For good reason, we have become a nation obsessed with weight. We now have weight loss programs of all types and we are inundated with information from the media about trimming our waistlines. With all of this attention, one would think that obesity would be on the decline. Clearly it is not.
It may be that we’re focused on the wrong thing.
For decades, the prevailing thought has been that Americans are obese because we eat and drink too much, exercise too little, and are destined by genetics to gain weight. Even though these are factors, emerging science is pointing to another equally important driver of the obesity epidemic: the change in our environment and the prevalence of toxins that adversely affect metabolism.
A better reckoning with environmental factors could help us understand a phenomenon we’ve all observed in clinical practice: the individual who simply cannot lose weight despite diligent adherence to appropriate dietary regimens, vigilance against over-eating, and careful attention to food choices and regular exercise.
The old rule of “calories in, calories out” simply doesn’t apply to many individuals: something other than caloric consumption and burn rates is affecting their metabolism.Culture of Chemicals
More than 80,000 chemicals are currently used in U.S. commerce,4
with 22,000 of these being introduced in the last four decades.5
Only 200 of these chemicals have been tested for safety, and only five are partially regulated through the Toxic Substances Control Act.4
Yet dozens of studies have shown the deleterious effects of these environmental pollutants, pesticides, plastics, and food additives.6
The CDC regularly assesses Americans’ exposure to environmental chemicals through the National Health and Nutrition Examination Survey (NHANES). Its fourth report (published in 2009) found there was “widespread exposure” among study participants to industrial chemicals, such as flame retardants.7
Bisphenol A (found in plastics) and perfluorooctanoic acid (found in non-stick coatings) were also present in most of the participants’ blood and urine samples.7
The EPA also conducted a study on the US population’s exposure to toxic chemicals. Run from 1970-1989, this study tested adipose tissue, because many chemical toxins are fat-soluble and will accumulate in this kind of tissue. The survey documented a “significant prevalence of pesticide residues in the general population”8 of all ages.9-10
Our “culture of chemicals” even affects newborns. In 2004, the Environmental Working Group led a study that examined umbilical cord blood from 10 babies at U.S. hospitals.11
They found at least 287 chemicals in the cord blood, including pesticides, flame retardants, perfluorochemicals, and waste from burning coal, gasoline, and garbage.11
Looking at these study results, it is easy to conclude that we are all carrying a significant toxic load. Because toxins are stored in adipose tissue, overweight and obese individuals are carrying an even greater toxic burden than those who are lean.Altered Adipogenesis
A new understanding has emerged in the past few years that this burden of toxicity may explain the rise in obesity, and the problem that many people have with losing weight.
Researchers have found that certain environmental chemicals act as endocrine disruptors that alter fat production and energy balance, leaving some people more susceptible to weight gain.12-16
These compounds work in different ways. Some alter adipogenesis—the process of creating fat cells—causing people to have a greater numbers of fat cells, a larger size of their existing fat cells, or abnormal fat cell distribution.15
Other toxins alter levels of the appetite-regulating hormone leptin, or increase the activity of estrogen.13,15
One of the first statements of this toxin-obesity hypothesis emerged from a meta-analysis published in 2002 in the Journal of Alternative and Complementary Medicine
The author concluded that the obesity epidemic can’t entirely be explained by changes in food intake, exercise, or even genetics.
She argued that calorie consumption has actually declined throughout the 20th
century and that decreases in physical activity do not statistically correlate with the extreme rise in obesity in the past few decades.12
Concluding that human exposure to chemicals “may have damaged many of the body’s natural weight-control mechanisms,” she noted that this impact, “may play a significant role in the worldwide obesity epidemic.”12
Another seminal article examined specific cases where an association had already been shown between environmental chemical exposure and obesity13
—such as studies linking childhood obesity with maternal smoking during pregnancy.17-18
The author also highlighted the potent endocrine-disrupting capabilities of tributyltin, a chemical compound that causes female marine invertebrates to take on male sex characteristics.19-20 Weight Gain & Weight Loss Resistance
The altering of fat cells and the disruption of hormone levels are just two of many mechanisms by which environmental toxins can act as endocrine disruptors. They can also increase inflammatory cytokine activity, cause oxidative stress, and impact energy metabolism.
A paper published in Obesity Review
in 2003 looked at the effects of organochlorines (pesticides and plastics) on metabolic rate and weight regulation.21
The authors reviewed 63 studies and found many mechanisms related to weight loss resistance. Primarily, they noted that organochlorines, “have been associated with altered immune and thyroid functions, particularly decreased triiodothyronine (T3) concentrations.”21
Other mechanisms included:
- Inhibition of enzymes in the mitochondrial electron transport chain (which can decrease energy)
- Decreased capacity for fatty acid utilization in skeletal muscle
- Decrease in thyroxine concentrations (as the toxins compete for the same thyroid receptors)
- Inflammation and oxidative stress as a cause-and-effect of toxin release
Furthermore, some herbicides induce hormonal shifts, leading to estrogen excesses and increased fat deposition. These herbicides, including the widely used atrazine, induce aromatase activity by as much as 250%.22
Aromatase is the key enzyme involved in converting androgens to estrogen. Why Can’t I Lose More Weight?
Many people who are trying to lose weight find that they can lose the first 20 or 30 pounds, but then hit a plateau where it is difficult to lose more. Part of this problem stems from the fact that when people do lose weight, toxins stored in fat tissue are released into circulation.
An increase in toxic load during weight loss—added to an already-substantial toxic burden—can create an inflammatory cascade that inhibits the body’s inherent, highly sophisticated detoxification system.23
This inflammatory process can also deplete reserves of glutathione, an important antioxidant, which alters the liver’s detoxification efficiency.23-25
In order to support healthy weight loss and lower the toxic load, we need to ask whether these released toxins can be effectively neutralized, so that they don’t compromise metabolic and hormonal mechanisms? Maximize Detoxification
This may seem like a vicious cycle—the body gains weight because it’s natural metabolism has been disrupted by chemicals, but the process of losing this weight only releases more chemicals to further alter the body’s natural functions.
The important leverage point here is that we can increase the efficiency of liver detoxification. Targeted use of a specialized array of nutrients that act as cofactors for phase I and phase II liver detoxification, can support the liver’s detoxifying abilities while at the same time providing antioxidants to deal with oxidative stress.
Herbs such as milk thistle, dandelion root, and gotu kola; dietary fibers like inulin, and nutrients such as vitamin C, bioflavanoids, B vitamins, and amino acids—to name just a few—should be included as supplemental detoxification support.
A low-allergenic, whole foods diet can also support the body’s natural detoxification processes by reducing immune system activation. Since weight gain is an inflammatory process, it is essential to lower the inflammatory load in the diet, not just by reducing the amount of chemical toxins consumed, but also by eliminating the most allergenic foods. This, in turn, lowers systemic inflammation and improves metabolic efficiency.
I recommend a diet that emphasizes wholesome, fresh foods (preferably organically grown) that includes lean protein, vegetables, vegetable starches and fruit. I also advise elimination of all grains, legumes, nuts, seeds, dairy and eggs. I generally recommend lean sources of proteins, vegetables, vegetable starches and fruit.
Over the years, I have tried many dietary approaches to support detoxification and optimize the body’s natural metabolic system, and I have found this approach to be the most successful. What I particularly like about this approach is that it supports the healthy functioning of a number of body functions, not just detoxification and metabolism.
People can also lower their toxic load through specific lifestyle changes. Some of these include detox baths, skin brushing, drinking filtered water, and changing to stainless steel (rather than coated “non-stick”) cookware. I also recommend switching to more natural, allergen-free household and personal care products.
Self-care cannot be overlooked—developing healthy sleep habits, adding relaxation to the daily routine, and engaging in physical activity all allow for more effective detoxification and improve overall quality of life.
A well-designed detoxification program should not only foster short-term weight loss, but also encourage long-term lifestyle and dietary changes.
The benefits of weight loss cannot be overstated—a reduction in risk for heart disease, obesity, diabetes, and cancer. Yes, we must address the issues of overeating, lack of physical activity, poor food choices, and genetic metabolic issues. However, we can no longer ignore the impact of environmental toxins on weight loss, weight gain, and obesity.
What this means for the clinical picture is to develop and undertake strategies to reduce the toxic burden and optimize detoxification capacity. I have found over the years that a dietary and lifestyle-based detoxification program can produce dramatic shifts in body composition, along with better blood sugar balance, healthier lipid levels, and improved liver enzyme function. People who had previously been unable to lose weight may find that they’re able to break through the weight loss resistance.Linda Clark, MA, CNC, is an adjunct professor at John F. Kennedy University and teaches graduate courses in holistic nutrition, functional endocrinology, nutrition consulting, diet and meal planning, and functional testing for the holistic health master’s program. She holds a master’s degree in holistic health education from John F. Kennedy University and a nutrition consultant certification from Bauman College.
Ms. Clark owns Universal Wellness Associates, a holistic nutrition and wellness practice located in Fair Oaks, California. For the past six years, she has conducted seminars throughout the Western United States as a speaker for Apex Energetics™. She is the author of a booklet called Gluten-Free Life, which is distributed to healthcare professionals across the country. She has also developed the Detox 360™ diet and lifestyle program, distributed by Apex Energetics.
1. Weight-control Information Network. Overweight and Obesity Statistics. Bethesda, MD: National Institute of Diabetes and Digestive Kidney Diseases;October 2012.
2. Ogden CL, Carroll MD. Prevalence of overweight, obesity, and extreme obesity among adults: United States, trends 1960-1962 through 2007-2008. Atlanta, GA: National Center for Health Statistics, Centers for Disease Control and Prevention; June 2010.
3. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among U.S. adults, 1999-2010. JAMA. 2012 Feb;307(5):491-497
4. Hearings Before the Subcommittee on Commerce, Trade, and Consumer Protection Committee on Energy and Commerce, U.S. House of Representatives. July 29, 2010. (testimony of Steve Owens, Assistant Administrator, Office of Chemical Safety and Pollution Prevention, U.S. Environmental Protection Agency).
5. Schierow L. The Toxic Substances Control Act (TSCA): Implementation and New Challenges. Washington, DC: Congressional Research Service; July 28, 2009.
6. Wilding BC, Curtis K, Welker-Hood K. Hazardous Chemicals in Health Care: A Snapshot of Chemicals in Doctors and Nurses. Washington, DC: Physicians for Social Responsibility; 2009.
7. Centers for Disease Control and Prevention, National Center for Environmental Health. Fourth National Report on Human Exposure to Environmental Chemicals. Atlanta, GA: Centers for Disease Control and Prevention; 2009.
8. Committee on National Monitoring of Human Tissues, Board on Environmental Studies and Toxicology, National Research Council. Monitoring Human Tissues for Toxic Substances. Washington, DC: The National Academies Press, 1991.
9. Kutz FW, Strassman SC, Sperling JF. Survey of selected organochlorine pesticides in the general population of the United States: Fiscal years 1970-1975. Ann N Y Acad Sci. 1979 May 31;320:60-68
10. Strassman SC, Kutz FW. Trends of organochlorine pesticide residues in human tissue. In: Khan MAQ, Stanton RH eds. Toxicology of Halogenated Hydrocarbons: Health & Ecological Effects. New York: Pergamon Press; 1981,
11. Environmental Working Group. Body Burden—The Pollution in Newborns. Washington, DC: Environmental Working Group; July 2005.
12. Baillie-Hamilton PF. Chemical toxins: a hypothesis to explain the global obesity epidemic. J Altern Complement Med. 2002 Apr;8(2):185-192
13. Blumberg B, Grün F. Environmental obesogens: organotins and endocrine disruption via nuclear receptor signaling. Endocrinology. 2006 Jun;147(6 Suppl):S50-S55
14. Heindel JJ. Endocrine disruptors and the obesity epidemic. Toxicol Sci. 2003 Dec;76(2):247-249
15. Holtcamp W. Obesogens: Environmental link to obesity? Environ Health Perspect. 2012 Feb;120(2):a62-a68
16. Newbold RR, Padilla-Banks E, Snyder RJ, Jefferson WN. Perinatal exposure to environmental estrogens and the development of obesity. Mol Nutr Food Res. 2007;51:912-917
17. Toschke AM, Koletzko B, Slikker Jr W, Hermann M, von Kries R. Childhood obesity is associated with maternal smoking in pregnancy. Eur J Pediatr. 161:445-448
18. Hill SY, Shen S, Locke Wellman J, Rickin E, Lowers L. Offspring from families at high risk for alcohol dependence: increased body mass index in association with prenatal exposure to cigarettes but not alcohol. Psychiatry Res;135:203-216
19. Blaber SJM. The occurrence of a penis-like outgrowth behind the right tentacle in spent females of Nucella lapillus. Proc Malacol Soc Lond. 1970;39:231-233.
20. Matthiessen P, Gibbs P. Critical appraisal of the evidence for tributyltin-mediated endocrine disruption in mollusks. Environ Toxicol Chem. 1998;17:37-43.
21. Pelletier C, Imbeault P, Tremblay A. Energy balance and pollution by organochlorines and polychlorinated biphenyls. Obes Rev. 2003 Feb;4(1):17-24
22. Sanderson JT, Seinen W, Giesy JP, van den Berg M. 2-Chloro-s-triazine herbicides induce aromatase (CYP19) activity in H295R human adrenocortical carcinoma cells: a novel mechanism for estrogenicity? Toxicol Sci. 2000 Mar;54(1):121-127
23. Mecdad AA, Ahmed MH, El Halwagy MEA, Afify MMM. A study on oxidative stress biomarkers and immunomodulatory effects of pesticides in pesticide-sprayers. Egypt Jour Forens Sci. 2011 Jun;1(2):93-98.
24. Agrawal A, Sharma B. Pesticides induced oxidative stress in mammalian systems: a review. Int J Biol Med Res. 2010;1(3):90-104.
25. Zordoky BN, El-Kadi AO. Role of NF-kappaB in the regulation of cytochrome P450 enzymes. Curr Drug Metab. 2009 Feb;10(2):164-178